Research Centers

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Informing the management of gastrointestinal cancers and diseases using simulation modeling - Dr. Chin Hur

Our research focuses on applying outcomes methodologies to the clinical field of gastroenterology. Specific examples include the use of decision-analytic modeling to perform comparative effectiveness research regarding the screening and management of various gastrointestinal cancers and diseases.

Dr. Hur’s research group’s interests lie in outcomes research, specifically technology assessment with a focus on decision analysis and disease modeling, and the application of these methodologies to the management of cancers and pre-malignant states (e.g. dysplasia) in the gastrointestinal tract. This management includes the identification of clinical predictors, diagnostic algorithms, and the optimization of treatment. Some of our specific projects include a disease model of Barrett’s Esophagus and Esophageal Cancer, an analysis of the impact of the implementation of Virtual Colonoscopies for colorectal cancer (CRC) screening and the possible role for chemoprevention in cancer care. We are affiliated with the MGH Institute for Technology Assessment (ITA). The mission of the ITA is to conduct health outcomes research to guide the development, evaluation and utilization of medical technologies that improve the quality and cost-effectiveness of medical care. 

http://www.mgh-ita.org/

 

 

Additionally, we are a part of the National Cancer Institute’s (NCI) Cancer Intervention and Surveillance Modeling Network (CISNET), a consortium of NCI-sponsored investigators that use statistical modeling to improve our understanding of cancer control interventions in prevention, screening, and treatment and their effects on population trends in incidence and mortality. These models can be used to guide public health research and priorities.  The MGH serves as the coordinating center for the esophageal cancer group’s collaborative research efforts.

http://cisnet.cancer.gov/

Principal Investigators:

Chung Yin Kong, PhD

Elissa Ozanne, PhD

Programmers:

Kevin Nattinger

Research Assistants:

Zehra Omer

Disease Model of Barrett's Esophagus and Esophageal Adenocarcinoma

Barrett’s esophagus- the construction and continued refinement of this disease model has allowed analyses that have attempted to determine the optimal management strategy for those patients with this pre-malignant condition which is a precursor to esophageal cancer. Specific analyses have addressed the cost-effectiveness of endoscopic surveillance, ablative therapies, as well aspirin for chemoprevention. Future areas of research will focus on the collaborative and multiscale modeling efforts with other groups through NCI’s CISNET.

Cost-Effectiveness of cancer chemoprevention (e.g. aspirin and/or selective COX-2 inhibitorsophagus

The use of non-steroidal anti-inflammatory drugs (NSAIDs) including aspirin and selective COX-2 Inhibitors for cancer chemoprevention is currently an area of much research. Using our disease model of Barrett's esophagus we have evaluated the cost-effectiveness of aspirin chemoprevention in this population. We have also modeled aspirin versus selective COX-2 Inhibitors in colon cancer chemoprevention.

Technology Assessment of "Virtual Colonoscopy

Virtual Colonoscopies for CRC screening- a mathematical model was constructed to determine the consequences if virtual colonoscopies were implemented for CRC screening. Future research in this area will focus on costs from various perspectives related to virtual colonoscopies and patient preferences for CRC screening.

Selected Publications

Original research

Hur C, Nishioka NS, Gazelle GS. Cost-effectiveness of Photodynamic Therapy for the Treatment of Barrett’s Esophagus with High Grade Dysplasia. Digestive Diseases and Sciences 2003;48(7):1273-83.

Hur C, Nishioka N, Gazelle GS. Cost-effectiveness of Aspirin Chemoprevention for Barrett's esophagus. Journal of the National Cancer Institute 2004;96(4):316-25.

Hur C, Lee S, Gazelle GS. The Cost-Effectiveness of Aspirin versus Cyclooxygenase-2 Selective Inhibitors for Colorectal Carcinoma Chemoprevention in Healthy Individuals. Cancer 2004;101(1):189-97.

Hur C, Gazelle GS, Zalis ME, Podolsky DK. An Analysis of the Potential Impact of Computed Tomographic Colonography (Virtual Colonoscopy) on Colonoscopy Demand. Gastroenterology 2004;12(5):1312-21.

Hur C, Lee S, Gazelle GS. Analysis of aspirin-associated risks in healthy individuals. Annals of Pharmacotherapy 2005;39(1):51-7.

Hur C, Wittenberg E, Nishioka NS, Gazelle GS. Patient Preferences for the Management of High Grade Dysplasia in Barrett’s Esophagus. Digestive Diseases and Sciences Digestive Disease and Sciences 2005;50(1):115-25.

Jo WS, Bandipalliam P, Shannon KM, Niendorf KB, Chan-Smutko G, Hur C, Syngal S, Chung DC. Correlation of polyp number and family history of colon cancer with germline MYH mutations. Clinical Gastroenterology and Hepatology 2005;3(10):1022-8.

Hur C, Gazelle GS, Hsu EH, Halpern EF, Podolsky DK. The Effect of Prior Colonic Imaging on Endoscopic Productivity: Potential Impact of CT Colonography. Clinical Gastroenterology and Hepatology 2005;3(11):1124-7.

Hur C, Chan AT, Tramontano AC, Gazelle GS. Coxibs Versus Combination NSAID and PPI Therapy for Chronic Pain: An Exploration of the Risks, Benefits, and Costs. Annals of Pharmacotherapy 2006;40(6):1052-1063.

Siegel CA, Hur C, Korzenik JR, Gazelle GS, Sands BE. Risks and Benefits of Infliximab for the Treatment of Crohn’s Disease. Clinical Gastroenterology and Hepatology 2006;4(8):1017-24.

