Su-Hsin Chang

Approaches to developing de novo cancer population models to examine questions about cancer and race in bladder, gastric, and endometrial cancer and multiple myeloma: the Cancer Intervention and Surveillance Modeling Network incubator program

Abstract Background We are developing 10 de novo population-level mathematical models in 4 malignancies (multiple myeloma and bladder, gastric, and uterine cancers). Each of these sites has documented disparities in outcome that are believed to be downstream effects of systemic racism. Methods Ten models are being independently developed as part of the Cancer Intervention and Surveillance Modeling Network incubator program. These models simulate trends in cancer incidence, early diagnosis, treatment, and mortality for the general population and are stratified by racial subgroup. Model inputs are based on large population datasets, clinical trials, and observational studies. Some core parameters are shared, and other parameters are model specific. All models are microsimulation models that use self-reported race to stratify model inputs. They can simulate the distribution of relevant risk factors (eg, smoking, obesity) and insurance status (for multiple myeloma and uterine cancer) in US birth cohorts and population. Discussion The models aim to refine approaches in prevention, detection, and management of 4 cancers given uncertainties and constraints. They will help explore whether the observed racial disparities are explainable by inequities, assess the effects of existing and potential cancer prevention and control policies on health equity and disparities, and identify policies that balance efficiency and fairness in decreasing cancer mortality.

Estimating the impact of increasing cervical cancer screening in the National Breast and Cervical Cancer Early Detection Program among low-income women in the USA

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free cervical cancer screening to low-income women. This study estimated the health benefits gained in terms of life years (LYs) saved and quality-adjusted life years (QALYs) gained if cervical cancer screening by the NBCCEDP increased to reach more eligible women. Data from Surveillance, Epidemiology, and End Results, NBCCEDP, and Medical Expenditure Panel Surveys were used. LYs saved and QALYs gained/100,000 women were estimated using modeling methods. They were used to predict additional health benefits gained if screening by the NBCCEDP increased from 6.5% up to 10-25% of the eligible women. Overall, per 100,000 women screened by the NBCCEDP, 1,731 LYs were saved and 1,608 QALYs were gained. For white women, 1,926 LYs were saved and 1,780 QALYs were gained/100,000 women screened by the NBCCEDP. For black women, 1,506 LYs were saved and 1,300 QALYs were gained/100,000 women screened. If the proportion of eligible women screened by the NBCCEDP increased to 10-25%, the estimated health benefits would range from 6,626-34,896 LYs saved and 6,153-32,407 QALYs gained. The reported estimates emphasize the value of cervical cancer screening program by extending LE in low-income women. Further, it demonstrates that screening a higher percentage of eligible women in the NBCCEDP may yield more health benefits.

Cost-Effectiveness of Combined Minimally Invasive Hysterectomy and Bariatric Surgery in Women With Morbid Obesity and Endometrial Hyperplasia or Early-Stage Endometrial Cancer

We studied the cost-effectiveness of simultaneous bariatric surgery and minimally invasive hysterectomy (MIH) (combined surgery) in comparison to MIH alone in endometrial cancer (EC) survivors with obesity-related disease (ORD). Cost-effectiveness analysis. Hypothetical cohort of women aged 50 to 69 with obesity (BMI ≥ 30 kg/m Combined surgery vs MIH alone. We constructed a decision-analytic model with lifetime horizon to compare life expectancy and lifetime healthcare costs between patients with combined surgery and those with MIH alone. Utility weights, a measure of health states that affect quality of life, from published studies were used to calculate quality-adjusted life years (QALYs). Lifetime healthcare costs associated with ORD and costs for MIH and surgical complications were obtained from published studies. Costs for combined surgery were obtained from a single institution. All costs were evaluated from the healthcare sector perspective and presented in US dollars at the 2022 price level. Future costs and QALYs were discounted to present values using an annual rate of 3%. For the 50 to 59 age group, QALYs for combined surgery were 14.8 compared with 11.0 for MIH alone. The lifetime healthcare cost for patients with combined surgery was $186 124 compared with $335 995 for MIH alone. For the 60 to 69 age group, QALYs for combined surgery were 12.0 compared with 7.9 for MIH alone. The lifetime healthcare cost for patients with combined surgery was $155 451 compared with $273 403 for MIH alone. Combined surgery yielded higher QALYs and lower costs than MIH alone. For women with endometrial intraepithelial neoplasia or early-stage EC with obesity and ORD, combined surgery may represent a cost-saving and QALYs-improving option for treatment. However, barriers to this approach may be insurmountable.