@article{pmid38709852,

title = {Challenges of COVID-19 Case Forecasting in the US, 2020-2021},

author = {Velma K Lopez and Estee Y Cramer and Robert Pagano and John M Drake and Eamon B O'Dea and Madeline Adee and Turgay Ayer and Jagpreet Chhatwal and Ozden O Dalgic and Mary A Ladd and Benjamin P Linas and Peter P Mueller and Jade Xiao and Johannes Bracher and Alvaro J Castro Rivadeneira and Aaron Gerding and Tilmann Gneiting and Yuxin Huang and Dasuni Jayawardena and Abdul H Kanji and Khoa Le and Anja Mühlemann and Jarad Niemi and Evan L Ray and Ariane Stark and Yijin Wang and Nutcha Wattanachit and Martha W Zorn and Sen Pei and Jeffrey Shaman and Teresa K Yamana and Samuel R Tarasewicz and Daniel J Wilson and Sid Baccam and Heidi Gurung and Steve Stage and Brad Suchoski and Lei Gao and Zhiling Gu and Myungjin Kim and Xinyi Li and Guannan Wang and Lily Wang and Yueying Wang and Shan Yu and Lauren Gardner and Sonia Jindal and Maximilian Marshall and Kristen Nixon and Juan Dent and Alison L Hill and Joshua Kaminsky and Elizabeth C Lee and Joseph C Lemaitre and Justin Lessler and Claire P Smith and Shaun Truelove and Matt Kinsey and Luke C Mullany and Kaitlin Rainwater-Lovett and Lauren Shin and Katharine Tallaksen and Shelby Wilson and Dean Karlen and Lauren Castro and Geoffrey Fairchild and Isaac Michaud and Dave Osthus and Jiang Bian and Wei Cao and Zhifeng Gao and Juan Lavista Ferres and Chaozhuo Li and Tie-Yan Liu and Xing Xie and Shun Zhang and Shun Zheng and Matteo Chinazzi and Jessica T Davis and Kunpeng Mu and Ana Pastore Y Piontti and Alessandro Vespignani and Xinyue Xiong and Robert Walraven and Jinghui Chen and Quanquan Gu and Lingxiao Wang and Pan Xu and Weitong Zhang and Difan Zou and Graham Casey Gibson and Daniel Sheldon and Ajitesh Srivastava and Aniruddha Adiga and Benjamin Hurt and Gursharn Kaur and Bryan Lewis and Madhav Marathe and Akhil Sai Peddireddy and Przemyslaw Porebski and Srinivasan Venkatramanan and Lijing Wang and Pragati V Prasad and Jo W Walker and Alexander E Webber and Rachel B Slayton and Matthew Biggerstaff and Nicholas G Reich and Michael A Johansson},

doi = {10.1371/journal.pcbi.1011200},

issn = {1553-7358},

year  = {2024},

date = {2024-05-01},

journal = {PLoS Comput Biol},

volume = {20},

number = {5},

pages = {e1011200},

abstract = {During the COVID-19 pandemic, forecasting COVID-19 trends to support planning and response was a priority for scientists and decision makers alike. In the United States, COVID-19 forecasting was coordinated by a large group of universities, companies, and government entities led by the Centers for Disease Control and Prevention and the US COVID-19 Forecast Hub (https://covid19forecasthub.org). We evaluated approximately 9.7 million forecasts of weekly state-level COVID-19 cases for predictions 1-4 weeks into the future submitted by 24 teams from August 2020 to December 2021. We assessed coverage of central prediction intervals and weighted interval scores (WIS), adjusting for missing forecasts relative to a baseline forecast, and used a Gaussian generalized estimating equation (GEE) model to evaluate differences in skill across epidemic phases that were defined by the effective reproduction number. Overall, we found high variation in skill across individual models, with ensemble-based forecasts outperforming other approaches. Forecast skill relative to the baseline was generally higher for larger jurisdictions (e.g., states compared to counties). Over time, forecasts generally performed worst in periods of rapid changes in reported cases (either in increasing or decreasing epidemic phases) with 95% prediction interval coverage dropping below 50% during the growth phases of the winter 2020, Delta, and Omicron waves. Ideally, case forecasts could serve as a leading indicator of changes in transmission dynamics. However, while most COVID-19 case forecasts outperformed a naïve baseline model, even the most accurate case forecasts were unreliable in key phases. Further research could improve forecasts of leading indicators, like COVID-19 cases, by leveraging additional real-time data, addressing performance across phases, improving the characterization of forecast confidence, and ensuring that forecasts were coherent across spatial scales. In the meantime, it is critical for forecast users to appreciate current limitations and use a broad set of indicators to inform pandemic-related decision making.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38713084,

title = {Recent and projected incidence trends and risk of anal cancer among people with HIV in North america},

author = {Ashish A Deshmukh and Yueh-Yun Lin and Haluk Damgacioglu and Meredith Shiels and Sally B Coburn and Raynell Lang and Keri N Althoff and Richard Moore and Michael J Silverberg and Alan G Nyitray and Jagpreet Chhatwal and Kalyani Sonawane and Keith Sigel},

doi = {10.1093/jnci/djae096},

issn = {1460-2105},

year  = {2024},

date = {2024-05-01},

journal = {J Natl Cancer Inst},

abstract = {BACKGROUND: Anal cancer risk is elevated among people with HIV (PWH). Recent anal cancer incidence patterns among PWH in the United States (US) and Canada remain unclear. It is unknown how the incidence patterns may evolve in future years.nnMETHODS: Using data from the North American AIDS Cohort Collaboration on Research and Design, we investigated absolute anal cancer incidence and incidence trends in the US, Canada, and different US regions. We further estimated relative risk compared with persons without HIV, relative risk among various subgroups, and projected future anal cancer burden among US PWH.nnRESULTS: During 2001-2016, in the US, age-standardized anal cancer incidence declined 2.2%/year (95%CI=-4.4% to -0.1%), particularly in the Western region (-3.8%/year [95%CI=-6.5% to -0.9%]. In Canada, incidence remained stable. Considerable geographic variation in risk was observed by US regions (eg, over four-fold risk in the Midwest and Southeast compared to the Northeast among men who have sex with men [MSM] with HIV). Anal cancer risk increased with a decrease in nadir CD4 count and was elevated among those with opportunistic illnesses. Anal cancer burden among US PWH is expected to decrease in future years (through 2035), but >70% of cases will continue to occur in MSM with HIV and people with AIDS.nnCONCLUSION: Geographic variation in anal cancer risk and trends may reflect underlying differences in screening practices and HIV epidemic. MSM with HIV and PWH with AIDS will continue to bear most anal cancer burden, highlighting the importance of precision prevention.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38607627,

title = {Semaglutide vs Endoscopic Sleeve Gastroplasty for Weight Loss},

author = {Muhammad Haseeb and Jagpreet Chhatwal and Jade Xiao and Pichamol Jirapinyo and Christopher C Thompson},

doi = {10.1001/jamanetworkopen.2024.6221},

issn = {2574-3805},

year  = {2024},

date = {2024-04-01},

journal = {JAMA Netw Open},

volume = {7},

number = {4},

pages = {e246221},

abstract = {IMPORTANCE: Obesity is a disease with a large socioeconomic burden. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic bariatric procedure with wide global adoption. More recently, new weight-loss medications, such as glucagon-like peptide-1 receptor agonists (eg, semaglutide), have attracted increased attention due to their efficacy. However, their cost-effectiveness over an extended period compared with ESG is a critical gap that needs to be better explored for informed health care decision-making.nnOBJECTIVE: To assess the cost-effectiveness of semaglutide compared with ESG over 5 years for individuals with class II obesity.nnDESIGN, SETTING, AND PARTICIPANTS: This economic evaluation study, conducted from September 1, 2022, to May 31, 2023, used a Markov cohort model to compare ESG and semaglutide, with a no-treatment baseline strategy. The study comprised adult patients in the US health care system with class II obesity (body mass index [BMI] of 35-39.9). The base case was a 45-year-old patient with class II obesity (BMI of 37). Patients undergoing ESG were subjected to risks of perioperative mortality and adverse events with resultant costs and decrement in quality of life.nnINTERVENTIONS: Strategies included treatment with semaglutide and ESG.nnMAIN OUTCOMES AND MEASURES: Costs (2022 US dollars), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) with a willingness-to-pay threshold of $100 000/QALY. A 5-year time horizon with a cycle length of 1 month with a 3% discount rate was used. Probabilities, costs, and quality-of-life estimates of the model were derived from published literature. One-way, 2-way, and probabilistic sensitivity analyses were also performed.nnRESULTS: The model found that ESG was more cost-effective than semaglutide over a 5-year time horizon, with an ICER of -$595 532/QALY. Endoscopic sleeve gastroplasty added 0.06 QALYs and reduced total cost by $33 583 relative to semaglutide. The results remained robust on 1-way and probabilistic sensitivity analyses. Endoscopic sleeve gastroplasty sustained greater weight loss over 5 years vs semaglutide (BMI of 31.7 vs 33.0). To achieve nondominance, the annual price of semaglutide, currently $13 618, would need to be $3591.nnCONCLUSIONS AND RELEVANCE: This study suggests that ESG is cost saving compared with semaglutide in the treatment of class II obesity. On price threshold analyses, a 3-fold decrease in the price of semaglutide is needed to achieve nondominance.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37991182,