Hur C, Wittenberg E, Nishioka NS, Gazelle GS. Quality of Life in Patients with Various Barrett’s Esophagus Associated Health States. Health and Quality of Life Outcomes 2006;4(1):45. (PMCID: PMC1559597)

Hur C, Chung DC, Schoen RE, Gazelle GS. The Management of Small Polyps Found by Virtual Colonoscopy: Results of a Decision Analysis. Clinical Gastroenterology and Hepatology 2007;5(2):237-44.

Kaplan GG, Hur C, Korzenik J, Sands BE. Infliximab Dose Escalation Versus Initiation of Adalimumab for Loss of Response in Crohn’s Disease: A Cost-Effectiveness Analysis. Alimentary Pharmacology and Therapeutics 2007;26(11-12):1509-20.

Yeh JM, Kuntz KM, Ezzati M, Hur C, Kong CY, Goldie SJ. Development of an Empirically Calibrated Model of Gastric Cancer in Two High-Risk Countries. Cancer Epidemiology, Biomarkers, and Prevention 2008;17(5):1179-87.

Pandharipande PV, Gervais DA, Mueller PR, Hur C, Gazelle GS. Radiofrequency Ablation Versus Nephron-Sparing Surgery for Small, Unilateral Renal Cell Carcinoma: A Cost-Effectiveness Analysis. Radiology 2008 Jul;248(1):169-78.

Hur C, Broughton DE, Ozanne E, Nishioka NS, Gazelle GS. Patient Preferences for Chemoprevention in Barrett’s Esophagus. Am J of Gastro 2008;103(10):2432-2442.

Pandharipande PV, Harisinghani MG, Specht MC, Hur C, Lee J, Gazelle GS. Staging MR Lymphangiography of the Axilla for Operable Breast Cancer: A Cost-Effectiveness Analysis. Am J Roentgenol 2008 Nov;191(5)1308-19.

Yachimski P, Nishioka NS, Richards, E, Hur, C. Treatment choice for Barrett’s esophagus with high-grade dysplasia or carcinoma: predictors of surgical versus endoscopic therapy. Clinical Gastroenterology and Hepatology 2008;6(11):1206-11.

Yachimski P, Hur C. Upper endoscopy in patients with acute myocardial infarction and upper gastrointestinal bleeding: Results of a decision analysis. Digestive Diseases and Sciences 2009:54(4):701-11.

Hur C, Broughton DE, Kong CY, Ozanne E, Truong T, Gazelle GS. Patient Preferences for the Chemoprevention of Colorectal Cancer. Digestive Diseases and Sciences 2009;54(10):2207-14.

Greenblatt WH, Hur C, Knudsen AB, Evans JA, Chung DC, Gazelle GS. Cost-Effectiveness of Prophylactic Surgery for Duodenal Cancer in Familial Adenomatous Polyposis. Cancer Epidemiology Biomarkers & Prevention 2009;18(10):2677-84. (PMCID: PMC2759853)

Huang ES, Turner BG, Fernandez-Del-Castillo C, Brugge WR, Hur, C. Pancreatic Cystic Lesions: Clinical Predictors of Malignancy. Aliment Pharmacol Ther 2010;31(2):285.94. (NIHMS 153996)

Huang ES, Gazelle GS, Hur C. Consensus guidelines in the management of branch duct intraductal papillary mucinous neoplasm: a cost-effectiveness analysis. Dig Dis Sci 2010;55(3):852-60.

Hur C, Hayeck TJ, Yeh JM, Richards EB, Spechler SJ, Gazelle GS, Kong CY. Development, Calibration, and Validation of a U.S. White Male Population-based Simulation Model of Esophageal Adenocarcinoma. PLoS ONE 2010;5(3):e9483.

Yachimski P, Lee RA, Tramontano AC, Nishioka NS, Hur C. Secular trends in patients diagnosed with Barrett’s esophagus. Dig Dis Sci 2010;55(4):960-6. Epub 2009 Oct 2.

Hayeck TJ, Kong CY, Spechler SJ, Gazelle GS, Hur C. The Prevalence of Barrett’s Esophagus in the US: Estimates from a Simulation Model Confirmed by SEER Data. Dis Esophagus 2010 [Epub March 26]. 27. Yeh JM, Ho W, Hur C. Cost-Effectiveness of Endoscopic Surveillance of Gastric Ulcers to Improve Survival. Gastrointestinal Endoscopy 2010 [Epub April 27].

Yeh JM, Hur C, Kuntz KM, Ezzati M, Goldie SJ. Cost-effectiveness of Treatment and Routine Surveillance of Precancerous Lesions to Prevent Gastric Cancer. Cancer 2010 Jun 15;116(12):2941-53.

Ho W, Broughton DE, Donelan K, Gazelle GS, Hur C. An Analysis of Barriers and Patient Preferences for Computed Tomographic Colonography for Colorectal Cancer Screening in a Nonadherent Urban Population. Am J Roentgenol 2010 Aug;195(2):393-7.

 

Non-experimental articles

Hur C, Nishioka NS, Gazelle GS. Two Models Better Than One. Gut 2005;54(8):204. (PMCID: PMC1774877)

Schoen RE, Hur C. What is the clinical importance of small polyps with regard to colorectal cancer screening? Nature Clinical Practice Gastroenterology & Hepatology 2006;3:488-489.

Hur C. Esophageal Capsule Endoscopy for Barrett's Esophagus Screening: A Hard Pill to Swallow? Clinical Gastroenterology and Hepatology 2007;5(3):307-9.

Hur C. The Cost-Effectiveness of Virtual Colonoscopy and the Importance of Small Polyps. AGA Perspectives 2007;3(4):8-14.

Hur C, Yachimski P. How useful is histologic confirmation of intestinal metaplasia in patients with long-segment Barrett’s esophagus? Nature Clinical Practice Gastroenterology & Hepatology 2008; 5(3):140-1.