2021
Khurshid, Shaan; Chen, Wanyi; Singer, Daniel E; Atlas, Steven J; Ashburner, Jeffrey M; Choi, Jin G; Hur, Chin; Ellinor, Patrick T; McManus, David D; Chhatwal, Jagpreet; Lubitz, Steven A
Comparative Clinical Effectiveness of Population-Based Atrial Fibrillation Screening Using Contemporary Modalities: A Decision-Analytic Model Journal Article
In: J Am Heart Assoc, vol. 10, no. 18, pp. e020330, 2021, ISSN: 2047-9980.
@article{pmid34476979,
title = {Comparative Clinical Effectiveness of Population-Based Atrial Fibrillation Screening Using Contemporary Modalities: A Decision-Analytic Model},
author = {Shaan Khurshid and Wanyi Chen and Daniel E Singer and Steven J Atlas and Jeffrey M Ashburner and Jin G Choi and Chin Hur and Patrick T Ellinor and David D McManus and Jagpreet Chhatwal and Steven A Lubitz},
doi = {10.1161/JAHA.120.020330},
issn = {2047-9980},
year = {2021},
date = {2021-09-01},
journal = {J Am Heart Assoc},
volume = {10},
number = {18},
pages = {e020330},
abstract = {Background Atrial fibrillation (AF) screening is endorsed by certain guidelines for individuals aged ≥65 years. Yet many AF screening strategies exist, including the use of wrist-worn wearable devices, and their comparative effectiveness is not well-understood. Methods and Results We developed a decision-analytic model simulating 50 million individuals with an age, sex, and comorbidity profile matching the United States population aged ≥65 years (ie, with a guideline-based AF screening indication). We modeled no screening, in addition to 45 distinct AF screening strategies (comprising different modalities and screening intervals), each initiated at a clinical encounter. The primary effectiveness measure was quality-adjusted life-years, with incident stroke and major bleeding as secondary measures. We defined continuous or nearly continuous modalities as those capable of monitoring beyond a single time-point (eg, patch monitor), and discrete modalities as those capable of only instantaneous AF detection (eg, 12-lead ECG). In total, 10 AF screening strategies were effective compared with no screening (300-1500 quality-adjusted life-years gained/100 000 individuals screened). Nine (90%) effective strategies involved use of a continuous or nearly continuous modality such as patch monitor or wrist-worn wearable device, whereas 1 (10%) relied on discrete modalities alone. Effective strategies reduced stroke incidence (number needed to screen to prevent a stroke: 3087-4445) but increased major bleeding (number needed to screen to cause a major bleed: 1815-4049) and intracranial hemorrhage (number needed to screen to cause intracranial hemorrhage: 7693-16 950). The test specificity was a highly influential model parameter on screening effectiveness. Conclusions When modeled from a clinician-directed perspective, the comparative effectiveness of population-based AF screening varies substantially upon the specific strategy used. Future screening interventions and guidelines should consider the relative effectiveness of specific AF screening strategies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background Atrial fibrillation (AF) screening is endorsed by certain guidelines for individuals aged ≥65 years. Yet many AF screening strategies exist, including the use of wrist-worn wearable devices, and their comparative effectiveness is not well-understood. Methods and Results We developed a decision-analytic model simulating 50 million individuals with an age, sex, and comorbidity profile matching the United States population aged ≥65 years (ie, with a guideline-based AF screening indication). We modeled no screening, in addition to 45 distinct AF screening strategies (comprising different modalities and screening intervals), each initiated at a clinical encounter. The primary effectiveness measure was quality-adjusted life-years, with incident stroke and major bleeding as secondary measures. We defined continuous or nearly continuous modalities as those capable of monitoring beyond a single time-point (eg, patch monitor), and discrete modalities as those capable of only instantaneous AF detection (eg, 12-lead ECG). In total, 10 AF screening strategies were effective compared with no screening (300-1500 quality-adjusted life-years gained/100 000 individuals screened). Nine (90%) effective strategies involved use of a continuous or nearly continuous modality such as patch monitor or wrist-worn wearable device, whereas 1 (10%) relied on discrete modalities alone. Effective strategies reduced stroke incidence (number needed to screen to prevent a stroke: 3087-4445) but increased major bleeding (number needed to screen to cause a major bleed: 1815-4049) and intracranial hemorrhage (number needed to screen to cause intracranial hemorrhage: 7693-16 950). The test specificity was a highly influential model parameter on screening effectiveness. Conclusions When modeled from a clinician-directed perspective, the comparative effectiveness of population-based AF screening varies substantially upon the specific strategy used. Future screening interventions and guidelines should consider the relative effectiveness of specific AF screening strategies.