title = {Unspoken Truths: Mental Health Among Academic Surgeons},

author = {Reagan A Collins and Tianna Herman and Rebecca A Snyder and Krista L Haines and Anne Stey and Tania K Arora and Sunil K Geevarghese and Joseph D Phillips and Diego Vicente and Cornelia L Griggs and Imani E McElroy and Anji E Wall and Tasha M Hughes and Srijan Sen and Jaber Valinejad and Andres Alban and J Shannon Swan and Nathaniel Mercaldo and Mohammad S Jalali and Jagpreet Chhatwal and G Scott Gazelle and Erika Rangel and Chi-Fu Jeffrey Yang and Karen Donelan and Jessica A Gold and Colin P West and Carrie Cunningham},

doi = {10.1097/SLA.0000000000006159},

issn = {1528-1140},

year  = {2024},

date = {2024-03-01},

journal = {Ann Surg},

volume = {279},

number = {3},

pages = {429--436},

abstract = {OBJECTIVE: To characterize the current state of mental health within the surgical workforce in the United States.nnBACKGROUND: Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown.nnMETHODS: Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed.nnRESULTS: Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4%-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. In all, 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P <0.001), anxiety (31.6% vs. 16.2%, P =0.001), PTSD (12.8% vs. 5.6%, P =0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P =0.022). Overall, 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past 2 weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P =0.033) and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P <0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P =0.002) were associated with increased odds of suicidal ideation over the past 12 months.nnCONCLUSIONS: Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the United States.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38470046,

title = {The Need to Revise the Model for Face Validity},

author = {Elliot B Tapper and Jagpreet Chhatwal},

doi = {10.14309/ajg.0000000000002696},

issn = {1572-0241},

year  = {2024},

date = {2024-03-01},

journal = {Am J Gastroenterol},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38492923,

title = {Hepatitis C Elimination in Rwanda: Progress, Feasibility, and Economic Evaluation},

author = {Huaiyang Zhong and Alec Aaron and Lindsey Hiebert and Janvier Serumondo and Yueran Zhuo and Madeline Adee and Gallican N Rwibasira and John W Ward and Jagpreet Chhatwal},

doi = {10.1016/j.jval.2024.03.005},

issn = {1524-4733},

year  = {2024},

date = {2024-03-01},

journal = {Value Health},

abstract = {OBJECTIVES: In 2018, Rwanda launched a national program to eliminate the hepatitis C virus (HCV). We aim to assess the impact of the program to date and identify strategies to achieve the World Health Organization's HCV elimination goals by 2030.nnMETHODS: We developed a microsimulation model to simulate Rwanda's HCV epidemic from 2015 through 2050 and evaluated temporal trends in HCV infection, prevalence, mortality, and the total cost of care for scenarios that could achieve HCV elimination by 2030.nnRESULTS: Between 2018 and 2022, over 7 million people were screened for HCV, and 60 000 were treated. The study projected that Rwanda could achieve HCV elimination as early as 2027. A feasible strategy of an annual screening rate of 15% and a treatment rate of 100% would achieve all World Health Organization elimination goals by 2028, requiring screening an additional 4 million people and treating 23 900 patients by 2030. The elimination strategy costs $25 million for screening and diagnosis and $21 million for treatment from 2015 to 2050. The national program would avert 4900 hepatocellular carcinoma cases and 6700 HCV-related deaths and save the health system $25.33 million from 2015 to 2050.nnCONCLUSIONS: Rwanda is poised to become one of the first countries in the world to eliminate HCV. Rwanda's program serves as a blueprint for other countries in the African region. By rapid screening and treatment scale-up (eg, by leveraging HIV platforms) and by drug price negotiations, HCV elimination is not only feasible but can be cost-saving in low-income settings.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37463414,

title = {The Rising Costs of Alcohol-Associated Liver Disease in the United States},

author = {Jovan Julien and Turgay Ayer and Elliot B Tapper and Jagpreet Chhatwal},

doi = {10.14309/ajg.0000000000002405},

issn = {1572-0241},

year  = {2024},

date = {2024-02-01},

journal = {Am J Gastroenterol},

volume = {119},

number = {2},

pages = {270--277},

abstract = {INTRODUCTION: Alcohol-associated liver disease (ALD) is rising in the United States because of an increase in high-risk drinking, but population-level ALD cost is unknown. Our aim was to project the direct and indirect costs associated with ALD in the US population through 2040.nnMETHODS: We used a previously validated microsimulation model of alcohol consumption and ALD with model parameters estimated from publicly available data sources, including the National Epidemiologic Survey Alcohol and Related Conditions-III, the Center for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research, the Bureau of Labor Statistics, and published studies informing the impact of alcohol consumption on ALD severity in the United States resident population. The simulated scenario included current and projected ALD-associated costs.nnRESULTS: From 2022 to 2040, the ALD is projected to cost $880 billion, $355 billion in direct healthcare-related costs, and $525 billion in lost labor and economic consumption. The annual cost of ALD is projected to increase from $31 billion in 2022 to $66 billion (118% increase) in 2040. Although the female population makes up 29% of these costs in 2022, by 2040 on a per annum basis, female costs would be 43% of the total annual expenditure.nnDISCUSSION: Increased consumption of alcohol in the US population, especially in females, will cause a steep rise in the economic burden of ALD in the United States. These findings highlight the need for planners and policymakers to plan for the increased impact of liver disease in the United States.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37302445,

title = {Hepatocellular Carcinoma Incidence Threshold for Surveillance in Virologically Cured Hepatitis C Individuals},

author = {Jagpreet Chhatwal and Ali Hajjar and Peter P Mueller and Gizem Nemutlu and Neeti Kulkarni and Mary Linton B Peters and Fasiha Kanwal},

doi = {10.1016/j.cgh.2023.05.024},

issn = {1542-7714},

year  = {2024},

date = {2024-01-01},

journal = {Clin Gastroenterol Hepatol},

volume = {22},

number = {1},

pages = {91--101.e6},

abstract = {BACKGROUND & AIMS: Guidelines recommend biannual surveillance for hepatocellular carcinoma (HCC) in hepatitis C individuals with cirrhosis if the HCC incidence rate is above 1.5 per 100 person-years (PY). However, the incidence threshold for surveillance in individuals who achieve a virologic cure is unknown. We estimated the HCC incidence rate above which routine HCC surveillance is cost-effective in this growing population of virologically cured hepatitis C individuals with cirrhosis or advanced fibrosis.nnMETHODS: We developed a Markov-based microsimulation model of the natural history of HCC in individuals with hepatitis C who achieved virologic cure with oral direct-acting antivirals. We used published data on the natural history of hepatitis C, competing risk post virologic cure, HCC tumor progression, real-world HCC surveillance adherence, contemporary HCC treatment options and associated costs, and utilities of different health states. We estimated the HCC incidence above which biannual HCC surveillance using ultrasound and alpha-fetoprotein would be cost-effective.nnRESULTS: In virologically cured hepatitis C individuals with cirrhosis or advanced fibrosis, HCC surveillance is cost-effective if HCC incidence exceeds 0.7 per 100 PY using $100,000 per quality-adjusted life year willingness-to-pay. At this HCC incidence, routine HCC surveillance would result in 2650 and 5700 additional life years per 100,000 cirrhosis and advanced fibrosis persons, respectively, compared with no surveillance. At $150,000 willingness-to-pay, surveillance is cost-effective if HCC incidence exceeds 0.4 per 100 PY. Sensitivity analysis showed that the threshold mostly remained below 1.5 per 100 PY.nnCONCLUSIONS: The contemporary HCC incidence threshold is much lower than the previous 1.5% incidence value used to guide HCC surveillance decisions. Updating clinical guidelines could improve the early diagnosis of HCC.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37500964,

title = {Consensus report from the 10th Global Forum for Liver Magnetic Resonance Imaging: developments in HCC management},

author = {Bachir Taouli and Ahmed Ba-Ssalamah and Julius Chapiro and Jagpreet Chhatwal and Kathryn Fowler and Tae Wook Kang and Gesine Knobloch and Dow-Mu Koh and Masatoshi Kudo and Jeong Min Lee and Takamichi Murakami and David J Pinato and Kristina I Ringe and Bin Song and Parissa Tabrizian and Jin Wang and Jeong Hee Yoon and Mengsu Zeng and Jian Zhou and Valérie Vilgrain},

doi = {10.1007/s00330-023-09928-y},

issn = {1432-1084},

year  = {2023},

date = {2023-12-01},

journal = {Eur Radiol},

volume = {33},

number = {12},

pages = {9152--9166},

abstract = {The 10th Global Forum for Liver Magnetic Resonance Imaging (MRI) was held as a virtual 2-day meeting in October 2021, attended by delegates from North and South America, Asia, Australia, and Europe. Most delegates were radiologists with experience in liver MRI, with representation also from specialists in liver surgery, oncology, and hepatology. Presentations, discussions, and working groups at the Forum focused on the following themes: • Gadoxetic acid in clinical practice: Eastern and Western perspectives on current uses and challenges in hepatocellular carcinoma (HCC) screening/surveillance, diagnosis, and management • Economics and outcomes of HCC imaging • Radiomics, artificial intelligence (AI) and deep learning (DL) applications of MRI in HCC. These themes are the subject of the current manuscript. A second manuscript discusses multidisciplinary tumor board perspectives: how to approach early-, mid-, and late-stage HCC management from the perspectives of a liver surgeon, interventional radiologist, and oncologist (Taouli et al, 2023). Delegates voted on consensus statements that were developed by working groups on these meeting themes. A consensus was considered to be reached if at least 80% of the voting delegates agreed on the statements. CLINICAL RELEVANCE STATEMENT: This review highlights the clinical applications of gadoxetic acid-enhanced MRI for liver cancer screening and diagnosis, as well as its cost-effectiveness and the applications of radiomics and AI in patients with liver cancer. KEY POINTS: • Interpretation of gadoxetic acid-enhanced MRI differs slightly between Eastern and Western guidelines, reflecting different regional requirements for sensitivity vs specificity. • Emerging data are encouraging for the cost-effectiveness of gadoxetic acid-enhanced MRI in HCC screening and diagnosis, but more studies are required. • Radiomics and artificial intelligence are likely, in the future, to contribute to the detection, staging, assessment of treatment response and prediction of prognosis of HCC-reducing the burden on radiologists and other specialists and supporting timely and targeted treatment for patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37439935,

