FIGURE 1.

Schematic of multistate simulation model. Arrow thicknesses qualitatively represent relative magnitude of incidence rates. Blue arrows, transition from no dementia to dementia. Orange arrows, transition from no history of cancer to history of cancer. Green arrows, transition to death. Transition rates were obtained from real-world data. For example, for the age band 65 to 70, the dementia incidence rate is 5.4/1000 person-years (PY) (ACT study), cancer (all types) incidence rate is 162.2/1,000PY (SEER data). The overall mortality rate is 413.3/1000 PY (U.S. life tables); cancer increases the mortality rate 2.92-fold (SEER), dementia increases the mortality rate 7.45-fold,³⁴ and the effects of cancer and dementia on mortality are multiplicative. In the base case selective survival model, U reduces both cancer mortality and dementia incidence rates by 30%. Abbreviations: ACT = Adult Changes in Thought; SEER = Surveillance, Epidemiology, and End Results