Khurshid, Shaan; Chen, Wanyi; Bode, Weeranun D; Wasfy, Jason H; Chhatwal, Jagpreet; Lubitz, Steven A
Comparative Effectiveness of Implantable Defibrillators for Asymptomatic Brugada Syndrome: A Decision-Analytic Model Journal Article
In: J Am Heart Assoc, vol. 10, no. 16, pp. e021144, 2021, ISSN: 2047-9980.
@article{pmid34387130,
title = {Comparative Effectiveness of Implantable Defibrillators for Asymptomatic Brugada Syndrome: A Decision-Analytic Model},
author = {Shaan Khurshid and Wanyi Chen and Weeranun D Bode and Jason H Wasfy and Jagpreet Chhatwal and Steven A Lubitz},
doi = {10.1161/JAHA.121.021144},
issn = {2047-9980},
year = {2021},
date = {2021-08-01},
journal = {J Am Heart Assoc},
volume = {10},
number = {16},
pages = {e021144},
abstract = {Background Optimal management of asymptomatic Brugada syndrome (BrS) with spontaneous type I electrocardiographic pattern is uncertain. Methods and Results We developed an individual-level simulation comprising 2 000 000 average-risk individuals with asymptomatic BrS and spontaneous type I electrocardiographic pattern. We compared (1) observation, (2) electrophysiologic study (EPS)-guided implantable cardioverter-defibrillator (ICD), and (3) upfront ICD, each using either subcutaneous or transvenous ICD, resulting in 6 strategies tested. The primary outcome was quality-adjusted life years (QALYs), with cardiac deaths (arrest or procedural-related) as a secondary outcome. We varied BrS diagnosis age and underlying arrest rate. We assessed cost-effectiveness at $100 000/QALY. Compared with observation, EPS-guided subcutaneous ICD resulted in 0.35 QALY gain/individual and 4130 cardiac deaths avoided/100 000 individuals, and EPS-guided transvenous ICD resulted in 0.26 QALY gain and 3390 cardiac deaths avoided. Compared with observation, upfront ICD reduced cardiac deaths by a greater margin (subcutaneous ICD, 8950; transvenous ICD, 6050), but only subcutaneous ICD improved QALYs (subcutaneous ICD, 0.25 QALY gain; transvenous ICD, 0.01 QALY loss), and complications were higher. ICD-based strategies were more effective at younger ages and higher arrest rates (eg, using subcutaneous devices, upfront ICD was the most effective strategy at ages 20-39.4 years and arrest rates >1.37%/year; EPS-guided ICD was the most effective strategy at ages 39.5-51.3 years and arrest rates 0.47%-1.37%/year, and observation was the most effective strategy at ages >51.3 years and arrest rates <0.47%/year). EPS-guided subcutaneous ICD was cost-effective ($80 508/QALY). Conclusions Device-based approaches (with or without EPS risk stratification) can be more effective than observation among selected patients with asymptomatic BrS. BrS management should be tailored to patient characteristics.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background Optimal management of asymptomatic Brugada syndrome (BrS) with spontaneous type I electrocardiographic pattern is uncertain. Methods and Results We developed an individual-level simulation comprising 2 000 000 average-risk individuals with asymptomatic BrS and spontaneous type I electrocardiographic pattern. We compared (1) observation, (2) electrophysiologic study (EPS)-guided implantable cardioverter-defibrillator (ICD), and (3) upfront ICD, each using either subcutaneous or transvenous ICD, resulting in 6 strategies tested. The primary outcome was quality-adjusted life years (QALYs), with cardiac deaths (arrest or procedural-related) as a secondary outcome. We varied BrS diagnosis age and underlying arrest rate. We assessed cost-effectiveness at $100 000/QALY. Compared with observation, EPS-guided subcutaneous ICD resulted in 0.35 QALY gain/individual and 4130 cardiac deaths avoided/100 000 individuals, and EPS-guided transvenous ICD resulted in 0.26 QALY gain and 3390 cardiac deaths avoided. Compared with observation, upfront ICD reduced cardiac deaths by a greater margin (subcutaneous