Evan Myers
Overview:
My research interests are broadly in the application of quantitative methods, especially mathematical modeling and decision analysis, to problems in women's health. Recent and current activities include integration of simulation modeling and systematic reviews to inform decisions surrounding cervical, ovarian, and breast cancer prevention and control, screening for postpartum depression, and management of uterine fibroids. We are also engaged in exploring methods for integrating guidelines development and research prioritization. In addition, I have ongoing collaborations using the tools of decision analysis with faculty in other clinical areas Research is conducted through the Division of Reproductive Sciences in the Department of Obstetrics and Gynecology, the Evidence Synthesis Group in the Duke Clinical Research Institute, and the Duke Cancer Institute. I'm also the course director for CRP 259, "Decision Sciences in Clinical Research", in Duke's Clinical Research Training Program.
Positions:
Walter L. Thomas Distinguished Professor of Obstetrics and Gynecology in the School of Medicine
Obstetrics and Gynecology, Women's Community & Population Health
School of Medicine
Professor of Obstetrics and Gynecology
Obstetrics and Gynecology, Women's Community & Population Health
School of Medicine
Core Faculty Member, Duke-Margolis Center for Health Policy
Duke - Margolis Center For Health Policy
Institutes and Provost's Academic Units
Member of the Duke Cancer Institute
Duke Cancer Institute
School of Medicine
Member in the Duke Clinical Research Institute
Duke Clinical Research Institute
School of Medicine
Education:
M.D. 1988
University of Pennsylvania
M.P.H. 1992
University of North Carolina - Chapel Hill
House Staff - Resident, Ob/Gyn
Duke University
Associate, Ob/Gyn
Duke University
Grants:
Pregnancy and Response to Antiretroviral Therapy in South Africa
Administered By
Duke Global Health Institute
Awarded By
National Institutes of Health
Role
Advisor
Start Date
End Date
Genomics Tests for Ovarian Cancer Detection and Management
Administered By
Institutes and Centers
Awarded By
Agency for Healthcare Research and Quality
Role
Principal Investigator
Start Date
End Date
Comparison of Operative to Medical Endocrine Therapy (COMET) for Low Risk DCIS
Awarded By
Alliance for Clinical Trials in Oncology Foundation
Role
Investigator
Start Date
End Date
Topic Refinement 2015
Administered By
Duke Clinical Research Institute
Awarded By
Patient Centered Outcomes Research Institute
Role
Co Investigator
Start Date
End Date
PCORI_Triage and FR Prioritization - Amendment #3
Administered By
Duke Clinical Research Institute
Awarded By
Patient Centered Outcomes Research Institute
Role
Co Investigator
Start Date
End Date
Publications:
Racial differences in the association of body mass index and ovarian cancer risk in the OCWAA Consortium.
BACKGROUND: Obesity disproportionately affects African American (AA) women and has been shown to increase ovarian cancer risk, with some suggestions that the association may differ by race. METHODS: We evaluated body mass index (BMI) and invasive epithelial ovarian cancer (EOC) risk in a pooled study of case-control and nested case-control studies including AA and White women. We evaluated both young adult and recent BMI (within the last 5 years). Associations were estimated using multi-level and multinomial logistic regression models. RESULTS: The sample included 1078 AA cases, 2582 AA controls, 3240 White cases and 9851 White controls. We observed a higher risk for the non-high-grade serous (NHGS) histotypes for AA women with obesity (ORBMI 30+= 1.62, 95% CI: 1.16, 2.26) and White women with obesity (ORBMI 30+= 1.20, 95% CI: 1.02, 2.42) compared to non-obese. Obesity was associated with higher NHGS risk in White women who never used HT (ORBMI 30+= 1.40, 95% CI: 1.08, 1.82). Higher NHGS ovarian cancer risk was observed for AA women who ever used HT (ORBMI 30+= 2.66, 95% CI: 1.15, 6.13), while in White women, there was an inverse association between recent BMI and risk of EOC and HGS in ever-HT users (EOC ORBMI 30+= 0.81, 95% CI: 0.69, 0.95, HGS ORBMI 30+= 0.73, 95% CI: 0.61, 0.88). CONCLUSION: Obesity contributes to NHGS EOC risk in AA and White women, but risk across racial groups studied differs by HT use and histotype.
