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Institute of Medicine (US); National Research Council (US); Pignone M, Russell L, Wagner J, editors. Economic Models of Colorectal Cancer Screening in Average-Risk Adults: Workshop Summary. Washington (DC): National Academies Press (US); 2005.

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Economic Models of Colorectal Cancer Screening in Average-Risk Adults: Workshop Summary.

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Appendix CWorkshop Speaker and Staff Biographies

Louise B. Russell, Ph.D., (Chair) is Research Professor of Health Economics at the Institute for Health, Health Care Policy, and Aging Research, Rutgers University. Before coming to Rutgers in 1987, Dr. Russell was a Senior Fellow at the Brookings Institution for 12 years. She is an elected member of the Institute of Medicine of the National Academy of Sciences and currently serves on its National Cancer Policy Board. She co-chaired the U.S. Public Health Service Panel on Cost-Effectiveness in Health and Medicine, which published recommendations for improving the quality and comparability of cost-effectiveness studies in mid-1996 (Cost-Effectiveness in Health and Medicine, Oxford University Press; and a series of three articles in The Journal of the American Medical Association, October 1996). She was also a member of the first U.S. Preventive Services Task Force of the Department of Health and Human Services (1984-1988). She has published numerous articles and seven books, including Educated Guesses: Making Policy About Medical Screening Tests (1994), Medicare's New Hospital Payment System: Is It Working? (1989), and Is Prevention Better than Cure? (1986).

Martin L. Brown, Ph.D., (Co-Chair) has been the Chief of NCI's Health Services and Economics Branch since October 1999. Dr. Brown received his Ph.D. in Natural Resource Economics from the University of California, Berkeley, in 1981. He first joined the NCI in 1988 as a Health Economist, after serving as Associate Professor in the Department of Economics at Howard University. Since coming to NCI his research has focused on the economic burden of cancer to individuals and society; the acquisition and analysis of economic data on cancer prevention and control from controlled trials and from administrative records; evaluation and development of methodology and analytical tools for modeling and estimating the cost-effectiveness of specific cancer prevention and control interventions; programs and policies; the relationship of socioeconomic status, community structure, and health system organization to access to and use of cancer prevention and control services; and the financial structure of research support in the context of the changing system of healthcare delivery organization and financing.

Dr. Brown has published over 50 articles, reports, and book chapters in these research areas since coming to NCI. Dr. Brown is the economics editor of the Journal of the National Cancer Institute, has served as a reviewer for many journals, and has served on peer-review committees for the National Cancer Institute of Canada and the California Cancer Research Program. Dr. Brown serves as NCI Program Director for the Cancer Research Network, a national consortium of research organizations, affiliated with health maintenance organizations that conduct population-based research on cancer epidemiology, prevention and control.

Todd Anderson, M.S., joined the Congressional Budget Office in 1999 and has worked primarily on projects related to Medicare. He is the principal data analyst for CBO's work examining the circumstances of high-cost beneficiaries in Medicare and has also worked on a model to estimate the impact of competition-based reform proposals on Medicare. In addition, Mr. Anderson is the primary author of a CBO Study of pharmacy margins on Medicaid prescription drugs and has worked on cost estimates of proposals to provide wage insurance to displaced workers and to increase the federal minimum wage. Prior to joining CBO, Todd worked as a Health Insurance Specialist at the Health Care Financing Administration and as a revenue analyst for a private-sector health care contractor. He holds a Masters degree in Public Administration from the University of Washington.

Eric Feuer, Ph.D., Eric J. “Rocky” Feuer, PhD, has been the Chief of the Statistical Research and Applications Branch since 1999. Prior to that he was head of the Surveillance Modeling and Methods Section in the Division of Cancer Prevention and Control. He has been at the NCI since 1987. Before coming to NCI, he was the Chief Statistician for the Cancer Center at Mount Sinai School of Medicine in New York.

Dr. Feuer received his Ph.D. in Biostatistics from the University of North Carolina at Chapel Hill in 1983. His research has focused on evaluating and developing new cancer progress measures; modeling the impact of cancer control interventions on the cancer burden; and developing statistical methods for the analysis, interpretation, and presentation of national cancer statistics. He is the author of over 75 peer-reviewed publications.

