Myriam Hunink, MD PhD
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POSITION TITLE: Professor of Radiology and Clinical Epidemiology, Erasmus University Medical Center / Adjunct Professor of Health Decision Science, Harvard T.H. Chan School of Public Health Boston
|Institution and location
||Field of Study
|University of Leiden
|University of Leiden
|University of Leiden
||MD cum laude
||1984 - 1992
|Erasmus University, Rotterdam, The Netherlands
||PhD cum laude
||Health Decision Sciences
|Free University Hospital, Amsterdam
|Brigham and Women's Hospital/Harvard Medical School, Boston
||Cardiovascular and Interventional Radiology
Prof. Hunink’s research focuses on comparative effectiveness research and health technology assessment studies of diagnostic and prognostic imaging tests (biomarkers) and image-guided therapies, in particular for cardiovascular disease. Her other research interests include integrated diagnostics and computerized decision support for evidence-based use of imaging tests. More recently she has delved into (imaging to measure) the effectiveness of lifestyle interventions, in particular mindfulness-based stress reduction and yoga. She has longstanding experience in a wide range of methodologies including randomised controlled trial designs, meta-analysis, decision analysis, simulation modeling, and comparative effectiveness and cost-effectiveness analyses, and she teaches several courses in these fields. Hunink is lead author on a widely used textbook in the field of decision analysis. She previously founded the European network for Assessment of Imaging in Medicine (EuroAIM), coordinated three large multicentre clinical studies, was a member of multiple committees internationally, nationally and locally, and chaired the Medical Research Advisory Committee at the ErasmusMC for 5 years. Furthermore, she is a past president of the Society for Medical Decision Making, a multidisciplinary international society (www.smdm.org).
Positions and Honors
Employment and positions held:
1984-1988 Resident in Diagnostic Radiology, Free University Hospital, Amsterdam.
1988-1989 Research associate Clinical Decision Making, Erasmus University, Rotterdam, and Visiting research fellow, Tufts - New England Medical Center.
1989-1991 Clinical fellow, Cardiovascular and Interventional Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston.
1991-1992 Research fellow, Harvard School of Public Health, and Department of Radiology, Brigham and Women's Hospital/Harvard, Boston.
1992-1993 Assistant Professor Health Policy; Harvard School of Public Health, Boston/USA
1993-1998 Professor in Clinical Epidemiology and Decision Sciences (1993 Associate; 1997: Full) University Hospital Groningen/NL
1993-present Adjunct Professor of Health Decision Sciences (1993 Associate; 1997: Full) Harvard School of Public Health, Boston/USA
1998-present Professor of Radiology & Clinical Epidemiology, Erasmus MC – University Medical Center Rotterdam/NL
Selected other positions held:
2014-present Member (methodologist) expert team for the development of the European Society of Radiology referral guidelines (ESR iGuide)
2014-present Coordinator Virtual Clinical Trial Unit EIBIR
2012-present Committee on Environmental Factors and Health, Health Council of the Netherlands
2010-present Medical Research Advisory Committee Erasmus (Mrace), Chair of the Subcommittee for Health Care Efficiency Research
2008-present Chair, Awards Committee, Society for Medical Decision Making
2006-present Scientific Advisory Board, NODD Institute for Prevention and Early Diagnosis (NIPED)
2000-present Multiple search committees for full professor positions
1998-present Director Clinical Epidemiology, Netherlands Institute for Health Sciences
1998-present Research committee, Dept of Radiology, Erasmus MC
1998-present Member, since 2001 Vice-chair, since 2009 Chair, Board of the Consult Service Clinical Patient Oriented Research (CPO), Erasmus MC
2007-2010 Projectleader of the European Network for the Assessment of Imaging in Medicine (EuroAIM) of the European Institute for Biomedical Imaging Research (EIBIR)
2005-2007 Program Committee, European Congress of Radiology (ECR)
2004-2007 Health Services Policy Subcommittee, Scientific Program Committee, RSNA
2003-2004 Co-chair, European Biennial Meeting of the Society for Medical Decision Making
2002-2007 Chair – Medical Research Advisory Committee Erasmus (Mrace), Erasmus MC
2006 Eugene Saenger Award for Distinguished Service, Society for Medical Decision Making
1999-2002 President-elect, President, and Past-President, Society for Medical Decision Making
1999-2004 Associate Editor Medical Decision Making
1996-1998 Editorial Board Medical Decision Making
1993-1998 Dutch Org Scientific Research (NWO) – PIONIER Award, Decision-making in the management of peripheral arterial disease