title = {Consensus report from the 10th global forum for liver magnetic resonance imaging: multidisciplinary team discussion},

author = {Bachir Taouli and Ahmed Ba-Ssalamah and Julius Chapiro and Jagpreet Chhatwal and Kathryn Fowler and Tae Wook Kang and Gesine Knobloch and Dow-Mu Koh and Masatoshi Kudo and Jeong Min Lee and Takamichi Murakami and David J Pinato and Kristina I Ringe and Bin Song and Parissa Tabrizian and Jin Wang and Jeong Hee Yoon and Mengsu Zeng and Jian Zhou and Valérie Vilgrain},

doi = {10.1007/s00330-023-09919-z},

issn = {1432-1084},

year  = {2023},

date = {2023-12-01},

journal = {Eur Radiol},

volume = {33},

number = {12},

pages = {9167--9181},

abstract = {The 10th Global Forum for Liver Magnetic Resonance Imaging was held in October 2021. The themes of the presentations and discussions at this Forum are described in detail in the review by Taouli et al (2023). The focus of this second manuscript developed from the Forum is on multidisciplinary tumor board perspectives in hepatocellular carcinoma (HCC) management: how to approach early-, mid-, and late-stage management from the perspectives of a liver surgeon, an interventional radiologist, and an oncologist. The manuscript also includes a panel discussion by multidisciplinary experts on three selected cases that explore challenging aspects of HCC management. CLINICAL RELEVANCE STATEMENT: This review highlights the importance of a multidisciplinary team approach in liver cancer patients and includes the perspectives of a liver surgeon, an interventional radiologist, and an oncologist, including illustrative case studies. KEY POINTS: • A liver surgeon, interventional radiologist, and oncologist presented their perspectives on the treatment of early-, mid-, and late-stage HCC. • Different perspectives on HCC management between specialties emphasize the importance of multidisciplinary tumor boards. • A multidisciplinary faculty discussed challenging aspects of HCC management, as highlighted by three case studies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37703345,

title = {Hepatitis C Elimination in Moldova Is Feasible and Cost-Saving: A Modeling Study},

author = {Alec Aaron and Huaiyang Zhong and Lindsey Hiebert and Yueran Zhuo and Madeline Adee and Angela Paraschiv and Silvia Stratulat and John W Ward and Jagpreet Chhatwal},

doi = {10.1093/infdis/jiad138},

issn = {1537-6613},

year  = {2023},

date = {2023-09-01},

journal = {J Infect Dis},

volume = {228},

number = {Suppl 3},

pages = {S189--S197},

abstract = {BACKGROUND: Moldova, an upper-middle-income country in Eastern Europe, is facing a high burden of hepatitis C virus (HCV). Our objective was to assist the National Agency of Public Health of Moldova in planning to achieve the World Health Organization's HCV elimination goals by 2030.nnMETHODS: This study adapted a previously developed microsimulation model to simulate the HCV epidemic in Moldova from 2004 to 2050. Model outcomes included temporal trends in HCV infection, prevalence, mortality, and total cost of care, including screening and treatment. We evaluated scenarios that could eliminate HCV by 2030.nnRESULTS: Multiple strategies could lead to HCV elimination in Moldova by 2030. A realistic scenario of a 20% annual screening and 80% treatment rate would require 2.75 million individuals to be screened and 65 000 treated by 2030. Compared to 2015, this program will reduce HCV incidence by 98% and HCV-related deaths by 72% in 2030. Between 2022 and 2030, this strategy would cost $17.5 million for HCV screening and treatment. However, by 2050, the health system would save >$85 million compared to no investment in elimination efforts.nnCONCLUSIONS: HCV elimination in Moldova is feasible and can be cost saving, but requires resources to scale HCV screening and treatment.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37703336,

title = {Estimates of Hepatitis C Seroprevalence and Viremia in State Prison Populations in the United States},

author = {Anne C Spaulding and Shanika S Kennedy and Jeffery Osei and Ebrima Sidibeh and Isabella V Batina and Jagpreet Chhatwal and Matthew J Akiyama and Lara B Strick},

doi = {10.1093/infdis/jiad227},

issn = {1537-6613},

year  = {2023},

date = {2023-09-01},

journal = {J Infect Dis},

volume = {228},

number = {Suppl 3},

pages = {S160--S167},

abstract = {BACKGROUND: Prior studies demonstrate that eliminating hepatitis C virus (HCV) in the United States (US) heavily depends on treating incarcerated persons. Knowing the scope of the carceral HCV epidemic by state will help guide national elimination efforts.nnMETHODS: Between 2019 and 2023, all state prison systems received surveys requesting data on hepatitis C antibody and viremic prevalence. We supplemented survey information with publicly available HCV data to corroborate responses and fill in data gaps.nnRESULTS: Weighting HCV prevalence by state prison population size, we estimate that 15.2% of the US prison population is HCV seropositive and 8.7% is viremic; 54.9% of seropositive persons have detectable RNA. Applying prevalence estimates to the total prison population at year-end 2021, 91 090 persons with HCV infection resided in a state prison.nnCONCLUSIONS: With updated and more complete HCV data from all 50 states, HCV prevalence in state prisons is nearly 9-fold higher than the US general population. The heterogeneity in HCV prevalence by state prison system may reflect variable exposure before arrest and/or differences in treatment availability during incarceration. Elimination of HCV in the country depends on addressing the carceral epidemic, and one of the first steps is understanding the size of the problem.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37461007,

title = {A multimorbidity model for estimating health outcomes from the syndemic of injection drug use and associated infections in the United States},

author = {John J Chiosi and Peter P Mueller and Jagpreet Chhatwal and Andrea L Ciaranello},

doi = {10.1186/s12913-023-09773-1},

issn = {1472-6963},

year  = {2023},

date = {2023-07-01},

journal = {BMC Health Serv Res},

volume = {23},

number = {1},

pages = {760},

abstract = {BACKGROUND: Fatal drug overdoses and serious injection-related infections are rising in the US. Multiple concurrent infections in people who inject drugs (PWID) exacerbate poor health outcomes, but little is known about how the synergy among infections compounds clinical outcomes and costs. Injection drug use (IDU) converges multiple epidemics into a syndemic in the US, including opioid use and HIV. Estimated rates of new injection-related infections in the US are limited due to widely varying estimates of the number of PWID in the US, and in the absence of clinical trials and nationally representative longitudinal observational studies of PWID, simulation models provide important insights to policymakers for informed decisions.nnMETHODS: We developed and validated a MultimorbiditY model to Reduce Infections Associated with Drug use (MYRIAD). This microsimulation model of drug use and associated infections (HIV, hepatitis C virus [HCV], and severe bacterial infections) uses inputs derived from published data to estimate national level trends in the US. We used Latin hypercube sampling to calibrate model output against published data from 2015 to 2019 for fatal opioid overdose rates. We internally validated the model for HIV and HCV incidence and bacterial infection hospitalization rates among PWID. We identified best fitting parameter sets that met pre-established goodness-of-fit targets using the Pearson's chi-square test. We externally validated the model by comparing model output to published fatal opioid overdose rates from 2020.nnRESULTS: Out of 100 sample parameter sets for opioid use, the model produced 3 sets with well-fitting results to key calibration targets for fatal opioid overdose rates with Pearson's chi-square test ranging from 1.56E-5 to 2.65E-5, and 2 sets that met validation targets. The model produced well-fitting results within validation targets for HIV and HCV incidence and serious bacterial infection hospitalization rates. From 2015 to 2019, the model estimated 120,000 injection-related overdose deaths, 17,000 new HIV infections, and 144,000 new HCV infections among PWID.nnCONCLUSIONS: This multimorbidity microsimulation model, populated with data from national surveillance data and published literature, accurately replicated fatal opioid overdose, incidence of HIV and HCV, and serious bacterial infections hospitalization rates. The MYRIAD model of IDU could be an important tool to assess clinical and economic outcomes related to IDU behavior and infections with serious morbidity and mortality for PWID.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37204402,

title = {Effectiveness of HCC surveillance programs using multitarget blood test: A modeling study},

author = {Jagpreet Chhatwal and Sumeyye Samur and Ju Dong Yang and Lewis R Roberts and Mindie H Nguyen and A Burak Ozbay and Turgay Ayer and Neehar D Parikh and Amit G Singal},