Authors
Ochs-Balcom, HM; Johnson, C; Guertin, KA; Qin, B; Beeghly-Fadiel, A; Camacho, F; Bethea, TN; Dempsey, LF; Rosenow, W; Joslin, CE; Myers, E; Moorman, PG; Harris, HR; Peres, LC; Wendy Setiawan, V; Wu, AH; Rosenberg, L; Schildkraut, JM; Bandera, EV
MLA Citation
Ochs-Balcom, Heather M., et al. “Racial differences in the association of body mass index and ovarian cancer risk in the OCWAA Consortium.” Br J Cancer, vol. 127, no. 11, Nov. 2022, pp. 1983–90. Pubmed, doi:10.1038/s41416-022-01981-6.
URI
https://scholars.duke.edu/individual/pub1550908
PMID
36138071
Source
pubmed
Published In
Br J Cancer
Volume
127
Published Date
Start Page
1983
End Page
1990
DOI
10.1038/s41416-022-01981-6
Model-Projected Cost-Effectiveness of Adult Hearing Screening in the USA.
BACKGROUND: While 60% of older adults have hearing loss (HL), the majority have never had their hearing tested. OBJECTIVE: We sought to estimate long-term clinical and economic effects of alternative adult hearing screening schedules in the USA. DESIGN: Model-based cost-effectiveness analysis simulating Current Detection (CD) and linkage of persons with HL to hearing healthcare, compared to alternative screening schedules varying by age at first screen (45 to 75 years) and screening frequency (every 1 or 5 years). Simulated persons experience yearly age- and sex-specific probabilities of acquiring HL, and subsequent hearing aid uptake (0.5-8%/year) and discontinuation (13-4%). Quality-adjusted life-years (QALYs) were estimated according to hearing level and treatment status. Costs from a health system perspective include screening ($30-120; 2020 USD), HL diagnosis ($300), and hearing aid devices ($3690 year 1, $910/subsequent year). Data sources were published estimates from NHANES and clinical trials of adult hearing screening. PARTICIPANTS: Forty-year-old persons in US primary care across their lifetime. INTERVENTION: Alternative screening schedules that increase baseline probabilities of hearing aid uptake (base-case 1.62-fold; range 1.05-2.25-fold). MAIN MEASURES: Lifetime undiscounted and discounted (3%/year) costs and QALYs and incremental cost-effectiveness ratios (ICERs). KEY RESULTS: CD resulted in 1.20 average person-years of hearing aid use compared to 1.27-1.68 with the screening schedules. Lifetime total per-person undiscounted costs were $3300 for CD and ranged from $3630 for 5-yearly screening beginning at age 75 to $6490 for yearly screening beginning at age 45. In cost-effectiveness analysis, yearly screening beginning at ages 75, 65, and 55 years had ICERs of $39,100/QALY, $48,900/QALY, and $96,900/QALY, respectively. Results were most sensitive to variations in hearing aid utility benefit and screening effectiveness. LIMITATION: Input uncertainty around screening effectiveness. CONCLUSIONS: We project that yearly hearing screening beginning at age 55+ is cost-effective by US standards.
Authors
Borre, ED; Dubno, JR; Myers, ER; Emmett, SD; Pavon, JM; Francis, HW; Ogbuoji, O; Sanders Schmidler, GD
MLA Citation
Borre, Ethan D., et al. “Model-Projected Cost-Effectiveness of Adult Hearing Screening in the USA.” J Gen Intern Med, Aug. 2022. Pubmed, doi:10.1007/s11606-022-07735-7.
URI
https://scholars.duke.edu/individual/pub1532345
PMID
35931909
Source
pubmed
Published In
J Gen Intern Med
Published Date
DOI
10.1007/s11606-022-07735-7
Race Differences in the Associations between Menstrual Cycle Characteristics and Epithelial Ovarian Cancer.
