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:
A Comparative Analysis of Health-Related Quality of Life 1 Year Following Myomectomy or Uterine Artery Embolization: Findings from the COMPARE-UF Registry.
Objective: To compare 12-month post-treatment health-related quality of life (HR-QoL) and symptom severity (SS) changes among patients with symptomatic uterine fibroids (SUF) not seeking fertility and undergo a hysterectomy, abdominal myomectomy (AM), or uterine artery embolization (UAE). Materials and Methods: The Comparing Options for Management: Patient-Centered Results for Uterine Fibroids (COMPARE-UF) Registry is a multi-institutional prospective observational cohort study of patients treated for SUF. A subset of 1465 women 31-45 years of age, who underwent either hysterectomy (n = 741), AM (n = 446), or UAE (n = 155) were included in this analysis. Demographics, fibroid history, and symptoms were obtained by baseline questionnaires and at 1 year post-treatment. Results were stratified by all treatments and propensity score weighting to adjust for differences in baseline characteristics. Results: Women undergoing UAE reported the lowest baseline HR-QoL and highest SS scores (mean = 40.6 [standard deviation (SD) = 23.8]; 62.3 [SD = 24.2]) followed by hysterectomy (44.3 [24.3]; 59.8 [SD = 24.1]). At 12 months, women who underwent a hysterectomy experienced the largest change in both HR-QoL (48.7 [26.2]) and SS (51.9 [25.6]) followed by other uterine-sparing treatments. Propensity score weighting revealed all treatments produced substantial improvement, with hysterectomy patients reporting the highest HR-QoL score (92.0 [17.8]) compared with myomectomy (86.7 [17.2]) and UAE (82.6 [21.5]) (p < 0.0001). Similarly, hysterectomy patients reported the lowest SS scores (8.2 [15.1]) compared with myomectomy (16.5 [15.1]) and UAE (19.6 [17.5]) (p < 0.0001). Conclusion: All procedures showed improvement in HR-QoL and reduction in SS score at 12 months, hysterectomy showing maximum improvement. Of importance, at 12 months, patients who underwent either a myomectomy or UAE reported comparable symptom relief and HR-QoL. Clinicaltrials.Gov Identifier: NCT02260752.
Authors
Anchan, RM; Wojdyla, D; Bortoletto, P; Terry, K; Disler, E; Milne, A; Gargiulo, A; Petrozza, J; Brook, O; Srouji, S; Morton, CC; Greenberg, J; Wegienka, G; Stewart, EA; Nicholson, WK; Thomas, L; Venable, S; Laughlin-Tommaso, S; Diamond, MP; Maxwell, GL; Marsh, EE; Myers, ER; Vines, AI; Wise, LA; Wallace, K; Jacoby, VL; Spies, JB
MLA Citation
Anchan, Raymond M., et al. “A Comparative Analysis of Health-Related Quality of Life 1 Year Following Myomectomy or Uterine Artery Embolization: Findings from the COMPARE-UF Registry.” J Womens Health (Larchmt), vol. 32, no. 4, Apr. 2023, pp. 423–33. Pubmed, doi:10.1089/jwh.2022.0133.
URI
https://scholars.duke.edu/individual/pub1562527
PMID
36637808
Source
pubmed
Published In
J Womens Health (Larchmt)
Volume
32
Published Date
Start Page
423
End Page
433
DOI
10.1089/jwh.2022.0133
The potential cost-effectiveness of novel cord blood therapies in children with autism spectrum disorder.
OBJECTIVE: To model the long-term clinical and economic outcomes of potential cord blood therapy in autism spectrum disorder (ASD). STUDY DESIGN: Markov microsimulation of ASD over the lifespan was used to compare two strategies: 1) standard of care (SOC), including behavioral and educational interventions, and 2) novel cord blood (CB) intervention in addition to SOC. Input data reflecting behavioral outcomes included baseline Vineland Adaptive Behavior Scale (VABS-3), monthly VABS-3 changes, and CB intervention efficacy on adaptive behavior based on a randomized, placebo-controlled trial (DukeACT). Quality-adjusted life-years (QALYs) were correlated to VABS-3. Costs for children with ASD ($15,791, ages 2-17 years) and adults with ASD ($56,559, ages 18+ years), and the CB intervention (range $15,000-45,000) were incorporated. Alternative CB efficacy and costs were explored. RESULTS: We compared model-projected results to published data on life-expectancy, mean VABS-3 changes, and lifetime costs. Undiscounted lifetime QALYs in the SOC and CB strategies were 40.75 and 40.91. Discounted lifetime costs in the SOC strategy were $1,014,000, and for CB ranged from $1,021,000-$1,058,000 with CB intervention cost ($8,000-$45,000). At $15,000 cost, CB was borderline cost-effective (ICER = $105,000/QALY). In one-way sensitivity analysis, CB cost and efficacy were the most influential parameters on CB ICER. CB intervention was cost-effective at costs<$15,000 and efficacies ≥2.0. Five-year healthcare payer projected budgetary outlays at a $15,000 CB cost were $3.847B. CONCLUSIONS: A modestly effective intervention designed to improve adaptive behavior in autism can be cost-effective under certain circumstances. Intervention cost and efficacy most affected the cost-effectiveness results and should be targeted to increase economic efficiency.