doi = {10.1097/HC9.0000000000000146},

issn = {2471-254X},

year  = {2023},

date = {2023-06-01},

journal = {Hepatol Commun},

volume = {7},

number = {6},

abstract = {BACKGROUND: The effectiveness of ultrasound-based surveillance for HCC in patients with cirrhosis is limited by suboptimal sensitivity for early tumor detection and poor adherence. Emerging blood-based biomarkers have been proposed as an alternative surveillance strategy. We aimed to evaluate the comparative effectiveness of a multitarget HCC blood test (mt-HBT)-with and without improved adherence-against ultrasound-based HCC surveillance.nnMETHODS: We developed a Markov-based mathematical model that simulated a virtual trial in patients with compensated cirrhosis comparing potential surveillance strategies: biannual surveillance using ultrasound, ultrasound plus AFP, and mt-HBT with or without improved adherence (+10% increase). We used published data to inform underlying liver disease progression rates, HCC tumor growth patterns, performance characteristics of surveillance modalities, and efficacy of treatments. Primary outcomes of interest were the number of early-stage HCCs detected and life years gained.nnRESULTS: Per 100,000 patients with cirrhosis, mt-HBT detected 1680 more early-stage HCCs than ultrasound alone and 350 more early-stage HCCs than ultrasound + AFP, yielding an additional 5720 and 1000 life years, respectively. mt-HBT with improved adherence detected 2200 more early-stage HCCs than ultrasound and 880 more early-stage HCCs than ultrasound + AFP, yielding an additional 8140 and 3420 life years, respectively. The number of screening tests needed to detect one HCC case was 139 with ultrasound, 122 with ultrasound + AFP, 119 with mt-HBT, and 124 with mt-HBT with improved adherence.nnCONCLUSIONS: mt-HBT is a promising alternative to ultrasound-based HCC surveillance, particularly given anticipated improved adherence with blood-based biomarkers could increase HCC surveillance effectiveness.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37294571,

title = {Estimated Reductions in Opioid Overdose Deaths With Sustainment of Public Health Interventions in 4 US States},

author = {Jagpreet Chhatwal and Peter P Mueller and Qiushi Chen and Neeti Kulkarni and Madeline Adee and Gary Zarkin and Marc R LaRochelle and Amy B Knudsen and Carolina Barbosa},

doi = {10.1001/jamanetworkopen.2023.14925},

issn = {2574-3805},

year  = {2023},

date = {2023-06-01},

journal = {JAMA Netw Open},

volume = {6},

number = {6},

pages = {e2314925},

abstract = {IMPORTANCE: In 2021, more than 80 000 US residents died from an opioid overdose. Public health intervention initiatives, such as the Helping to End Addiction Long-term (HEALing) Communities Study (HCS), are being launched with the goal of reducing opioid-related overdose deaths (OODs).nnOBJECTIVE: To estimate the change in the projected number of OODs under different scenarios of the duration of sustainment of interventions, compared with the status quo.nnDESIGN, SETTING, AND PARTICIPANTS: This decision analytical model simulated the opioid epidemic in the 4 states participating in the HCS (ie, Kentucky, Massachusetts, New York, and Ohio) from 2020 to 2026. Participants were a simulated population transitioning from opioid misuse to opioid use disorder (OUD), overdose, treatment, and relapse. The model was calibrated using 2015 to 2020 data from the National Survey on Drug Use and Health, the US Centers for Disease Control and Prevention, and other sources for each state. The model accounts for reduced initiation of medications for OUD (MOUDs) and increased OODs during the COVID-19 pandemic.nnEXPOSURE: Increasing MOUD initiation by 2- or 5-fold, improving MOUD retention to the rates achieved in clinical trial settings, increasing naloxone distribution efforts, and furthering safe opioid prescribing. An initial 2-year duration of interventions was simulated, with potential sustainment for up to 3 additional years.nnMAIN OUTCOMES AND MEASURES: Projected reduction in number of OODs under different combinations and durations of sustainment of interventions.nnRESULTS: Compared with the status quo, the estimated annual reduction in OODs at the end of the second year of interventions was 13% to 17% in Kentucky, 17% to 27% in Massachusetts, 15% to 22% in New York, and 15% to 22% in Ohio. Sustaining all interventions for an additional 3 years was estimated to reduce the annual number of OODs at the end of the fifth year by 18% to 27% in Kentucky, 28% to 46% in Massachusetts, 22% to 34% in New York, and 25% to 41% in Ohio. The longer the interventions were sustained, the better the outcomes; however, these positive gains would be washed out if interventions were not sustained.nnCONCLUSIONS AND RELEVANCE: In this decision analytical model study of the opioid epidemic in 4 US states, sustained implementation of interventions, including increased delivery of MOUDs and naloxone supply, was found to be needed to reduce OODs and prevent deaths from increasing again.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36549175,

title = {Cervical cancer geographical burden analyzer: An interactive, open-access tool for understanding geographical disease burden in patients with recurrent or metastatic cervical cancer},

author = {Tara Castellano and Kathleen Moore and Jie Ting and Christina Washington and Yasin Yildiz and Andy Surinach and Kalyani Sonawane and Jagpreet Chhatwal and Turgay Ayer},

doi = {10.1016/j.ygyno.2022.12.004},

issn = {1095-6859},

year  = {2023},

date = {2023-02-01},

journal = {Gynecol Oncol},

volume = {169},

pages = {113--117},

abstract = {OBJECTIVE: Cervical cancer (CC) disproportionately affects women based on socioeconomic status and racial/ethnic background. There is limited research in quantifying and visualizing whether substantial geographical disparities in the US exist with respect to CC burden, and especially with respect to recurrent or metastatic CC (r/mCC) disease burden. Identifying regions with higher r/mCC burden may help inform effective healthcare resource allocation and navigating patients to appropriate care.nnMETHODS: We conducted a retrospective analysis of the 2015-2020 MarketScan® Commercial and Supplemental Medicare claims data; r/mCC burden was estimated as the number of patients initiating r/mCC systemic therapy over CC-diagnosed patients for each of the 410 metropolitan statistical areas (MSAs) considered. We developed a public, web-based tool, the Cervical Cancer Geographical Disease Burden Analyzer (Cervical Cancer Geo-Analyzer, http://www.geo-analyzer.org), that allows users to visualize r/mCC burden across MSAs over multiple years.nnRESULTS: There was considerable variation in r/mCC burden across MSAs, with a range of 0-83.3%. Burden increased in Boston-Cambridge-Newton, MA (r/mCC to CC ratio: 41% in 2018 to 50% in 2020), and Sacramento-Roseville-Arden-Arcade, CA (33% in 2018 to 50% in 2020). On the other hand, while r/mCC burden remained high, it decreased in Grand Rapids, MI (55% in 2018 to 31% in 2020) and San Francisco-Oakland-Hayward, CA (40% in 2018 to 26% in 2020). There were regions with sparse or no data, suggesting a need for more representative data capture.nnCONCLUSION: The Cervical Geo-Analyzer is a tool to visualize areas with high need for CC interventions. It also builds the foundation for further work to understand local risk factors of disease burden, identify populations of interest, characterize health disparities of CC or r/mCC and inform targeted interventions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36113098,

title = {Cost-Effectiveness and Value-of-Information Analysis Using Machine Learning-Based Metamodeling: A Case of Hepatitis C Treatment},

author = {John Austin McCandlish and Turgay Ayer and Jagpreet Chhatwal},

doi = {10.1177/0272989X221125418},

issn = {1552-681X},

year  = {2023},

date = {2023-01-01},

journal = {Med Decis Making},

volume = {43},

number = {1},

pages = {68--77},

abstract = {BACKGROUND: Metamodels can address some of the limitations of complex simulation models by formulating a mathematical relationship between input parameters and simulation model outcomes. Our objective was to develop and compare the performance of a machine learning (ML)-based metamodel against a conventional metamodeling approach in replicating the findings of a complex simulation model.nnMETHODS: We constructed 3 ML-based metamodels using random forest, support vector regression, and artificial neural networks and a linear regression-based metamodel from a previously validated microsimulation model of the natural history hepatitis C virus (HCV) consisting of 40 input parameters. Outcomes of interest included societal costs and quality-adjusted life-years (QALYs), the incremental cost-effectiveness (ICER) of HCV treatment versus no treatment, cost-effectiveness analysis curve (CEAC), and expected value of perfect information (EVPI). We evaluated metamodel performance using root mean squared error (RMSE) and Pearson's  on the normalized data.nnRESULTS: The  values for the linear regression metamodel for QALYs without treatment, QALYs with treatment, societal cost without treatment, societal cost with treatment, and ICER were 0.92, 0.98, 0.85, 0.92, and 0.60, respectively. The corresponding  values for our ML-based metamodels were 0.96, 0.97, 0.90, 0.95, and 0.49 for support vector regression; 0.99, 0.83, 0.99, 0.99, and 0.82 for artificial neural network; and 0.99, 0.99, 0.99, 0.99, and 0.98 for random forest. Similar trends were observed for RMSE. The CEAC and EVPI curves produced by the random forest metamodel matched the results of the simulation output more closely than the linear regression metamodel.nnCONCLUSIONS: ML-based metamodels generally outperformed traditional linear regression metamodels at replicating results from complex simulation models, with random forest metamodels performing best.nnHIGHLIGHTS: Decision-analytic models are frequently used by policy makers and other stakeholders to assess the impact of new medical technologies and interventions. However, complex models can impose limitations on conducting probabilistic sensitivity analysis and value-of-information analysis, and may not be suitable for developing online decision-support tools.Metamodels, which accurately formulate a mathematical relationship between input parameters and model outcomes, can replicate complex simulation models and address the above limitation.The machine learning-based random forest model can outperform linear regression in replicating the findings of a complex simulation model. Such a metamodel can be used for conducting cost-effectiveness and value-of-information analyses or developing online decision support tools.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36506039,