1992-1993 General Electric Radiology Research Academic Fellowship, The diagnostic workup of peripheral arterial disease
Contributions to Science
Web of science Jan 2016
325 items, 11233 times cited, h-index = 54
Google Scholar Jan 2016
32816 citations, h-index = 72
Hunink MGM, Weinstein MC, Wittenberg E, Drummond MF, Pliskin JS, Wong JB, Glasziou PP. Decision Making in Health and Medicine: Integrating Evidence and Values. Cambridge University Press, Cambridge, UK, 2014. ISBN 978-1-107-69047-9
The overarching aim of Dr. Hunink’s research is to integrate quantitative evidence with patient-centered outcomes in order to guide patients, physicians, and policy-makers in their decision making. Her most important scientific contributions are:
1. Evaluation of diagnostic imaging tests for suspected cardiovascular disease:
Multiple imaging tests exist for the diagnosis of suspected cardiovascular disease and with the recent advances in imaging technology, the arsenal of tests is still increasing. The evaluation of testing algorithms should consider an individual’s prior probability of disease, the tests’ sensitivity, specificity, risks, and patient burden, the risks associated with missing the diagnosis, the harms of false positive and incidental findings, and the costs of diagnostic testing, treatment, and follow-up. This work synthesizes the best-available evidence into a coherent framework which provides insights into the choices, their consequences and the trade-offs involved. These analyses demonstrated that imaging for suspected cardiovascular disease in order to guide therapy is usually cost-effective compared to not using imaging tests. The driving factor that is decisive as to whether imaging is cost-effective is the prior probability of disease. Furthermore, the choice between different advanced imaging modalities leads to very little difference in expected outcome and costs. Also, the results showed that the costs of the imaging test is usually irrelevant to the decision since therapy, follow-up, and events in the future are far more costly than the cost of the initial test. Dr. Hunink has initiated multiple studies in this area, secured funding, supervised the work, and was senior author on the resulting manuscripts. Representative publications are:
- Genders TS, Petersen SE, Pugliese F, Dastidar AG, Fleischmann KE, Nieman K, Hunink MG. The optimal imaging strategy for patients with stable chest pain: a cost-effectiveness analysis. Ann Intern Med. 2015 Apr 7;162(7):474-84
- Beyer SE, Hunink MG, Schoberl F, von Baumgarten L, Petersen SE, Dichgans M, et al. Different Imaging Strategies in Patients With Possible Basilar Artery Occlusion: Cost-Effectiveness Analysis. Stroke. 2015 Jul;46(7):1840-9.
- Sanelli PC, Pandya A, Segal AZ, Gupta A, Hurtado-Rua S, Ivanidze J, Kesavabhotla K, Mir D, Mushlin AI, Hunink MG. Cost-effectiveness of CT angiography and perfusion imaging for delayed cerebral ischemia and vasospasm in aneurysmal subarachnoid hemorrhage. Am J Neuroradiol. 2014 Sep;35(9):1714-20.
- Genders TS, Ferket BS, Dedic A, Galema TW, Mollet NR, de Feyter PJ, Fleischmann KE, Nieman K, Hunink MG. Coronary computed tomography versus exercise testing in patients with stable chest pain: comparative effectiveness and costs. Int J Cardiol. 2013 Aug 20;167(4):1268-75.
2. Imaging for screening and prevention of cardiovascular disease:
Judicious use of novel imaging tests can potentially have a major impact on cardiovascular disease (CVD) outcomes by identifying those who can benefit from preventive interventions. Guidelines for screening and prevention of CVD typically advocate classification into low-, intermediate-, and high-risk groups. Further workup and preventive interventions can then be tailored to the risk of disease and future events. This line of research evaluates prognostic risk classification with biomarkers and assess their added value over and above risk scores based on traditional risk factors. The results show that novel imaging markers hold promise to refine risk classification. In particular, the results demonstrated that CT coronary calcium is an effective imaging marker for CVD risk classification. Cost-effectiveness of CT coronary calcium was demonstrated for selected patients. Dr. Hunink has initiated work in this area, written and received grants, supervised master and doctoral students, collaborated with an international team, and was senior author on several manuscripts. Publications include:
- van Kempen BJH, Ferket BS, Steyerberg EW, Max W, Hunink MGM, Fleischmann KE. Comparing the cost-effectiveness of four novel risk markers for screening asymptomatic individuals to prevent cardiovascular disease (CVD) in the US population. Int J Cardiol 2016 Jan 15;203:422-31.