ICD, 8950; transvenous ICD, 6050), but only subcutaneous ICD improved QALYs (subcutaneous ICD, 0.25 QALY gain; transvenous ICD, 0.01 QALY loss), and complications were higher. ICD-based strategies were more effective at younger ages and higher arrest rates (eg, using subcutaneous devices, upfront ICD was the most effective strategy at ages 20-39.4 years and arrest rates >1.37%/year; EPS-guided ICD was the most effective strategy at ages 39.5-51.3 years and arrest rates 0.47%-1.37%/year, and observation was the most effective strategy at ages >51.3 years and arrest rates <0.47%/year). EPS-guided subcutaneous ICD was cost-effective ($80 508/QALY). Conclusions Device-based approaches (with or without EPS risk stratification) can be more effective than observation among selected patients with asymptomatic BrS. BrS management should be tailored to patient characteristics.
Toumi, Asmae; Zhao, Haoruo; Chhatwal, Jagpreet; Linas, Benjamin P; Ayer, Turgay
In: JAMA Netw Open, vol. 4, no. 8, pp. e2119621, 2021, ISSN: 2574-3805.
@article{pmid34402891,
title = {Association of Limited In-Person Attendance in US National Football League and National Collegiate Athletic Association Games With County-Level COVID-19 Cases},
author = {Asmae Toumi and Haoruo Zhao and Jagpreet Chhatwal and Benjamin P Linas and Turgay Ayer},
doi = {10.1001/jamanetworkopen.2021.19621},
issn = {2574-3805},
year = {2021},
date = {2021-08-01},
journal = {JAMA Netw Open},
volume = {4},
number = {8},
pages = {e2119621},
abstract = {IMPORTANCE: In 2020 and early 2021, the National Football League (NFL) and National Collegiate Athletic Association (NCAA) opted to host football games in stadiums across the country. The in-person attendance of games varied with time and from county to county. There is currently no evidence on whether limited in-person attendance of games is associated with COVID-19 case numbers on a county-level.nnOBJECTIVE: To assess whether NFL and NCAA football games with limited in-person attendance were associated with increased COVID-19 cases in the counties they were held compared with a matched set of counties.nnDESIGN, SETTING, AND PARTICIPANTS: In this time-series cross-sectional study, every county hosting NFL or NCAA games with in-person attendance (treated group) in 2020 and 2021 was matched with a county that that did not host a game on the corresponding day but had an identical game history for up to 14 days prior (control group). A standard matching method was used to further refine this matched set so that the treated and matched control counties had similar population size, nonpharmaceutical interventions in place, and COVID-19 trends. The association of hosting games with in-person attendance with COVID-19 cases was assessed using a difference-in-difference estimator. Data were analyzed from August 29 to December 28, 2020.nnEXPOSURES: Hosting NFL or NCAA games.nnMAIN OUTCOMES AND MEASURES: The main outcome was estimation of new COVID-19 cases per 100 000 residents at the county level reported up to 14 days after a game among counties with NFL and NCAA games with in-person attendance.nnRESULTS: A total of 528 games with in-person attendance (101 NFL games [19.1%]; 427 NCAA games [80.9%]) were included. The matching algorithm returned 361 matching sets of counties. The median (interquartile range [IQR]) number of attendance for NFL games was 9949 (6000 to 13 797) people. The median number of attendance for NCAA games was not available, and attendance was recorded as a binary variable. The median (IQR) daily new COVID-19 cases in treatment group counties hosting games was 26.14 (10.77-50.25) cases per 100 000 residents on game day. The median (IQR) daily new COVID-19 cases in control group counties where no games were played was 24.11 (9.64-48.55) cases per 100 000 residents on game day. The treatment effect size ranged from -5.17 to 4.72, with a mean (SD) of 1.21 (2.67) cases per 100 000 residents, within the 14-day period in all counties hosting the games, and the daily treatment effect trend remained relatively steady during this period.nnCONCLUSIONS AND RELEVANCE: This cross-sectional study did not find a consistent increase in the daily COVID-19 cases per 100 000 residents in counties where NFL and NCAA games were held with limited in-person attendance. These findings suggest that NFL and NCAA football games hosted with limited in-person attendance were not associated with substantial risk for increased local COVID-19 cases.