BACKGROUND: Menstrual cycle characteristics-including age at menarche and cycle length- have been associated with ovarian cancer risk in White women. However, the associations between menstrual cycle characteristics and ovarian cancer risk among Black women have been sparsely studied. METHODS: Using the Ovarian Cancer in Women of African Ancestry (OCWAA) Consortium that includes 1,024 Black and 2,910 White women diagnosed with epithelial ovarian cancer (EOC) and 2,325 Black and 7,549 White matched controls, we investigated associations between menstrual cycle characteristics (age at menarche, age at menstrual regularity, cycle length, and ever missing three periods) and EOC risk by race and menopausal status. Multivariable logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Black women were more likely to be <11 years at menarche than White women (controls: 9.9% vs. 6.0%). Compared with ≥15 years at menarche, <11 years was associated with increased EOC risk for White (OR = 1.25; 95% CI, 0.99-1.57) but not Black women (OR = 1.10; 95% CI, 0.80-1.55). Among White women only, the association was greater for premenopausal (OR = 2.20; 95% CI, 1.31-3.68) than postmenopausal women (OR = 1.06; 95% CI, 0.82-1.38). Irregular cycle length was inversely associated with risk for White (OR = 0.78; 95% CI, 0.62-0.99) but not Black women (OR = 1.06; 95% CI, 0.68-1.66). CONCLUSIONS: Earlier age at menarche and cycle irregularity are associated with increased EOC risk for White but not Black women. IMPACT: Associations between menstrual cycle characteristics and EOC risk were not uniform by race.
Authors
Nash, R; Johnson, CE; Harris, HR; Peres, LC; Joslin, CE; Bethea, TN; Bandera, EV; Ochs-Balcom, HM; Myers, ER; Guertin, KA; Camacho, F; Beeghly-Fadiel, A; Moorman, PG; Setiawan, VW; Rosenberg, L; Schildkraut, JM; Wu, AH
MLA Citation
Nash, Rebecca, et al. “Race Differences in the Associations between Menstrual Cycle Characteristics and Epithelial Ovarian Cancer.” Cancer Epidemiol Biomarkers Prev, vol. 31, no. 8, Aug. 2022, pp. 1610–20. Pubmed, doi:10.1158/1055-9965.EPI-22-0115.
URI
https://scholars.duke.edu/individual/pub1524242
PMID
35654411
Source
pubmed
Published In
Cancer Epidemiol Biomarkers Prev
Volume
31
Published Date
Start Page
1610
End Page
1620
DOI
10.1158/1055-9965.EPI-22-0115
Cost-effectiveness of Pulmonary Rehabilitation Among US Adults With Chronic Obstructive Pulmonary Disease.
IMPORTANCE: Pulmonary rehabilitation (PR) after exacerbation of chronic obstructive pulmonary disease (COPD) is effective in reducing COPD hospitalizations and mortality while improving health-related quality of life, yet use of PR remains low. Estimates of the cost-effectiveness of PR in this setting could inform policies to improve uptake. OBJECTIVE: To estimate the cost-effectiveness of participation in PR after hospitalization for COPD. DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation estimated the cost-effectiveness of participation in PR compared with no PR after COPD hospitalization in the US using a societal perspective analysis. A Markov microsimulation model was developed to estimate the cost-effectiveness in the US health care system with a lifetime horizon, 1-year cycle length, and a discounted rate of 3% per year for both costs and outcomes. Data sources included published literature from October 1, 2001, to April 1, 2021, with the primary source being an analysis of Medicare beneficiaries living with COPD between January 1, 2014, and December 31, 2015. The analysis was designed and conducted from October 1, 2019, to December 15, 2021. A base case microsimulation, univariate analyses, and a probabilistic sensitivity analysis were performed. INTERVENTIONS: Pulmonary rehabilitation compared with no PR after COPD hospitalization. MAIN OUTCOMES AND MEASURES: Net cost in US dollars, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. RESULTS: Among the hypothetical cohort with a mean age of 76.9 (age range, 60-92) years and 58.6% women, the base case microsimulation from a societal perspective demonstrated that PR resulted in net cost savings per patient of $5721 (95% prediction interval, $3307-$8388) and improved quality-adjusted life expectancy (QALE) (gain of 0.53 [95% prediction interval, 0.43-0.63] years). The findings of net cost savings and improved QALE with PR did not change in univariate analyses of patient age, the Global Initiative for Obstructive Lung Disease stage, or number of PR sessions. In a probabilistic sensitivity analysis, PR resulted in net cost savings and improved QALE in every one of 1000 samples and was the dominant strategy in 100% of simulations at any willingness-to-pay threshold. In a 1-way sensitivity analysis of total cost, assuming completion of 36 sessions, a single PR session would remain cost saving to $171 per session and had an incremental cost-effectiveness ratio of $884 per session for $50 000/QALY and $1597 per session for $100 000/QALY. CONCLUSIONS AND RELEVANCE: In this economic evaluation, PR after COPD hospitalization appeared to result in net cost savings along with improvement in QALE. These findings suggest that stakeholders should identify policies to increase access and adherence to PR for patients with COPD.