Dr. Feuer was elected as a fellow of the American Statistical Association in 2000. He received the NIH Director's Award in 1999 in recognition of his work with advancing statistical methods to interpret national cancer statistics. He serves on the Regional Committee of the Eastern North America Region (ENAR) of the International Biometric Society and was the program chair of its annual meeting in 1997. He was a statistical editor for the Journal of the National Cancer Institute from 1994 to 2000. He is a co-founding editor of the JNCI Cancer Surveillance Series, and serves as a reviewer for journals in statistics, epidemiology and cancer surveillance and control.

Karen M. Kuntz, ScD., is Associate Professor of Decision Science at the Harvard School of Public Health and is based at the Harvard Center for Risk Analysis. Dr. Kuntz's research focuses on the methodology and application of decision analysis and cost-effectiveness analysis in the evaluation of clinical and public health strategies. She is Principal Investigator of one of the NCI-funded Cancer Intervention and Surveillance Modeling Network (CISNET) grants to evaluate national trends in colorectal cancer incidence and mortality. She is also directing another NCI-funded project to develop a simulation model of colorectal and breast cancer that incorporates risk factors, screening, and treatment. Dr. Kuntz has also been involved in a number of other cancer-related disease models that evaluated health gains and/or cost-effectiveness associated with cancer prevention strategies as well as treatment and staging strategies for patients with cancer. In addition, Dr. Kuntz has extensive modeling experience in the clinical area of cardiovascular disease, conducting economic analyses on treatment and diagnostic approaches for patients with suspected carotid disease, patients after myocardial infarction, patients with stable chest pain, and primary prevention. In addition to specific applications, Dr. Kuntz has published on a number of methodological issues involving the evaluation of biases in decision modeling and the relationship between expert panel and decision-analytic outcomes. Recently, Dr. Kuntz was elected President Elect of the Society for Medical Decision Making and has assumed the role of Director for the AHRQ-funded Post-Doctoral Fellowship in Health Services Research at Harvard. Dr. Kuntz received her masters and doctorate, both in biostatistics, from the Harvard School of Public Health.

Uri Ladabaum, M.D., M.S., is currently Assistant Clinical Professor of Medicine in the Division of Gastroenterology at the University of California, San Francisco. Dr. Ladabaum completed undergraduate studies in Biochemistry at the University of California, Berkeley, in 1987 and graduated from the University of California, San Francisco School of Medicine in 1991. He served as a Resident in Internal Medicine from 1991 to 1994 and then as Chief Resident in Internal Medicine from 1994 to 1995 at Stanford University Hospital. Dr. Ladabaum completed a three-year clinical and research Fellowship in Gastroenterology at the University of Michigan, Ann Arbor in 1998. During that time, he completed an M.S. program in Clinical Research Design and Statistical Analysis at the University of Michigan School of Public Health. Dr. Ladabaum served as Lecturer in the Division of Gastroenterology at the University of Michigan, Ann Arbor from 1998 to 1999. In 1999, Dr. Ladabaum joined the Division of Gastroenterology at the University of California, San Francisco as an Assistant Clinical Professor of Medicine and Director of the Gastrointestinal Motility Program.

Dr. Ladabaum's research focuses on two areas: health services research and cost-effectiveness analyses and the functional gastrointestinal disorders. In the first area, Dr. Ladabaum's research has centered on decision analytic models of colorectal cancer screening and chemoprevention in persons at average or above average risk for colorectal cancer and has included evaluations of management strategies for dyspepsia, screening for hepatocellular carcinoma, and evaluation and pharmacotherapy for irritable bowel syndrome. In the second area, Dr. Ladabaum has performed multiple studies of gastrointestinal physiology and visceral sensation. Colorectal cancer screening continues to be an active area of investigation for Dr. Ladabaum. His current efforts include decision analytic evaluations of emerging technologies for colorectal cancer screening and models of the potential population-wide clinical and economic impact of colorectal cancer screening in the United States.