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
IMPORTANCE: In 2020 and early 2021, the National Football League (NFL) and National Collegiate Athletic Association (NCAA) opted to host football games in stadiums across the country. The in-person attendance of games varied with time and from county to county. There is currently no evidence on whether limited in-person attendance of games is associated with COVID-19 case numbers on a county-level.nnOBJECTIVE: To assess whether NFL and NCAA football games with limited in-person attendance were associated with increased COVID-19 cases in the counties they were held compared with a matched set of counties.nnDESIGN, SETTING, AND PARTICIPANTS: In this time-series cross-sectional study, every county hosting NFL or NCAA games with in-person attendance (treated group) in 2020 and 2021 was matched with a county that that did not host a game on the corresponding day but had an identical game history for up to 14 days prior (control group). A standard matching method was used to further refine this matched set so that the treated and matched control counties had similar population size, nonpharmaceutical interventions in place, and COVID-19 trends. The association of hosting games with in-person attendance with COVID-19 cases was assessed using a difference-in-difference estimator. Data were analyzed from August 29 to December 28, 2020.nnEXPOSURES: Hosting NFL or NCAA games.nnMAIN OUTCOMES AND MEASURES: The main outcome was estimation of new COVID-19 cases per 100 000 residents at the county level reported up to 14 days after a game among counties with NFL and NCAA games with in-person attendance.nnRESULTS: A total of 528 games with in-person attendance (101 NFL games [19.1%]; 427 NCAA games [80.9%]) were included. The matching algorithm returned 361 matching sets of counties. The median (interquartile range [IQR]) number of attendance for NFL games was 9949 (6000 to 13 797) people. The median number of attendance for NCAA games was not available, and attendance was recorded as a binary variable. The median (IQR) daily new COVID-19 cases in treatment group counties hosting games was 26.14 (10.77-50.25) cases per 100 000 residents on game day. The median (IQR) daily new COVID-19 cases in control group counties where no games were played was 24.11 (9.64-48.55) cases per 100 000 residents on game day. The treatment effect size ranged from -5.17 to 4.72, with a mean (SD) of 1.21 (2.67) cases per 100 000 residents, within the 14-day period in all counties hosting the games, and the daily treatment effect trend remained relatively steady during this period.nnCONCLUSIONS AND RELEVANCE: This cross-sectional study did not find a consistent increase in the daily COVID-19 cases per 100 000 residents in counties where NFL and NCAA games were held with limited in-person attendance. These findings suggest that NFL and NCAA football games hosted with limited in-person attendance were not associated with substantial risk for increased local COVID-19 cases.
Toumi, Asmae; DiGennaro, Catherine; Vahdat, Vahab; Jalali, Mohammad S; Gazelle, G Scott; Chhatwal, Jagpreet; Kelz, Rachel R; Lubitz, Carrie C
Trends in Thyroid Surgery and Guideline-Concordant Care in the United States, 2007-2018 Journal Article
In: Thyroid, vol. 31, no. 6, pp. 941–949, 2021, ISSN: 1557-9077.
