Esophageal Adenocarcinoma Policy Model: Trends, Risk Factors and Screening

项目摘要/摘要 食管腺癌的发病率一直在以惊人的速度上升。 在过去的三十年里。尽管每年埃博拉病例的绝对数量也保持在 对一般人群进行低度筛查，可能以靶向筛查为宜。胃灼热， 胃食道反流病(GERD)的主要症状，影响着6000万美国人和 可导致巴雷特食道(BE)，这是一种与最严重的 发展EAC的风险(30-125倍)。因为有相当数量的人感染了 在GERD和BE，这些患者的管理已经成为一个公共卫生问题。然而， 尚未提出可接受的EAC筛查或监测计划。 该提案的广泛、长期目标是确定一种有效和负担得起的 早期识别EAC的有针对性的筛查策略和干预计划 将减轻这种疾病的负担。 这些研究目标将通过开发和分析食道 腺癌政策模型(EACMO)。丰富的互补方法组合和 最先进的模拟技术将是实现众多项目所必需的 目标。来自多种来源的数据，包括监测、流行病学和最终结果 (SEER)、临床试验数据和已发表的文献将用于开发模拟 模特。将使用校准方法系统地微调模型参数以 产生目标终点(例如癌症发病率)。验证将通过使用 模型会复制其他已发布的数据。 具体目标是： 目标1：开发和验证EACMO 目标2：估计关键风险因素对美国EAC发病率上升的影响。 目标3：确定EAC的高危个体：Barrett食道的预测因素 目标4：评估合理食道的有效性、成本和成本-效果 腺癌筛查和治疗方案 该项目与健康相关的将是使用结果来设计临床试验， 指导政策决策并告知循证实践指南。多学科的 为这个项目组建的研究团队在模拟疾病的各个方面都有专业知识 EAC的建模、临床方面，以及经过验证的研究和合作历史。

Project Summary/Abstract The incidence of esophageal adenocarcinoma (EAC) has been rising at an alarming rate over the past three decades. Although the absolute number of EAC cases per year remains too low to screen the general population, targeted screening may be appropriate. Heartburn, the primary symptom of gastroesophageal reflux disease (GERD), affects 60 million Americans and can lead to Barrett's esophagus (BE), a pre-malignant condition associated with the greatest risk (30-125x) of developing EAC. Because of the significant number of individuals affected with GERD and BE, the management of these patients has become a public health issue. However, an accepted screening or surveillance program for EAC has not been proposed. The broad, long-term objectives of the proposal are to identify an effective and affordable targeted screening strategy for EAC with early identification and an intervention program which will diminish the burden of this disease. These research goals will be accomplished developing and analyzing an Esophageal AdenoCarcinoma Policy Model (EACMo). A rich mix of complementary methodologies and state of the art simulation techniques will be necessary to achieve the numerous project objectives. Data from numerous sources including Surveillance Epidemiology and End Results (SEER), clinical trial data and the published literature will be used to develop a simulation model. Calibration methodology will be used to systematically fine tune model parameters to produce targeted endpoints (e.g. cancer incidence). Validation will be achieved by having the model reproduce other published data. The specific aims are: Aim 1: Develop and validate the EACMo Aim 2: Estimate contributions of pivotal risk factors to the rise in EAC incidence in the U.S. Aim 3: Identify individuals at high risk for EAC: predictors of Barrett's esophagus Aim 4: Estimate the effectiveness, cost and cost-effectiveness of plausible esophageal adenocarcinoma screening and management programs The health relatedness of the project will be to use the results to design clinical trials, guide policy decisions and inform evidence-based practice guidelines. The multidisciplinary research team assembled for this project has expertise in all aspects of simulation disease modeling, clinical aspects of EAC, and a proven history of research and collaborations.