title = {Factors associated with receipt of second-line recurrent or metastatic cervical cancer treatment in the United States: A retrospective administrative claims analysis},

author = {Kalyani Sonawane and Tara Castellano and Christina Washington and Jie Ting and Andy Surinach and Carol Kirshner and Jagpreet Chhatwal and Turgay Ayer and Kathleen Moore},

doi = {10.1016/j.gore.2022.101101},

issn = {2352-5789},

year  = {2022},

date = {2022-12-01},

journal = {Gynecol Oncol Rep},

volume = {44},

number = {Suppl 1},

pages = {101101},

abstract = {PURPOSE: Contemporary, real-world data on eligible patients receiving treatment following progression on first-line (1L) recurrent or metastatic cervical cancer (r/mCC) therapy are needed to inform treatment algorithms and identify potential gaps in the r/mCC care continuum.nnMETHODS: This study estimated the prevalence and predictors of second-line (2L) r/mCC therapy among 1L-treated patients using the 2015-2020 IBM MarketScan® commercial claims database. Women ≥ 18 years diagnosed with cervical cancer and treated with first-line systemic therapies were identified and followed for 12 months from their 1L therapy end date. Women with claims for a new therapy after 60 days but no later than 365 days from the end of 1L treatment were identified as those who progressed and received 2L therapy for r/mCC. Descriptive statistics examined baseline cohort characteristics and multivariable logistic regression model examined the factors associated with receiving 2L treatment.nnRESULTS: We identified 384 1L-treated patients with r/mCC with ≥ 12 months of follow-up post-1L treatment. During follow-up, over half (51.0 %) of the 1L-treated r/mCC patients received 2L treatment. Patients from the South and Midwest had a lower likelihood of receiving 2L treatment compared with those living in the Northeast (adjusted odds ratio [aOR] = 0.43; 0.23-0.84) and (aOR = 0.52; 0.28-0.95, respectively). Patients not treated with bevacizumab in 1L were also less likely to receive 2L therapy (aOR = 0.65; 0.43-0.99).nnCONCLUSION: Additional research and targeted outreach efforts are needed to understand geography-, population-, or practice-specific barriers impacting access to 2L therapy among patients with r/mCC.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36589508,

title = {Factors associated with receipt of second-line recurrent or metastatic cervical cancer treatment in the United States: A retrospective administrative claims analysis},

author = {Kalyani Sonawane and Tara Castellano and Christina Washington and Jie Ting and Andy Surinach and Carol Kirshner and Jagpreet Chhatwal and Turgay Ayer and Kathleen Moore},

doi = {10.1016/j.gore.2022.101121},

issn = {2352-5789},

year  = {2022},

date = {2022-12-01},

journal = {Gynecol Oncol Rep},

volume = {44},

pages = {101121},

abstract = {PURPOSE: Contemporary, real-world data on eligible patients receiving treatment following progression on first-line (1L) recurrent or metastatic cervical cancer (r/mCC) therapy are needed to inform treatment algorithms and identify potential gaps in the r/mCC care continuum.nnMETHODS: This study estimated the prevalence and predictors of second-line (2L) r/mCC therapy among 1L-treated patients using the 2015-2020 IBM MarketScan® commercial claims database. Women ≥ 18 years diagnosed with cervical cancer and treated with first-line systemic therapies were identified and followed for 12 months from their 1L therapy end date. Women with claims for a new therapy after 60 days but no later than 365 days from the end of 1L treatment were identified as those who progressed and received 2L therapy for r/mCC. Descriptive statistics examined baseline cohort characteristics and multivariable logistic regression model examined the factors associated with receiving 2L treatment.nnRESULTS: We identified 384 1L-treated patients with r/mCC with ≥ 12 months of follow-up post-1L treatment. During follow-up, over half (51.0 %) of the 1L-treated r/mCC patients received 2L treatment. Patients from the South and Midwest had a lower likelihood of receiving 2L treatment compared with those living in the Northeast (adjusted odds ratio [aOR] = 0.43; 0.23-0.84) and (aOR = 0.52; 0.28-0.95, respectively). Patients not treated with bevacizumab in 1L were also less likely to receive 2L therapy (aOR = 0.65; 0.43-0.99).nnCONCLUSION: Additional research and targeted outreach efforts are needed to understand geography-, population-, or practice-specific barriers impacting access to 2L therapy among patients with r/mCC.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36327437,

title = {Longitudinal Associations of Risk Factors and Hepatocellular Carcinoma in Patients With Cured Hepatitis C Virus Infection},

author = {Jennifer R Kramer and Yumei Cao and Liang Li and Donna Smith and Jagpreet Chhatwal and Hashem B El-Serag and Fasiha Kanwal},

doi = {10.14309/ajg.0000000000001968},

issn = {1572-0241},

year  = {2022},

date = {2022-11-01},

journal = {Am J Gastroenterol},

volume = {117},

number = {11},

pages = {1834--1844},

abstract = {INTRODUCTION: There are limited data on the effect and evolution of risk factors for hepatocellular carcinoma (HCC) in patients with virologically cured hepatitis C virus (HCV) infection.nnMETHODS: We conducted a retrospective cohort study of patients with HCV who achieved sustained virological response with direct-acting antivirals from 130 Veterans Administration hospitals during 2014-2018, followed through 2021. Cox proportional hazards models were constructed at 3 landmark times (baseline and 12 and 24 months after sustained virological response) to examine associations between demographic, clinical, and behavioral factors and HCC risk, stratified by cirrhosis status.nnRESULTS: Among 92,567 patients (32% cirrhosis), 3,247 cases of HCC were diagnosed during a mean follow-up of 2.5 years. In patients with cirrhosis, male sex (hazard ratios [HR]: 1.89, 1.93, and 1.99), cirrhosis duration ≥5 years (HR: 1.71, 1.79, and 1.34), varices (HR: 1.73, 1.60, and 1.56), baseline albumin (HR: 0.48, 0.47, and 0.49), and change in albumin (HR: 0.82 and 0.90) predicted HCC risk at each landmark time. HCV genotype 3, previous treatment, bilirubin, smoking, and race influenced HCC risk at baseline, but their effects attenuated over time. In patients without cirrhosis, diabetes (HR: 1.54, 1.42, and 1.47) and hypertension (HR: 1.59, 1.65, and 1.74) were associated with HCC risk at all landmark times. Changes in fibrosis-4 scores over time were associated with HCC risk both in patients with and without cirrhosis.nnDISCUSSION: Risk factors for HCC were different in patients with and without cirrhosis and some also evolved during follow-up. These factors can help with risk stratification and HCC surveillance decisions in patients with cured HCV.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35945907,

title = {Comparison of a multitarget blood test to ultrasound and alpha-fetoprotein for hepatocellular carcinoma surveillance: Results of a network meta-analysis},

author = {Amit G Singal and Benjamin Haaland and Neehar D Parikh and A Burak Ozbay and Carol Kirshner and Shubham Chakankar and Kyle Porter and Jagpreet Chhatwal and Turgay Ayer},

doi = {10.1002/hep4.2045},

issn = {2471-254X},

year  = {2022},

date = {2022-10-01},

journal = {Hepatol Commun},

volume = {6},

number = {10},

pages = {2925--2936},

abstract = {Ultrasound-based surveillance has suboptimal sensitivity for early detection of hepatocellular carcinoma (HCC) in patients with cirrhosis. There are several emerging alternatives, including a novel multitarget HCC blood test (Mt-HBT). We compared performance of mt-HBT against ultrasound with or without alpha-fetoprotein (AFP) for early HCC detection in patients with cirrhosis. Per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, two reviewers searched PubMed, Cochrane, Embase, and clinicaltrials.gov databases from January 1990 through December 2020 to identify studies reporting sensitivity and/or specificity of ultrasound and AFP for overall and early stage HCC detection in patients with cirrhosis. Mt-HBT diagnostic performance was derived from a clinical validation study. A network meta-analysis model was built for comparative assessment, and pooled estimates of sensitivity at a fixed specificity were estimated based on Bayesian binormal receiver operating characteristic models for each modality. Forty-one studies (comprising 62,517 patients with cirrhosis) met inclusion criteria. Ultrasound-alone sensitivity was 51.6% (95% credible interval [CrI], 43.3%-60.5%) for early stage HCC detection, which increased with the addition of AFP to 74.1% (95% CrI, 62.6%-82.4%); however, this was offset by decreased specificity (87.9% vs. 83.9%, respectively). With specificity fixed at 90%, mt-HBT sensitivity for early stage HCC detection was higher than ultrasound alone (18.2%; 95% CrI, 0.2%-37.7%) and similar to ultrasound with AFP (-3.3%; 95% CrI, -22.3%-17.4%). Pairwise posterior probabilities suggested a preference for mt-HBT over ultrasound alone in 97.4% of cases but only 36.3% of cases versus ultrasound with AFP. Conclusion: A blood-based mt-HBT has higher sensitivity than ultrasound alone for early stage HCC detection but similar sensitivity compared to ultrasound and AFP. Mt-HBT could be a comparable alternative to existing methods for HCC surveillance in patients who are at risk.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36098969,