@article{pmid33280499,
title = {Trends in Thyroid Surgery and Guideline-Concordant Care in the United States, 2007-2018},
author = {Asmae Toumi and Catherine DiGennaro and Vahab Vahdat and Mohammad S Jalali and G Scott Gazelle and Jagpreet Chhatwal and Rachel R Kelz and Carrie C Lubitz},
doi = {10.1089/thy.2020.0643},
issn = {1557-9077},
year = {2021},
date = {2021-06-01},
journal = {Thyroid},
volume = {31},
number = {6},
pages = {941--949},
abstract = { The American Thyroid Association (ATA) published the 2015 Management Guidelines for patients with thyroid nodules and differentiated thyroid cancer, recommending a shift to less aggressive diagnostic, surgical, and postoperative treatment strategies. At the same time and perhaps related to the new guidelines, there has been a shift to outpatient thyroid surgery. The aim of the current study was to assess physician adherence to these recommendations by identifying and quantifying temporal trends in the rates and indications for thyroid procedures in the inpatient and outpatient settings. Using the IBM MarketScan Commercial database, we identified employer-insured patients in the United States who underwent outpatient and inpatient thyroid surgery from 2007 to 2018. Thyroid surgery was classified as total thyroidectomy (TT), thyroid lobectomy (TL), or a completion thyroidectomy. The surgical indication diagnosis was also determined and classified as either benign or malignant thyroid disease. We compared outpatient and inpatient trends in surgery between benign and malignant thyroid disease both before and after the release of the 2015 ATA guidelines. A total of 220,088 patients who underwent thyroid surgery were included in the analysis. Approximately 80% of TLs were performed in the outpatient setting versus 70% of TTs. Longitudinal analysis showed a statistically significant changepoint for TT proportion occurring in November 2015. The proportion of TT as compared with TL decreased from 80% in September 2015 to 39% by December 2018. For thyroid cancer, there is an increasing trend in performing TL over TT, increasing from 17% in 2015 to 28% by the end of 2018. There was a significant changepoint occurring in November 2015 in the operative and management trends for benign and malignant thyroid disease.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The American Thyroid Association (ATA) published the 2015 Management Guidelines for patients with thyroid nodules and differentiated thyroid cancer, recommending a shift to less aggressive diagnostic, surgical, and postoperative treatment strategies. At the same time and perhaps related to the new guidelines, there has been a shift to outpatient thyroid surgery. The aim of the current study was to assess physician adherence to these recommendations by identifying and quantifying temporal trends in the rates and indications for thyroid procedures in the inpatient and outpatient settings. Using the IBM MarketScan Commercial database, we identified employer-insured patients in the United States who underwent outpatient and inpatient thyroid surgery from 2007 to 2018. Thyroid surgery was classified as total thyroidectomy (TT), thyroid lobectomy (TL), or a completion thyroidectomy. The surgical indication diagnosis was also determined and classified as either benign or malignant thyroid disease. We compared outpatient and inpatient trends in surgery between benign and malignant thyroid disease both before and after the release of the 2015 ATA guidelines. A total of 220,088 patients who underwent thyroid surgery were included in the analysis. Approximately 80% of TLs were performed in the outpatient setting versus 70% of TTs. Longitudinal analysis showed a statistically significant changepoint for TT proportion occurring in November 2015. The proportion of TT as compared with TL decreased from 80% in September 2015 to 39% by December 2018. For thyroid cancer, there is an increasing trend in performing TL over TT, increasing from 17% in 2015 to 28% by the end of 2018. There was a significant changepoint occurring in November 2015 in the operative and management trends for benign and malignant thyroid disease.
Deshmukh, Ashish A; Suk, Ryan; Shiels, Meredith S; Damgacioglu, Haluk; Lin, Yueh-Yun; Stier, Elizabeth A; Nyitray, Alan G; Chiao, Elizabeth Y; Nemutlu, Gizem S; Chhatwal, Jagpreet; Schmeler, Kathleen; Sigel, Keith; Sonawane, Kalyani
Incidence Trends and Burden of Human Papillomavirus-Associated Cancers Among Women in the United States, 2001-2017 Journal Article
In: J Natl Cancer Inst, vol. 113, no. 6, pp. 792–796, 2021, ISSN: 1460-2105.