Theodore R. Levin, M.D., is a Research Scientist II at the Kaiser Permanente Division of Research in Oakland, CA, and a Senior Physician, in the Gastroenterology Department of the Kaiser Permanente Walnut Creek Medical Center. He has been involved in colorectal cancer-related research for over 8 years. He serves on the American Cancer Society Colorectal Cancer Operations Committee and on the U.S. Multi-Society Task Force on Colorectal Cancer. He received his B.S. in Psychology from Duke University, an M.S. in Physiology from Georgetown University, and an M.D. from the Emory University School of Medicine. He did his internship and residency in Internal Medicine at University of California at San Francisco (UCSF). He completed fellowships in Gastroenterology and Health Policy Studies also at UCSF, and continues to serve as an Assistant Clinical Professor of Medicine in the Gastroenterology Division at UCSF.

His research interests have focused on the clinical delivery of colorectal cancer screening. Specific interests are: the delivery of flexible sigmoidoscopy (ability of sigmoidoscopy to predict advanced proximal colonic neoplasia, complications of sigmoidoscopy, and the appropriate interval between screening sigmoidoscopy examinations), colonoscopy (complications of colonoscopy), and the use of novel screening tests such as immunochemical FOBTs and fecal DNA tests. He has served as PI of NCI RO1 grants evaluating the addition of immunochemical fecal occult blood tests to sigmoidoscopy screening and on the relationship between insulin resistance and adenomas of the colon and rectum. He is also currently the Kaiser Permanente PI of the NCI/Mayo Clinic multi-center study of fecal DNA screening.

Brian P. Mulhall, M.D., M.P.H., Dr. Mulhall is a gastroenterologist at Walter Reed Army Medical Center in Washington, DC. He obtained a B.S. in Biology and a B.A. in Philosophy/Ethics from the University of San Diego. He attended medical school at St. Louis University School of Medicine and graduated with a Distinction in Research. He completed his Residency in Internal Medicine at Madigan Army Medical Center, where he stayed as Chief of Medical Residents. He subsequently completed his Gastroenterology Fellowship at Walter Reed Army Medical Center while completing his M.P.H. at the Uniformed Services University of Health Sciences. He is now an Assistant Professor of Medicine at the Uniformed Services University of the Health Sciences. He is active in several professional societies and is currently a member of the Educational Affairs Committee for the American College of Gastroenterology. He has multiple publications and abstracts in a range of topics, including nocturnal gastroesophageal reflux, infectious esophagitis, colorectal cancer screening, and fatty liver disease.

Currently, Dr. Mulhall is involved in research looking at rates of adherence to surveillance guidelines, along with the institutional and social-cognitive barriers that negatively impact adherence. He is also examining the utilization of resources surrounding colorectal cancer screening, with an emphasis on development of practices that will maximize outcomes while preserving resources. He had the opportunity to work with Dr. Joseph Lipscomb at the National Cancer Institute this past year on a project assessing the value on linear programming as a tool for modeling constraints in colorectal cancer screening—an eye-opening experience. Frankly, though, Dr. Mulhall spends most of his time with an endoscope in-hand striving to prevent colorectal cancer.

Reid Ness, M.D., M.P.H., is an Assistant Professor of Medicine at the Vanderbilt University Medical Center. He was recruited to Vanderbilt in 2000 after a health serves research fellowship at Indiana University where he also received a Masters in Public Health in Health Education. Dr. Ness's primary research interest focuses on quality improvement in the provision of colorectal cancer preventative services. He is actively engaged as a co-investigator in several projects. These include the (1) MMC/VICC Partnership (U54/NCI: Adunyah/Moses PIs) pilot project examining predictors of non-adherence with recommended colonoscopy, (2) Vanderbilt GI Cancer SPORE project 5 which seeks to examine predictors of colorectal adenoma recurrence in a prospective cohort (SPORE/NCI: Coffey PI), (3) NCI funded study to examine predictors of colorectal adenoma recurrence in a retrospective cohort (RO1/NCI: Zheng PI), (4) NCI funded project to create a health policy model of CRC for use in cost-effectiveness analysis (RO1/NCI/AHRQ: Dittus PI), and (5) Southern Community Cohort Study (RO1/NCI: Blot PI), a large prospective cohort study examining factors associated with cancer outcomes disparities between Caucasian and African Americans. He was also the principal investigator on a pilot project funded through the VICC (VICC: Ness PI) entitled the “Nashville Colorectal Health Study” the goal of which was to gather pilot data for predictors of colorectal adenoma identification at colonoscopy, cognitive/emotional outcomes of colonoscopy, and micro-costing for colonoscopy.