Authors
MLA Citation
Borre, Ethan D., et al. “The potential cost-effectiveness of novel cord blood therapies in children with autism spectrum disorder.” Plos One, vol. 18, no. 4, 2023, p. e0282906. Pubmed, doi:10.1371/journal.pone.0282906.
URI
https://scholars.duke.edu/individual/pub1573283
PMID
37071655
Source
pubmed
Published In
Plos One
Volume
18
Published Date
Start Page
e0282906
DOI
10.1371/journal.pone.0282906
Estimated Monetary Value of Future Research Clarifying Uncertainties Around the Optimal Adult Hearing Screening Schedule.
IMPORTANCE: Adult hearing screening is not routinely performed, and most individuals with hearing loss (HL) have never had their hearing tested as adults. OBJECTIVE: To project the monetary value of future research clarifying uncertainties around the optimal adult hearing screening schedule. DESIGN, SETTING, AND PARTICIPANTS: In this economic evaluation, a validated decision model of HL (DeciBHAL-US: Decision model of the Burden of Hearing loss Across the Lifespan) was used to simulate current detection and treatment of HL vs hearing screening schedules. Key model inputs included HL incidence (0.06%-10.42%/y), hearing aid uptake (0.54%-8.14%/y), screening effectiveness (1.62 × hearing aid uptake), utility benefits of hearing aids (+0.11), and hearing aid device costs ($3690). Distributions to model parameters for probabilistic uncertainty analysis were assigned. The expected value of perfect information (EVPI) and expected value of partial perfect information (EVPPI) using a willingness to pay of $100 000 per quality-adjusted life-year (QALY) was estimated. The EVPI and EVPPI estimate the upper bound of the dollar value of future research. This study was based on 40-year-old persons over their remaining lifetimes in a US primary care setting. EXPOSURES: Screening schedules beginning at ages 45, 55, 65, and 75 years, and frequencies of every 1 or 5 years. MAIN OUTCOMES AND MEASURES: The main outcomes were QALYs and costs (2020 US dollars) from a health system perspective. RESULTS: The average incremental cost-effectiveness ratio for yearly screening beginning at ages 55 to 75 years ranged from $39 200 to $80 200/QALY. Yearly screening beginning at age 55 years was the optimal screening schedule in 38% of probabilistic uncertainty analysis simulations. The population EVPI, or value of reducing all uncertainty, was $8.2 to $12.6 billion varying with willingness to pay and the EVPPI, or value of reducing all screening effectiveness uncertainty, was $2.4 billion. CONCLUSIONS AND RELEVANCE: In this economic evaluation of US adult hearing screening, large uncertainty around the optimal adult hearing screening schedule was identified. Future research on hearing screening has a high potential value so is likely justified.
Authors
Borre, ED; Myers, ER; Dubno, JR; Emmett, SD; Pavon, JM; Francis, HW; Ogbuoji, O; Sanders Schmidler, GD
MLA Citation
Borre, Ethan D., et al. “Estimated Monetary Value of Future Research Clarifying Uncertainties Around the Optimal Adult Hearing Screening Schedule.” Jama Health Forum, vol. 3, no. 11, Nov. 2022, p. e224065. Pubmed, doi:10.1001/jamahealthforum.2022.4065.
URI
https://scholars.duke.edu/individual/pub1556695
PMID
36367737
Source
pubmed
Published In
Jama Health Forum
Volume
3
Published Date
Start Page
e224065
DOI
10.1001/jamahealthforum.2022.4065
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, vol. 38, no. 4, Mar. 2023, pp. 978–85. 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
Volume
38
Published Date
Start Page
978
End Page
985
DOI
10.1007/s11606-022-07735-7
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
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