title = {Analysis of a Simulation Model to Estimate Long-term Outcomes in Patients with Nonalcoholic Fatty Liver Disease},

author = {Jagpreet Chhatwal and Ozden O Dalgic and Wanyi Chen and Sumeyye Samur and Emily D Bethea and Jade Xiao and Chin Hur and Kathleen E Corey and Rohit Loomba},

doi = {10.1001/jamanetworkopen.2022.30426},

issn = {2574-3805},

year  = {2022},

date = {2022-09-01},

journal = {JAMA Netw Open},

volume = {5},

number = {9},

pages = {e2230426},

abstract = {IMPORTANCE: Quantitative assessment of disease progression in patients with nonalcoholic fatty liver disease (NAFLD) has not been systematically examined using competing liver-related and non-liver-related mortality.nnOBJECTIVE: To estimate long-term outcomes in NAFLD, accounting for competing liver-related and non-liver-related mortality associated with the different fibrosis stages of NAFLD using a simulated patient population.nnDESIGN, SETTING, AND PARTICIPANTS: This decision analytical modeling study used individual-level state-transition simulation analysis and was conducted from September 1, 2017, to September 1, 2021. A publicly available interactive tool, dubbed NAFLD Simulator, was developed that simulates the natural history of NAFLD by age and fibrosis stage at the time of (hypothetical) diagnosis defined by liver biopsy. Model health states were defined by fibrosis states F0 to F4, decompensated cirrhosis, hepatocellular carcinoma (HCC), and liver transplant. Simulated patients could experience nonalcoholic steatohepatitis resolution, and their fibrosis stage could progress or regress. Transition probabilities between states were estimated from the literature as well as calibration, and the model reproduced the outcomes of a large observational study.nnEXPOSURE: Simulated natural history of NAFLD.nnMAIN OUTCOMES AND MEASURES: Main outcomes were life expectancy; all cause, liver-related, and non-liver-related mortality; and cumulative incidence of decompensated cirrhosis and/or HCC.nnRESULTS: The model included 1 000 000 simulated patients with a mean (range) age of 49 (18-75) years at baseline, including 66% women. The life expectancy of patients aged 49 years was 25.3 (95% CI, 20.1-29.8) years for those with F0, 25.1 (95% CI, 20.1-29.4) years for those with F1, 23.6 (95% CI, 18.3-28.2) years for those with F2, 21.1 (95% CI, 15.6-26.3) years for those with F3, and 13.8 (95% CI, 10.3-17.6) years for those with F4 at the time of diagnosis. The estimated 10-year liver-related mortality was 0.1% (95% uncertainty interval [UI], <0.1%-0.2%) in F0, 0.2% (95% UI, 0.1%-0.4%) in F1, 1.0% (95% UI, 0.6%-1.7%) in F2, 4.0% (95% UI, 2.5%-5.9%) in F3, and 29.3% (95% UI, 21.8%-35.9%) in F4. The corresponding 10-year non-liver-related mortality was 1.8% (95% UI, 0.6%-5.0%) in F0, 2.4% (95% UI, 0.8%-6.3%) in F1, 5.2% (95% UI, 2.0%-11.9%) in F2, 9.7% (95% UI, 4.3%-18.1%) in F3, and 15.6% (95% UI, 10.1%-21.7%) in F4. Among patients aged 65 years, estimated 10-year non-liver-related mortality was higher than liver-related mortality in all fibrosis stages (eg, F2: 16.7% vs 0.8%; F3: 28.8% vs 3.0%; F4: 40.8% vs 21.9%).nnCONCLUSIONS AND RELEVANCE: This decision analytic model study simulated stage-specific long-term outcomes, including liver- and non-liver-related mortality in patients with NAFLD. Depending on age and fibrosis stage, non-liver-related mortality was higher than liver-related mortality in patients with NAFLD. By translating surrogate markers into clinical outcomes, the NAFLD Simulator could be used as an educational tool among patients and clinicians to increase awareness of the health consequences of NAFLD.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35915104,

title = {The United States COVID-19 Forecast Hub dataset},

author = {Estee Y Cramer and Yuxin Huang and Yijin Wang and Evan L Ray and Matthew Cornell and Johannes Bracher and Andrea Brennen and Alvaro J Castro Rivadeneira and Aaron Gerding and Katie House and Dasuni Jayawardena and Abdul Hannan Kanji and Ayush Khandelwal and Khoa Le and Vidhi Mody and Vrushti Mody and Jarad Niemi and Ariane Stark and Apurv Shah and Nutcha Wattanchit and Martha W Zorn and Nicholas G Reich and },

doi = {10.1038/s41597-022-01517-w},

issn = {2052-4463},

year  = {2022},

date = {2022-08-01},

journal = {Sci Data},

volume = {9},

number = {1},

pages = {462},

abstract = {Academic researchers, government agencies, industry groups, and individuals have produced forecasts at an unprecedented scale during the COVID-19 pandemic. To leverage these forecasts, the United States Centers for Disease Control and Prevention (CDC) partnered with an academic research lab at the University of Massachusetts Amherst to create the US COVID-19 Forecast Hub. Launched in April 2020, the Forecast Hub is a dataset with point and probabilistic forecasts of incident cases, incident hospitalizations, incident deaths, and cumulative deaths due to COVID-19 at county, state, and national, levels in the United States. Included forecasts represent a variety of modeling approaches, data sources, and assumptions regarding the spread of COVID-19. The goal of this dataset is to establish a standardized and comparable set of short-term forecasts from modeling teams. These data can be used to develop ensemble models, communicate forecasts to the public, create visualizations, compare models, and inform policies regarding COVID-19 mitigation. These open-source data are available via download from GitHub, through an online API, and through R packages.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36003419,

title = {Cost-effectiveness of Screening for Atrial Fibrillation Using Wearable Devices},

author = {Wanyi Chen and Shaan Khurshid and Daniel E Singer and Steven J Atlas and Jeffrey M Ashburner and Patrick T Ellinor and David D McManus and Steven A Lubitz and Jagpreet Chhatwal},

doi = {10.1001/jamahealthforum.2022.2419},

issn = {2689-0186},

year  = {2022},

date = {2022-08-01},

journal = {JAMA Health Forum},

volume = {3},

number = {8},

pages = {e222419},

abstract = {IMPORTANCE: Undiagnosed atrial fibrillation (AF) is an important cause of stroke. Screening for AF using wrist-worn wearable devices may prevent strokes, but their cost-effectiveness is unknown.nnOBJECTIVE: To evaluate the cost-effectiveness of contemporary AF screening strategies, particularly wrist-worn wearable devices.nnDESIGN SETTING AND PARTICIPANTS: This economic evaluation used a microsimulation decision-analytic model and was conducted from September 8, 2020, to May 23, 2022, comprising 30 million simulated individuals with an age, sex, and comorbidity profile matching the US population aged 65 years or older.nnINTERVENTIONS: Eight AF screening strategies, with 6 using wrist-worn wearable devices (watch or band photoplethysmography, with or without watch or band electrocardiography) and 2 using traditional modalities (ie, pulse palpation and 12-lead electrocardiogram) vs no screening.nnMAIN OUTCOMES AND MEASURES: The primary outcome was the incremental cost-effectiveness ratio, defined as US dollars per quality-adjusted life-year (QALY). Secondary measures included rates of stroke and major bleeding.nnRESULTS: In the base case analysis of this model, the mean (SD) age was 72.5 (7.5) years, and 50% of the individuals were women. All 6 screening strategies using wrist-worn wearable devices were estimated to be more effective than no screening (range of QALYs gained vs no screening, 226-957 per 100 000 individuals) and were associated with greater relative benefit than screening using traditional modalities (range of QALYs gained vs no screening, -116 to 93 per 100 000 individuals). Compared with no screening, screening using wrist-worn wearable devices was associated with a reduction in stroke incidence by 20 to 23 per 100 000 person-years but an increase in major bleeding by 20 to 44 per 100 000 person-years. The overall preferred strategy was wearable photoplethysmography, followed conditionally by wearable electrocardiography with patch monitor confirmation, which had an incremental cost-effectiveness ratio of $57 894 per QALY, meeting the acceptability threshold of $100 000 per QALY. The cost-effectiveness of screening was consistent across multiple scenarios, including strata of sex, screening at earlier ages (eg, ≥50 years), and with variation in the association of anticoagulation with risk of stroke in the setting of screening-detected AF.nnCONCLUSIONS AND RELEVANCE: This economic evaluation of AF screening using a microsimulation decision-analytic model suggests that screening using wearable devices is cost-effective compared with either no screening or AF screening using traditional methods.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35272954,

title = {Cost-Effectiveness of a Core Antigen-Based Rapid Diagnostic Test for Hepatitis C},

author = {Madeline Adee and Huaiyang Zhong and Elena Ivanova Reipold and Yueran Zhuo and Sonjelle Shilton and Jagpreet Chhatwal},