Michael P. Pignone, M.D., M.P.H., is an Assistant Professor of Medicine in the Division of General Internal Medicine at University of North Carolina-Chapel Hill (UNC). He received his medical degree and residency training in primary care internal medicine from the University of California at San Francisco. He then received fellowship training in clinical epidemiology and health services research through the Robert Wood Johnson Clinical Scholars program at UNC.

Dr. Pignone's research is focused on chronic disease prevention and physician- patient communication about risk in primary care settings. His main areas of interest include heart disease prevention, colorectal cancer screening, and disease management for common chronic illnesses such as diabetes, depression, heart failure, and chronic pain. He has conducted research examining the role of literacy in physician-patient communication and its effect on health outcomes, including racial/ethnic disparities

Deborah Schrag, M.D., M.P.H., is a health services researcher in the Department of Epidemiology and Biostatistics at Memorial Sloan-Kettering Cancer Center. She is also a medical oncologist in the Department of Medicine with a clinical practice dedicated to the treatment of patients with colorectal cancer. She is an Assistant Profesor of Medicine and Public Health at the Weill Cornell School of Medicine. She received her M.D. from Columbia University College of Physicians and Surgeons and then completed a residency in Internal Medicine at the Brigham and Women's Hospital in Boston. She trained as a medical oncologist at the Dana-Farber Cancer Institute with a focus on treatment of gastrointestinal malignancy, specifically colorectal cancer. Following her clinical training, she earned an M.P.H. degree at the Harvard School of Public Health with emphasis on cancer-related decision-analytic modeling. Her current research interests focus on analyzing dissemination of new cancer treatment strategies and understanding the mechanisms that lead to disparities and variation in the quality of care. In particular, her research focuses on the utilization of population-based data resources such as SEER-Medicare to evaluate patterns and costs of care as well as the quality of care. Her research has demonstrated that cancer therapies that are well accepted as standard of care are not consistently delivered to definable subsets of vulnerable patients, particularly the elderly and members of racial and ethnic minority groups.

Laura C. Seeff, M.D., Dr. Seeff is a medical officer in the Division of Cancer Prevention and Control (DCPC) at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. She is the principal investigator for a CDC study to estimate the capacity of physicians and non-physician endoscopists across the country to provide endoscopic colorectal cancer screening to all eligible persons. Published results from this study will be available in 2004. She is also overseeing nine state-level colorectal cancer capacity assessments in Iowa, Michigan, Texas, Maryland, Massachusetts, Minnesota, New Mexico, New York and Washington state. Additional states will be added to this study in FY 05. She has authored several studies documenting low rates of use for colorectal cancer screening tests in the United States, and is currently overseeing a study evaluating the complication rate in colonoscopies performed in asymptomatic persons. She provides medical and scientific consultation for the multi-year federal colorectal cancer action campaign, “Screen for Life”, which is entering its fifth year. She helped develop an educational slide set for health care providers entitled “A Call to Action: Prevention and Early Detection of Colorectal cancer”, which is available on the CDC website ( Dr. Seeff also investigates cervical cancer screening issues among foreign-born women living in the United States. Prior to joining CDC in July of 1998, Dr. Seeff was an assistant professor in the Department of Medicine at the Emory University School of Medicine, where she was responsible for establishing a colorectal cancer screening clinic for patients at Grady Memorial Hospital, performing screening sigmoidoscopies and teaching sigmoidoscopy to doctors-in-training.