- van Kempen BJ, Spronk S, Koller MT, Elias-Smale SE, Fleischmann KE, Ikram MA, Krestin GP, Hofman A, Witteman JC, Hunink MG. Comparative effectiveness and cost-effectiveness of CT-screening for coronary artery calcium in asymptomatic individuals. J Am Coll Cardiol. 2011 Oct 11;58(16):1690-701.
- Ferket BS, Genders TSS, Colkesen EB, Visser JJ, Spronk S, Steyerberg EW, Hunink MG. Systematic Review: Guidelines on Imaging of Asymptomatic Coronary Artery Disease. J Am Coll Cardiol 2011 Apr 12;57(15):1591-600.
- Ferket BS, Colkesen EB, Visser JJ, Spronk S, Kraaijenhagen RA, Steyerberg EW, Hunink MG. Systematic review of guidelines on cardiovascular risk assessment: Which recommendations should clinicians follow for a cardiovascular health check? Arch Intern Med. 2010 Jan 11;170(1):27-40. Review.
3. Image-guided therapy:
The growth of minimally-invasive image-guided therapies is exponential and such technologies are increasingly applied. However, is rapid implementation of these novel technologies justified? What is the evidence? What are the short- and long-term effects of the new technology compared to its alternatives? Do patient-centered outcomes improve? Are the additional costs of these cutting-edge technologies justified? These questions were addressed using decision models and RCTs. The results showed that endovascular therapies are commonly a good alternative to surgical intervention providing similar effectiveness at lower risk. In patients with claudication the results showed that supervised exercise provides benefits equal to that of endovascular therapy and that combining both therapies provides greater benefit than either alone. Dr. Hunink supervised a multicenter RCT in this area, supervised decision analyses, and participated in numerous studies initiated by others. Publications include:
- Fakhry F, Spronk S, et.al., Rouwet E, Hunink MGM. Endovascular Revascularization plus Supervised Exercise versus Supervised Exercise only in Patients with Peripheral Artery Disease and Intermittent Claudication. A Randomized Clinical Trial. JAMA. 2015 Nov 10;314(18):1936-44.
- Hogendoorn W, Hunink MG, Schlosser FJ, Moll FL, Sumpio BE, Muhs BE. A clinical decision model for selecting the most appropriate therapy for uncomplicated chronic dissections of the descending aorta. J Vasc Surg. 2014 Jul;60(1):20-30.
- Hogendoorn W, Hunink MG, Schlosser FJ, Moll FL, Sumpio BE, Muhs BE. Endovascular vs. Open Repair of Complicated Acute Type B Aortic Dissections. J Endovasc Ther. 2014 Aug;21(4):503-14.
- Fakhry F, Rouwet EV, den Hoed PT, Hunink MG, Spronk S. Long-term clinical effectiveness of supervised exercise therapy versus endovascular revascularization for intermittent claudication from a randomized clinical trial. Br J Surg. 2013 Aug;100(9):1164-71.
4. Lifestyle interventions and integrative health care:
While we continue to make great strides in the development of novel medical technologies to diagnose and treat disease, many physicians argue that it is much more effective to effectuate lifestyle changes to prevent disease and slow disease progression. Furthermore, helping patients cope with their disease and symptoms through an integrative approach to health can increase quality of life and well-being. In this research line Dr. Hunink evaluates lifestyle interventions such as physical exercise, yoga, mindfulness-based stress reduction and music therapy as adjuncts to usual care. A systematic review demonstrated that yoga is effective in modifying cardiovascular risk factors and that the effect is equal in magnitude to the effect of aerobic exercise. This paper received enormous media attention: 726 articles in newspapers, journals, magazines, websites including Time, BBC, Daily Mail, TF1, Nouvel Observateur, Fox, The Guardian, Philly, Independent, Huffington Post, Good Housekeeping, Reuters, U.S. News & World Report, Yahoo!, MNS, Forbes, Le Quotidien du Medecin. The press release broke all previous records of the European Society of Cardiology (publicity value of € 684,249). Furthermore, Dr. Hunink found mindfulness-based interventions to be effective in the management of several chronic diseases. She has initiated several studies in this area, obtained funding, supervised the work, and was senior author on the resulting manuscripts. Publications include:
- Chu P, Gotink R, Yeh Y, Goldie SJ, Hunink MGM. The effectiveness of yoga in modifying risk factors for cardiovascular disease and metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials. Eur J Prev Cardiol 2016, Vol. 23(3) 291–307
- Gotink RA, Chu P, Busschbach JJ, Benson H, Fricchione GL, Hunink MG. Standardised mindfulness-based interventions in healthcare: an overview of systematic reviews and meta-analyses of RCTs. PLoS ONE. 2015;10(4):e0124344
- Younge JO, Gotink RA, Baena CP, Roos-Hesselink JW, Hunink MGM. Mind-body practices for patients with cardiac disease: a systematic review and meta-analysis. Eur J Prev Cardiol. 2015 Nov;22(11):1385-98.