doi = {10.1016/j.jval.2022.01.004},

issn = {1524-4733},

year  = {2022},

date = {2022-07-01},

journal = {Value Health},

volume = {25},

number = {7},

pages = {1107--1115},

abstract = {OBJECTIVES: Hepatitis C virus (HCV) affects 58 million worldwide and > 79% of people remain undiagnosed. Rapid diagnostic tests (RDTs) for HCV can help improve diagnosis and treatment rates. Nevertheless, the high price and infrastructure needed to use current molecular HCV RDT options present a barrier to widespread use-particularly in low- and middle-income countries. We evaluated the performance and cost-effectiveness of a theoretical core antigen (cAg) RDT for HCV viremia confirmation, which requires fewer resources.nnMETHODS: We adapted a previously validated microsimulation model to simulate HCV disease progression and outcomes under different HCV testing algorithms in Georgia and Malaysia. We compared standard of care testing with laboratory-based ribonucleic acid HCV to a cAg-based RDT for HCV confirmation. We simulated a cohort of 10 000 adults in each country, with an HCV-ribonucleic acid prevalence of 5.40% in Georgia and 1.54% in Malaysia. We projected the cumulative healthcare costs, quality-adjusted life-years, and diagnosis coverage rates over a lifetime horizon.nnRESULTS: Compared with the standard of care testing, the cAg-based RDT would increase quality-adjusted life-years by 270 in Georgia and 259 in Malaysia per 10 000 people. The high diagnosis rate and treatment rate of the cAg-based RDT result in substantial cost savings because of averted HCV sequelae management costs. Cost savings are $281 000 for Georgia and $781 000 for Malaysia.nnCONCLUSIONS: We found that a cAg-based RDT for HCV could improve the diagnosis rate and result in cost savings. Such a test could have a substantial impact on the feasibility and cost of HCV elimination.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35157959,

title = {Duration and cost-effectiveness of hepatocellular carcinoma surveillance in hepatitis C patients after viral eradication},

author = {Peter P Mueller and Qiushi Chen and Turgay Ayer and Gizem S Nemutlu and Ali Hajjar and Emily D Bethea and Mary Linton B Peters and Brian P Lee and Naveed Z Janjua and Fasiha Kanwal and Jagpreet Chhatwal},

doi = {10.1016/j.jhep.2022.01.027},

issn = {1600-0641},

year  = {2022},

date = {2022-07-01},

journal = {J Hepatol},

volume = {77},

number = {1},

pages = {55--62},

abstract = {BACKGROUND & AIMS: Successful treatment of chronic hepatitis C with oral direct-acting antivirals (DAAs) leads to virological cure, however, the subsequent risk of hepatocellular carcinoma (HCC) persists. Our objective was to evaluate the cost-effectiveness of biannual surveillance for HCC in patients cured of hepatitis C and the optimal age to stop surveillance.nnMETHODS: We developed a microsimulation model of the natural history of HCC in individuals with hepatitis C and advanced fibrosis or cirrhosis who achieved virological cure with oral DAAs. We used published data on HCC incidence, tumor progression, real-world HCC surveillance adherence, and costs and utilities of different health states. We compared biannual HCC surveillance using ultrasound and alpha-fetoprotein for varying durations of surveillance (from 5 years to lifetime) vs. no surveillance.nnRESULTS: In virologically cured patients with cirrhosis, the incremental cost-effectiveness ratio (ICER) of biannual surveillance remained below $150,000 per additional quality-adjusted life year (QALY) (range: $79,500-$94,800) when surveillance was stopped at age 70, irrespective of the starting age (40-65). Compared with no surveillance, surveillance detected 130 additional HCCs in 'very early'/early stage and yielded 51 additional QALYs per 1,000 patients with cirrhosis. In virologically cured patients with advanced fibrosis, the ICER of biannual surveillance remained below $150,000/QALY (range: $124,600-$129,800) when surveillance was stopped at age 60, irrespective of the starting age (40-50). Compared with no surveillance, surveillance detected 24 additional HCCs in 'very early'/early stage and yielded 12 additional QALYs per 1,000 patients with advanced fibrosis.nnCONCLUSION: Biannual surveillance for HCC in patients cured of hepatitis C is cost-effective until the age of 70 for patients with cirrhosis, and until the age of 60 for patients with stable advanced fibrosis.nnLAY SUMMARY: Individuals who are cured of hepatitis C using oral antiviral drugs remain at risk of developing liver cancer. The value of lifelong screening for liver cancer in these individuals is not known. By simulating the life course of hepatitis C cured individuals, we found that ultrasound-based biannual screening for liver cancer is cost-effective up to age 70 in those with cirrhosis and up to age 60 in those with stable advanced fibrosis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34878683,

title = {Effect of increased alcohol consumption during COVID-19 pandemic on alcohol-associated liver disease: A modeling study},

author = {Jovan Julien and Turgay Ayer and Elliot B Tapper and Carolina Barbosa and William N Dowd and Jagpreet Chhatwal},

doi = {10.1002/hep.32272},

issn = {1527-3350},

year  = {2022},

date = {2022-06-01},

journal = {Hepatology},

volume = {75},

number = {6},

pages = {1480--1490},

abstract = {BACKGROUND AND AIMS: Alcohol consumption increased during the COVID-19 pandemic in 2020 in the United States. We projected the effect of increased alcohol consumption on alcohol-associated liver disease (ALD) and mortality.nnAPPROACH AND RESULTS: We extended a previously validated microsimulation model that estimated the short- and long-term effect of increased drinking during the COVID-19 pandemic in individuals in the United States born between 1920 and 2012. We modeled short- and long-term outcomes of current drinking patterns during COVID-19 (status quo) using survey data of changes in alcohol consumption in a nationally representative sample between February and November 2020. We compared these outcomes with a counterfactual scenario wherein no COVID-19 occurs and drinking patterns do not change. One-year increase in alcohol consumption during the COVID-19 pandemic is estimated to result in 8000 (95% uncertainty interval [UI], 7500-8600) additional ALD-related deaths, 18,700 (95% UI, 17,600-19,900) cases of decompensated cirrhosis, and 1000 (95% UI, 1000-1100) cases of HCC, and 8.9 million disability-adjusted life years between 2020 and 2040. Between 2020 and 2023, alcohol consumption changes due to COVID-19 will lead to 100 (100-200) additional deaths and 2800 (2700-2900) additional decompensated cirrhosis cases. A sustained increase in alcohol consumption for more than 1 year could result in additional morbidity and mortality.nnCONCLUSIONS: A short-term increase in alcohol consumption during the COVID-19 pandemic can substantially increase long-term ALD-related morbidity and mortality. Our findings highlight the need for individuals and policymakers to make informed decisions to mitigate the impact of high-risk alcohol drinking in the United States.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35977324,

title = {Projecting COVID-19 Mortality as States Relax Nonpharmacologic Interventions},

author = {Benjamin P Linas and Jade Xiao and Ozden O Dalgic and Peter P Mueller and Madeline Adee and Alec Aaron and Turgay Ayer and Jagpreet Chhatwal},

doi = {10.1001/jamahealthforum.2022.0760},

issn = {2689-0186},

year  = {2022},

date = {2022-04-01},

journal = {JAMA Health Forum},

volume = {3},

number = {4},

pages = {e220760},

abstract = {IMPORTANCE: A key question for policy makers and the public is what to expect from the COVID-19 pandemic going forward as states lift nonpharmacologic interventions (NPIs), such as indoor mask mandates, to prevent COVID-19 transmission.nnOBJECTIVE: To project COVID-19 deaths between March 1, 2022, and December 31, 2022, in each of the 50 US states, District of Columbia, and Puerto Rico assuming different dates of lifting of mask mandates and NPIs.nnDESIGN SETTING AND PARTICIPANTS: This simulation modeling study used the COVID-19 Policy Simulator compartmental model to project COVID-19 deaths from March 1, 2022, to December 31, 2022, using simulated populations in the 50 US states, District of Columbia, and Puerto Rico. Projected current epidemiologic trends for each state until December 31, 2022, assuming the current pace of vaccination is maintained into the future and modeling different dates of lifting NPIs.nnEXPOSURES: Date of lifting statewide NPI mandates as March 1, April 1, May 1, June 1, or July 1, 2022.nnMAIN OUTCOMES AND MEASURES: Projected COVID-19 incident deaths from March to December 2022.nnRESULTS: With the high transmissibility of current circulating SARS-CoV-2 variants, the simulated lifting of NPIs in March 2022 was associated with resurgences of COVID-19 deaths in nearly every state. In comparison, delaying by even 1 month to lift NPIs in April 2022 was estimated to mitigate the amplitude of the surge. For most states, however, no amount of delay was estimated to be sufficient to prevent a surge in deaths completely. The primary factor associated with recurrent epidemics in the simulation was the assumed high effective reproduction number of unmitigated viral transmission. With a lower level of transmissibility similar to those of the ancestral strains, the model estimated that most states could remove NPIs in March 2022 and likely not see recurrent surges.nnCONCLUSIONS AND RELEVANCE: This simulation study estimated that the SARS-CoV-2 virus would likely continue to take a major toll in the US, even as cases continued to decrease. Because of the high transmissibility of the recent Delta and Omicron variants, premature lifting of NPIs could pose a substantial threat of rebounding surges in morbidity and mortality. At the same time, continued delay in lifting NPIs may not prevent future surges.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34927126,

title = {Long-term impact of HPV vaccination and COVID-19 pandemic on oropharyngeal cancer incidence and burden among men in the USA: A modeling study},

author = {Haluk Damgacioglu and Kalyani Sonawane and Jagpreet Chhatwal and David R Lairson and Gary M Clifford and Anna R Giuliano and Ashish A Deshmukh},

