Diabetes, Medications and the Cost-Effectiveness of Screening for Colorectal Neoplasia

糖尿病、药物和结直肠肿瘤筛查的成本效益

• 批准号: 10237250
• 负责人: Sheetal Hardikar
• 金额: $ 15.82万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10237250
• 关键词: Accounting; Active Learning; Address; Adult; Age; Antidiabetic Drugs; Award; Chemopreventive Agent; Chronic; Clinic; Clinical; Code; Colonoscopy; Colorectal Adenoma; Colorectal Cancer; Colorectal Neoplasms; Colorectal Polyp; Computerized Medical Record; Data; Databases; Development; Development Plans; Diabetes Mellitus; Diagnosis; Diet; Early Diagnosis; Economic Models; Ensure; European; Family; Gastroenterology; Goals; Height; Histopathology; Hyperplastic Polyp; Incidence; Individual; Inflammation; Insulin; International; Intervention; Knowledge; Laboratories; Lesion; Light; Link; Literature; Malignant Neoplasms; Medical center; Mentorship; Meta-Analysis; Metformin; Modality; Modeling; Molecular; Natural Language Processing; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Pathway interactions; Patients; Persons; Pharmaceutical Preparations; Pharmacoepidemiology; Pharmacology; Pharmacotherapy; Pharmacy facility; Polyps; Positioning Attribute; Prevalence; Procedures; Public Health; Recording of previous events; Records; Regimen; Reporting; Research; Research Activity; Research Personnel; Resources; Risk; Risk Estimate; Risk Factors; Role; Severities; Smoking History; Subgroup; Sulfonylurea Compounds; Testing; Thiazolidinediones; Time; Training; Training Activity; Type 2 diabetic; Universities; Washington; Weight; Work; adenoma; base; biomedical informatics; cancer epidemiology; cancer prevention; career; career development; case control; clinical Diagnosis; cohort; colorectal cancer progression; colorectal cancer risk; colorectal cancer screening; comorbidity; cost effective; cost effectiveness; cost-effectiveness evaluation; demographics; diabetes mellitus therapy; diabetes risk; diabetic; economic evaluation; experience; health economics; high risk population; improved; lifestyle factors; mortality; non-diabetic; personalized screening; screening; screening guidelines; skills; success; text searching; translational scientist; treatment strategy

Project Summary/Abstract: The candidate's long-term career goal is to become an independent investigator with transdisciplinary expertise in cancer epidemiology, biomedical informatics, pharmacoepidemiology, and health economic modeling and evaluation. The focused didactic training, mentorship, and experiential learning through research activities proposed in this award will facilitate the development of critical skills in the pursuit of knowledge to inform and improve cancer prevention and screening. The candidate's research is motivated by the recognition that type-2 diabetes mellitus (T2DM) patients are at a 30-40% increased risk for colorectal cancer (CRC), and that anti-diabetic drugs may also alter CRC risk. Thus, this high-risk group presents an opportunity for targeted screening and early detection of CRC. Currently, CRC screening is based on age and family history, with no consideration for comorbidities, including T2DM. Building on her previous work in cancer epidemiology, the candidate seeks to determine the association between T2DM and risk of colorectal polyps: overall, by subtypes, and by lesion severity, individually reflecting different molecular pathways (Aim 1); and to examine the risk for colorectal polyps associated with anti-diabetic therapy: overall, by subtypes, and by lesion severity (Aim 2). These aims will be addressed by leveraging the rich resources of an existing colonoscopy- based cohort at the University of Washington Medical Center's (UWMC) Gastroenterology clinic established during 2003-2011. Demographics, select lifestyle factors, and detailed histopathology have been previously abstracted from UWMC's electronic medical records (EMR) database. The candidate proposes to extend this cohort through 2017 (N~38,000), and enhance it by linking existing data with diabetes-related variables from the EMR database using biomedical informatics (e.g., natural language processing, clinical text mining) to estimate the risk for colorectal neoplasia. Using these empirical estimates derived from Aims 1 and 2, the candidate will then build a microsimulation model projecting the risk for colorectal neoplasia in T2DM patients, accounting for their diabetes therapy. Alternative screening and treatment strategies, including altering the screening start-age, modifying diabetes treatment, or altering screening modality among T2DM patients, will be evaluated for their cost-effectiveness (Aim 3). This work may help inform targeted screening recommendations that could, in turn, lower the incidence and mortality of CRC among persons with T2DM, and improve the cost- effectiveness of CRC screening. The candidate has proposed a training and career development plan that builds upon her prior skills in cancer epidemiology to gain experience and proficiency in biomedical informatics, pharmacoepidemiology, and health economic modeling and evaluation, including cost-effectiveness approaches. The transdisciplinary mentorship team, comprised of national and international experts, will provide the necessary expertise to ensure the success of this proposal, as well as facilitate the candidate's transition into an independent translational investigator in the field of cancer prevention and screening.

项目概要/摘要：候选人的长期职业目标是成为一名独立调查员 在癌症流行病学，生物医学信息学，药物流行病学， 卫生经济学建模与评价。有重点的教学培训、指导和体验式学习 通过本奖项中提出的研究活动将促进关键技能的发展， 了解并改进癌症预防和筛查。候选人的研究动机是 认识到2型糖尿病（T2DM）患者发生结直肠癌的风险增加30 - 40% 癌症（CRC），抗糖尿病药物也可能改变CRC风险。因此，这一高危人群呈现出一种 有针对性的筛查和早期发现CRC的机会。目前，CRC筛查是基于年龄和 家族史，不考虑合并症，包括T2DM。基于她之前在癌症方面的工作 流行病学，候选人寻求确定T2DM和结直肠息肉风险之间的关联： 总体而言，按亚型和病变严重程度，分别反映不同的分子途径（目标1）;以及 检查与抗糖尿病治疗相关的结直肠息肉风险：总体、亚型和病变 严重性（目标2）。这些目标将通过利用现有结肠镜检查的丰富资源来实现- 在华盛顿大学医学中心（UWMC）胃肠病学诊所建立了一个基于队列的 在2003 - 2011年期间。人口统计学、选择的生活方式因素和详细的组织病理学先前已被 从UWMC的电子病历（EMR）数据库中提取。候选人建议延长这一期限， 队列至2017年（N~38，000），并通过将现有数据与来自 使用生物医学信息学的EMR数据库（例如，自然语言处理、临床文本挖掘）， 估计结直肠肿瘤的风险。利用从目标1和2得出的这些经验估计数， 然后，候选人将建立一个预测T2DM患者结直肠肿瘤风险的微观模拟模型， 他们的糖尿病治疗费用替代筛查和治疗策略，包括改变 筛选起始年龄、调整糖尿病治疗或改变T2DM患者的筛选方式， 评估其成本效益（目标3）。这项工作可能有助于告知有针对性的筛查建议 这反过来可以降低T2DM患者CRC的发病率和死亡率，并改善成本- CRC筛查的有效性。候选人已提出培训和职业发展计划， 凭借她之前在癌症流行病学方面的技能，获得生物医学信息学方面的经验和熟练程度， 药物流行病学和卫生经济学建模和评估，包括成本效益 接近。由国内和国际专家组成的跨学科导师团队将 提供必要的专业知识，以确保这一建议的成功，以及促进候选人的 转变为癌症预防和筛查领域的独立翻译研究者。