Marjolein van Ballegooijen, M.D., Ph.D., is an Assistant Professor of Medical Technology Assessment in the Screen Section of the Department of Public Health at the Erasmus MC (University Medical Center Rotterdam).

She received her medical degree from the University of Amsterdam, after which she joined the Department of Public Health in Rotterdam in 1987. In the first years, her main area of interest was cervical cancer screening. She worked on several national and international projects in this field, being responsible for the clinical and other medical input. This work resulted in her Ph.D., which she received Erasmus MC. The analysis performed for the national evaluation of program cervical cancer screening, had largely contributed to the updating of the official recommendations in 1994, e.g., the change in age-ranges and intervals for the program screening. Since 1996, she is involved in several national and international research projects on colon cancer screening.

Dr. van Ballegooijen's research is focused on decision-making concerning cancer screening, on basis of optimization of screening strategies from a cost-effectiveness point of view. In most of the projects she worked on, the MISCAN simulation program was used for the analysis of screening and epidemiologic data and the prediction of effects and costs.

Sally W. Vernon, M.A., Ph.D., Dr. Vernon is Professor of Behavioral Sciences and Epidemiology, Director of the Division of Health Promotion and Behavioral Sciences, and Senior Investigator in the Center for Health Promotion and Prevention Research, University of Texas-Houston, School of Public Health.

Her training is in epidemiology and behavioral sciences. Her interdisciplinary training has led to a research focus on translating epidemiologic evidence and principles to the design and evaluation of interventions to encourage the adoption of health behaviors. Her research interests encompass the epidemiology of mental disorders, with a particular focus on racial/ethnic differences in conceptualization and measurement; the analysis of psychosocial factors as predictors of health behaviors and health status indicators; and the design and evaluation of interventions to encourage adoption of cancer screening behaviors. Over the past 15 years, Dr. Vernon has published extensively in the area of cancer prevention and control with an emphasis on the primary and secondary prevention of breast, cervical, and colorectal cancers. More recently, she has worked in the area of informed consent and informed decision making about testing with the prostate specific antigen. In her recent work she has applied findings from epidemiologic studies to develop interventions to increase regular cancer screening behaviors, for cancers where the epidemiologic evidence supports the use of screening tests (e.g., cervical cancer) or to educate physicians and patients about the risks and benefits of tests with uncertain efficacy (e.g., prostate specific antigen).

Sandeep Vijan, M.D., M.S., is a Physician-Scientist at the Ann Arbor VA HSR&D Center of Excellence and an Assistant Professor of Internal Medicine at the University of Michigan Medical School. His research interests include evaluating the effectiveness and cost-effectiveness of preventive interventions in primary care, particularly those related to screening for common diseases and disease complications. He is also involved in evaluating methods of tailoring interventions based on individualized assessments of patient risks and preferences. Although he has a broad range of disease interests, his research has been primarily focused on diabetes and colorectal cancer.

Judith L. Wagner, Ph.D., Judith Wagner, Ph.D. has been a Scholar in Residence at the Institute of Medicine since January 2003. She has more than 30 years experience in health policy analysis and health technology economics. Most recently, as a Senior Analyst at the Congressional Budget Office, she specialized in prescription drug issues, including the design of a Medicare prescription drug benefit, Medicaid drug payment, and reform of current laws governing the entry of generic drugs into the market place. Before joining CBO, she was a consultant at the Mayo Clinic in Rochester, MN, where she conducted cost and cost-effectiveness analyses of medical procedures and technologies for both research and operational planning at the Clinic. She also managed major assessments of the cost-effectiveness of preventive and diagnostic technologies at the U.S. Congress Office of Technology Assessment, including studies of the cost-effectiveness of colorectal cancer screening in average-risk adults. Dr. Wagner holds a Ph.D. from Cornell University, where she studied economics and operations research with emphasis on environmental applications. She also holds master's degrees in economics from the University of Michigan and in environmental systems engineering from Cornell University.

Copyright © 2005, National Academy of Sciences.
Bookshelf ID: NBK83895


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