doi = {10.1016/j.lana.2021.100143},

issn = {2667-193X},

year  = {2022},

date = {2022-04-01},

journal = {Lancet Reg Health Am},

volume = {8},

pages = {100143},

abstract = {BACKGROUND: Oropharyngeal cancer (OPC) incidence is rising rapidly among men in the United States of America (USA). We aimed to project the impact of maintaining the current HPV vaccination uptake and achieving 80% national (Healthy People) goal on OPC incidence and burden.nnMETHODS: We developed an open-cohort micro-simulation model of OPC natural history among contemporary and future birth cohorts of men, accounting for sexual behaviors, population growth, aging, and herd immunity. We used data from nationally representative databases, cancer registries from all 50 states, large clinical trials, and literature. We evaluated the status quo scenario (the current HPV vaccination uptake remained stable) and alternative scenarios of improvements in uptake rates in adolescents (aged 9-17 years) and young adults (aged 18-26 years) by 2025 to achieve and maintain the 80% goal. The primary outcome was to project OPC incidence and burden from 2009 to 2100. We also assessed the impact of disruption in HPV vaccine uptake during the COVID-19 pandemic.nnFINDINGS: OPC incidence is projected to rise until the mid-2030s, reaching the age-standardized incidence rate of 9·8 (95% uncertainty interval [UI] 9·5-10·1) per 100 000 men, with the peak annual burden of 23 850 (UI, 23 200-24 500) cases. Under the status quo scenario, HPV vaccination could prevent 124 000 (UI, 117 000-131 000) by 2060, 400 000 (UI, 384 000-416 000) by 2080, and 792 000 (UI, 763 000-821 000) by 2100 OPC cases among men. Achievement and maintenance of 80% coverage among adolescent girls only, adolescent girls and boys, and adolescents plus young adults could prevent an additional number of 100 000 (UI, 95 000-105 000), 118 000 (UI, 113 000-123 000), and 142 000 (UI, 136 000-148 000) male OPC cases by 2100. Delayed recovery of the HPV vaccine uptake during the COVID-19 pandemic could lead to 600 (UI, 580-620) to 6200 (UI, 5940-6460) additional male OPC cases by 2100, conditional on the decline in the extent of the national HPV vaccination coverage and potential delay in rebounding.nnINTERPRETATION: Oropharyngeal cancer burden is projected to rise among men in the USA. Nationwide efforts to achieve the HPV vaccination goal of 80% coverage should be a public health priority. Rapid recovery of the declined HPV vaccination uptake during the COVID-19 pandemic is also crucial to prevent future excess OPC burden.nnFUNDING: National Cancer Institute and National Institute on Minority Health and Health Disparities of the USA.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34817928,

title = {Feasibility, effectiveness and cost of a decentralized HCV care model among the general population in Delhi, India},

author = {Jessica Markby and Ekta Gupta and Divya Soni and Sanjay Sarin and Mugil Murya and Preetishirin Katapur and Navneet Tewatia and Babu Entoor Ramachandran and Ryan Jose Ruiz and Mary Gaeddert and Alexander Tyshkovskiy and Madeline Adee and Jagpreet Chhatwal and Sundeep Miglani and Philippa Easterbrook and Shiv K Sarin and Sonjelle Shilton},

doi = {10.1111/liv.15112},

issn = {1478-3231},

year  = {2022},

date = {2022-03-01},

journal = {Liver Int},

volume = {42},

number = {3},

pages = {532--540},

abstract = {BACKGROUND AND AIMS: India has a significant burden of hepatitis C virus (HCV) infection and has committed to achieving national elimination by 2030. This will require a substantial scale-up in testing and treatment. The "HEAD-Start Project Delhi" aimed to enhance HCV diagnosis and treatment pathways among the general population.nnMETHODS: A prospective study was conducted at 5 district hospitals (Arm 1: one-stop shop), 15 polyclinics (Arm 2: referral for viral load (VL) testing and treatment) and 62 screening camps (Arm 3: referral for treatment). HCV prevalence, retention in the HCV care cascade, and turn-around time were measured.nnRESULTS: Between January and September 2019, 37 425 participants were screened for HCV. The median (IQR) age of participants was 35 (26-48) years, with 50.4% male and 49.6% female. A significantly higher proportion of participants in Arm 1 (93.7%) and Arm 3 (90.3%) received a VL test compared with Arm 2 (52.5%, P < .001). Of those confirmed positive, treatment was initiated at significantly higher rates for participants in both Arms 1 (85.6%) and 2 (73.7%) compared to Arm 3 (41.8%, P < .001). Arm 1 was found to be a cost-saving strategy compared to Arm 2, Arm 3, and no action.nnCONCLUSIONS: Delivery of all services at a single site (district hospitals) resulted in a higher yield of HCV seropositive cases and retention compared with sites where participants were referred elsewhere for VL testing and/or treatment. The highest level of retention in the care cascade was also associated with the shortest turn-around times.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34952885,

title = {Assessing the impact of simplified HCV care on linkage to care amongst high-risk patients at primary healthcare clinics in Malaysia: a prospective observational study},

author = {Jessica Markby and Sonjelle Shilton and Xiaohui Sem and Huan Keat Chan and Rosaida Md Said and Sasikala Siva and Zalwani Zainuddin and Norasiah Abu Bakar and Haniza Omar and Ryan Jose Iii Ruiz and Mary Gaeddert and Alexander Tyshkovskiy and Madeline Adee and Jagpreet Chhatwal and Suresh Kumar and Jean-Michel Piedagnel and Rozainanee Mohd Zain and Caroline Menétrey and Fazidah Yuswan and Nazrila Hairizan Nasir and Isabelle Andrieux-Meyer and Fatanah Ismail and Rozita Zakaria and Ruziaton Hasim and Shahnaz Murad and Philippa Easterbrook and Muhammad Radzi Abu Hassan},

doi = {10.1136/bmjopen-2021-055142},

issn = {2044-6055},

year  = {2021},

date = {2021-12-01},

journal = {BMJ Open},

volume = {11},

number = {12},

pages = {e055142},

abstract = {INTRODUCTION: To achieve the elimination of hepatitis C virus (HCV), substantial scale-up in access to testing and treatment is needed. This will require innovation and simplification of the care pathway, through decentralisation of testing and treatment to primary care settings and task-shifting to non-specialists. The objective of this study was to evaluate the feasibility and effectiveness of decentralisation of HCV testing and treatment using rapid diagnostic tests (RDTs) in primary healthcare clinics (PHCs) among high-risk populations, with referral of seropositive patients for confirmatory viral load testing and treatment.nnMETHODS: This observational study was conducted between December 2018 and October 2019 at 25 PHCs in three regions in Malaysia. Each PHC was linked to one or more hospitals, for referral of seropositive participants for confirmatory testing and pretreatment evaluation. Treatment was provided in PHCs for non-cirrhotic patients and at hospitals for cirrhotic patients.nnRESULTS: During the study period, a total of 15 366 adults were screened at the 25 PHCs, using RDTs for HCV antibodies. Of the 2020 (13.2%) HCV antibody-positive participants, 1481/2020 (73.3%) had a confirmatory viral load test, 1241/1481 (83.8%) were HCV RNA-positive, 991/1241 (79.9%) completed pretreatment assessment, 632/991 (63.8%) initiated treatment, 518/632 (82.0%) completed treatment, 352/518 (68.0%) were eligible for a sustained virological response (SVR) cure assessment, 209/352 (59.4%) had an SVR cure assessment, and SVR was achieved in 202/209 (96.7%) patients. A significantly higher proportion of patients referred to PHCs initiated treatment compared with those who had treatment initiated at hospitals (71.0% vs 48.8%, p<0.001).nnCONCLUSIONS: This study demonstrated the effectiveness and feasibility of a simplified decentralised HCV testing and treatment model in primary healthcare settings, targeting high-risk groups in Malaysia. There were good outcomes across most steps of the cascade of care when treatment was provided at PHCs compared with hospitals.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34725356,

title = {Assessing cost-effectiveness of hepatitis C testing pathways in Georgia using the Hep C Testing Calculator},

author = {Madeline Adee and Yueran Zhuo and Huaiyang Zhong and Tiannan Zhan and Rakesh Aggarwal and Sonjelle Shilton and Jagpreet Chhatwal},

doi = {10.1038/s41598-021-00362-y},

issn = {2045-2322},

year  = {2021},

date = {2021-11-01},

journal = {Sci Rep},

volume = {11},

number = {1},

pages = {21382},

abstract = {The cost of testing can be a substantial contributor to hepatitis C virus (HCV) elimination program costs in many low- and middle-income countries such as Georgia, resulting in the need for innovative and cost-effective strategies for testing. Our objective was to investigate the most cost-effective testing pathways for scaling-up HCV testing in Georgia. We developed a Markov-based model with a lifetime horizon that simulates the natural history of HCV, and the cost of detection and treatment of HCV. We then created an interactive online tool that uses results from the Markov-based model to evaluate the cost-effectiveness of different HCV testing pathways. We compared the current standard-of-care (SoC) testing pathway and four innovative testing pathways for Georgia. The SoC testing was cost-saving compared to no testing, but all four new HCV testing pathways further increased QALYs and decreased costs. The pathway with the highest patient follow-up, due to on-site testing, resulted in the highest discounted QALYs (123 QALY more than the SoC) and lowest costs ($127,052 less than the SoC) per 10,000 persons screened. The current testing algorithm in Georgia can be replaced with a new pathway that is more effective while being cost-saving.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}