Authors
Mosher, CL; Nanna, MG; Jawitz, OK; Raman, V; Farrow, NE; Aleem, S; Casaburi, R; MacIntyre, NR; Palmer, SM; Myers, ER
MLA Citation
Mosher, Christopher L., et al. “Cost-effectiveness of Pulmonary Rehabilitation Among US Adults With Chronic Obstructive Pulmonary Disease.” Jama Netw Open, vol. 5, no. 6, June 2022, p. e2218189. Pubmed, doi:10.1001/jamanetworkopen.2022.18189.
URI
https://scholars.duke.edu/individual/pub1524718
PMID
35731514
Source
pubmed
Published In
Jama Network Open
Volume
5
Published Date
Start Page
e2218189
DOI
10.1001/jamanetworkopen.2022.18189
Core feature sets: not just for outcomes, not just for research.
Authors
MLA Citation
Myers, Evan R. “Core feature sets: not just for outcomes, not just for research.” Am J Obstet Gynecol, vol. 226, no. 5, May 2022, pp. 605–06. Pubmed, doi:10.1016/j.ajog.2022.03.001.
URI
https://scholars.duke.edu/individual/pub1520754
PMID
35500999
Source
pubmed
Published In
American Journal of Obstetrics and Gynecology
Volume
226
Published Date
Start Page
605
End Page
606
DOI
10.1016/j.ajog.2022.03.001
Research Areas:
Cervix Uteri
Cesarean Section
Clinical Trials as Topic
Cohort Studies
Comparative Effectiveness Research
Computer Simulation
Controlled Clinical Trials as Topic
Cost Savings
Cost effectiveness
Cost of Illness
Cost-Benefit Analysis
Cross-Sectional Studies
Decision Making
Decision Trees
Diagnostic Techniques, Obstetrical and Gynecological
Direct Service Costs
Evidence-Based Medicine
Fertility
Fertility Agents, Female
Genital Diseases, Female
Genital Neoplasms, Female
Gynecologic Surgical Procedures
Gynecology
Health Care Costs
Health Expenditures
Health Policy
Health Services Research
Hospital Costs
Hysterectomy
Infertility, Female
Intraoperative Complications
Leiomyoma
Markov Chains
Mass Screening
Mass Vaccination
Models, Economic
Models, Statistical
Monte Carlo Method
Outcome Assessment (Health Care)
Papillomavirus Vaccines
Pelvic Neoplasms
Predictive Value of Tests
Pregnancy
Pregnancy Outcome
Preventive Health Services
Prognosis
Research Design
Sensitivity and Specificity
Technology Assessment, Biomedical
Urogenital Surgical Procedures
Women's Health

Walter L. Thomas Distinguished Professor of Obstetrics and Gynecology in the School of Medicine
Contact:
244 Baker House, Durham, NC 27710
Box 3279 Med Ctr, Durham, NC 27710