@article{pmid32833021,
title = {Incidence Trends and Burden of Human Papillomavirus-Associated Cancers Among Women in the United States, 2001-2017},
author = {Ashish A Deshmukh and Ryan Suk and Meredith S Shiels and Haluk Damgacioglu and Yueh-Yun Lin and Elizabeth A Stier and Alan G Nyitray and Elizabeth Y Chiao and Gizem S Nemutlu and Jagpreet Chhatwal and Kathleen Schmeler and Keith Sigel and Kalyani Sonawane},
doi = {10.1093/jnci/djaa128},
issn = {1460-2105},
year = {2021},
date = {2021-06-01},
journal = {J Natl Cancer Inst},
volume = {113},
number = {6},
pages = {792--796},
abstract = {Human papillomavirus (HPV)-associated anal and oropharyngeal cancer incidence has increased in recent years among US women. However, trends in incidence and burden (annual number of cases) of noncervical HPV-associated cancers relative to cervical cancer remain unclear. Using the 2001-2017 US cancer statistics dataset, we evaluated contemporary incidence trends and burden (annual number of cases) of HPV-associated cancers among women by anatomic site, race or ethnicity, and age. Overall, cervical cancer incidence plateaued among White women but continued to decline among Black and Hispanic women. Anal cancer incidence surpassed cervical cancer incidence among White women aged 65-74 years of age (8.6 and 8.2 per 100 000 in 2015) and 75 years or older (6.2 and 6.0 per 100 000 in 2014). The noncervical cancer burden (n = 11 871) surpassed the cervical cancer burden (n = 11 527) in 2013. Development of efficacious screening strategies for noncervical cancers and continued improvement in cervical cancer prevention are needed to combat HPV-associated cancers among women.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Human papillomavirus (HPV)-associated anal and oropharyngeal cancer incidence has increased in recent years among US women. However, trends in incidence and burden (annual number of cases) of noncervical HPV-associated cancers relative to cervical cancer remain unclear. Using the 2001-2017 US cancer statistics dataset, we evaluated contemporary incidence trends and burden (annual number of cases) of HPV-associated cancers among women by anatomic site, race or ethnicity, and age. Overall, cervical cancer incidence plateaued among White women but continued to decline among Black and Hispanic women. Anal cancer incidence surpassed cervical cancer incidence among White women aged 65-74 years of age (8.6 and 8.2 per 100 000 in 2015) and 75 years or older (6.2 and 6.0 per 100 000 in 2014). The noncervical cancer burden (n = 11 871) surpassed the cervical cancer burden (n = 11 527) in 2013. Development of efficacious screening strategies for noncervical cancers and continued improvement in cervical cancer prevention are needed to combat HPV-associated cancers among women.
Chhatwal, Jagpreet; Postma, Maarten J
Health Economics of Interventions to Tackle the Coronavirus 2019 Pandemic Miscellaneous
2021, ISSN: 1524-4733.
@misc{pmid33933227,
title = {Health Economics of Interventions to Tackle the Coronavirus 2019 Pandemic},
author = {Jagpreet Chhatwal and Maarten J Postma},
doi = {10.1016/j.jval.2021.03.002},
issn = {1524-4733},
year = {2021},
date = {2021-05-01},
journal = {Value Health},
volume = {24},
number = {5},
pages = {605--606},
keywords = {},
pubstate = {published},
tppubtype = {misc}
}
Adee, Madeline; Zhuo, Yueran; Zhan, Tiannan; Chen, Qiushi; Toumi, Asmae; Ayer, Turgay; Nwankwo, Chizoba; Zhong, Huaiyang; Puenpatom, Amy; Chhatwal, Jagpreet
A Tool to Inform Hepatitis C Elimination: A Case for Hepatitis C Elimination in China Journal Article
In: Clin Liver Dis (Hoboken), vol. 17, no. 3, pp. 99–106, 2021, ISSN: 2046-2484.
@article{pmid33868647,
title = {A Tool to Inform Hepatitis C Elimination: A Case for Hepatitis C Elimination in China},
author = {Madeline Adee and Yueran Zhuo and Tiannan Zhan and Qiushi Chen and Asmae Toumi and Turgay Ayer and Chizoba Nwankwo and Huaiyang Zhong and Amy Puenpatom and Jagpreet Chhatwal},
doi = {10.1002/cld.1109},
issn = {2046-2484},
year = {2021},
date = {2021-03-01},
journal = {Clin Liver Dis (Hoboken)},
volume = {17},
number = {3},
pages = {99--106},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Hornberger, John; Chhatwal, Jagpreet
Opioid Misuse: A Global Crisis Miscellaneous
2021, ISSN: 1524-4733.