- Younge JO, Kouwenhoven-Pasmooij TA, Freak-Poli R, Roos-Hesselink JW, Hunink MGM. Randomized study designs for lifestyle interventions: a tutorial. Int J Epidemiol. 2015 Dec;44(6):2006-19
5. Evidence-based radiology and decision support for imaging stewardship:
To ensure evidence-based choices for the use of imaging technology and evidence-based management of imaging findings in day-to-day clinical practice requires implementation of a computerized decision support system which is available at the point of care and is adaptable to the individual patient. To make this feasible, we need information on the performance of the imaging tests derived from systematic reviews and meta-analyses and we need updated clinical prediction models for the probability of disease. Our intention is to provide the most recent evidence on test performance together with prediction models that are dynamically updated and revised in an easy-to-use format to support decision-making with respect to diagnostic imaging at the point of care. In this research line we have published numerous systematic reviews and meta-analyses of imaging technology and developed and published several diagnostic prediction models for predicting the presence of disease. Dr. Hunink’s role was to initiate the research, find funding, supervise master and doctoral students, and be senior author on the publications, which include:
- Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MG. Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol. 2015 Sep;68(3):438-50
- Genders TS, Steyerberg EW, Hunink MG for the CAD consortium. Prediction model to estimate presence of coronary artery disease. BMJ. 2012 Jun 12;344:e3485
- Genders TS, Steyerberg EW, Hunink MG for the CAD consortium. A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension. The CAD Consortium. Eur Heart J. 2011 Jun;32(11):1316-30.
- Smits M, Dippel DW, Steyerberg EW, de Haan GG, Dekker HM, Vos PE, Kool DR, Nederkoorn PJ, Hofman PA, Twijnstra A, Tanghe HL, Hunink MG. Predicting intracranial traumatic findings on computed tomography in patients with minor head injury: the CHIP prediction rule. Ann Intern Med 2007 Mar 20;146(6):397-405.
Ongoing Research Support:
- ErasmusMC Research Fund. Cost-effectiveness of a lifestyle intervention for health and participation of personnel at the ErasmusMC. 2014-2016. Aim of the study is to evaluate motivational interviewing and a cardiovascular healthy lifestyle eHealth portal in improving the cardiovascular risk among personnel. (Role: PI).
- ZonMW Prevention. Cost-effectiveness of a lifestyle intervention for health and participation of personnel with physically strenuous employment: a cluster RCT. 2012-2016. Aim of the study is to assess motivational interviewing and a cardiovascular healthy lifestyle eHealth portal in improving the cardiovascular risk among personnel. (Role: PI).
- STW. Automatic Construction of Dynamic and Setting-Specific Prediction Rules in Radiology. 2013-2017. Aim of the study is to develop a prototype of computerized decision support for appropriate imaging which incorporates individualized predictions of disease based on clinical characteristics and to update these predictions dynamically as data is collected in day-to-day clinical practice. (Role: PI)
Selected completed Research Support:
- NIH R21 grant. Novel Risk Markers for Primary prevention of Coronary Artery Disease. 2011-2014. Aim of the study was to evaluate the comparative effectiveness and cost-effectiveness of novel risk markers in the primary prevention of coronary artery disease. (Role: co-investigator) (PI: K.E. Fleischmann, UCSF)
- ErasmusMC Research Fund. Cost-effectiveness of diagnostic imaging strategies for the diagnosis of coronary artery disease in patients with new onset chest pain suggestive of stable angina pectoris. 2009-2013. Goal of this study was to evaluate and compare the cost-effectiveness of different imaging algorithms in the diagnostic workup of patients with stable chest pain (Role: PI)
- ZonMW Health Care Efficiency Research. Endovascular Revascularization and Supervised Exercise in patients with Intermittent Claudication. Multicenter study. Aim of this project was to determine the (cost-) effectiveness of endovascular revascularization over and above supervised exercise. 2010-2014. (Role: PI)
- ErasmusMC Research Fund. SMART choices for lifestyle interventions for the prevention of cardiovascular and metabolic disorders. 2012-2014. Aim of this study was to model the comparative effectiveness of various lifestyle interventions for cardiovascular disease prevention (Role: PI)
- ErasmusMC Research Fund. Evaluating mind-body medicine for prevention and treatment of chronic diseases. 2011-2016. Goal of this project was to assess mindfulness and yoga and music in the management of chronic conditions (Role: PI)