@misc{pmid33518020,
title = {Opioid Misuse: A Global Crisis},
author = {John Hornberger and Jagpreet Chhatwal},
doi = {10.1016/j.jval.2020.12.003},
issn = {1524-4733},
year = {2021},
date = {2021-02-01},
journal = {Value Health},
volume = {24},
number = {2},
pages = {145--146},
keywords = {},
pubstate = {published},
tppubtype = {misc}
}
Linas, Benjamin P; Savinkina, Alexandra; Barbosa, Carolina; Mueller, Peter P; Cerdá, Magdalena; Keyes, Katherine; Chhatwal, Jagpreet
A clash of epidemics: Impact of the COVID-19 pandemic response on opioid overdose Journal Article
In: J Subst Abuse Treat, vol. 120, pp. 108158, 2021, ISSN: 1873-6483.
@article{pmid33298298,
title = {A clash of epidemics: Impact of the COVID-19 pandemic response on opioid overdose},
author = {Benjamin P Linas and Alexandra Savinkina and Carolina Barbosa and Peter P Mueller and Magdalena Cerdá and Katherine Keyes and Jagpreet Chhatwal},
doi = {10.1016/j.jsat.2020.108158},
issn = {1873-6483},
year = {2021},
date = {2021-01-01},
journal = {J Subst Abuse Treat},
volume = {120},
pages = {108158},
abstract = {Coronavirus disease 2019 (COVID-19) will have a lasting impact on public health. In addition to the direct effects of COVID-19 infection, physical distancing and quarantine interventions have indirect effects on health. While necessary, physical distancing interventions to control the spread of COVID-19 could have multiple impacts on people living with opioid use disorder, including impacts on mental health that lead to greater substance use, the availability of drug supply, the ways that people use drugs, treatment-seeking behaviors, and retention in care. The degree to which COVID-19 will impact the opioid epidemic and through which of the possible mechanisms that we discuss is important to monitor. We employed simulation modeling to demonstrate the potential impact of physical distancing on overdose mortality.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Coronavirus disease 2019 (COVID-19) will have a lasting impact on public health. In addition to the direct effects of COVID-19 infection, physical distancing and quarantine interventions have indirect effects on health. While necessary, physical distancing interventions to control the spread of COVID-19 could have multiple impacts on people living with opioid use disorder, including impacts on mental health that lead to greater substance use, the availability of drug supply, the ways that people use drugs, treatment-seeking behaviors, and retention in care. The degree to which COVID-19 will impact the opioid epidemic and through which of the possible mechanisms that we discuss is important to monitor. We employed simulation modeling to demonstrate the potential impact of physical distancing on overdose mortality.
2020
Aldridge, Arnie P; Barbosa, Carolina; Barocas, Joshua A; Bush, Joshua L; Chhatwal, Jagpreet; Harlow, Kristin J; Hyder, Ayaz; Linas, Benjamin P; McCollister, Kathryn E; Morgan, Jake R; Murphy, Sean M; Savitzky, Caroline; Schackman, Bruce R; Seiber, Eric E; Starbird, Laura E; Villani, Jennifer; Zarkin, Gary A
Health economic design for cost, cost-effectiveness and simulation analyses in the HEALing Communities Study Journal Article
In: Drug Alcohol Depend, vol. 217, pp. 108336, 2020, ISSN: 1879-0046.
@article{pmid33152672,
title = {Health economic design for cost, cost-effectiveness and simulation analyses in the HEALing Communities Study},
author = {Arnie P Aldridge and Carolina Barbosa and Joshua A Barocas and Joshua L Bush and Jagpreet Chhatwal and Kristin J Harlow and Ayaz Hyder and Benjamin P Linas and Kathryn E McCollister and Jake R Morgan and Sean M Murphy and Caroline Savitzky and Bruce R Schackman and Eric E Seiber and Laura E Starbird and Jennifer Villani and Gary A Zarkin},
doi = {10.1016/j.drugalcdep.2020.108336},
issn = {1879-0046},
year = {2020},
date = {2020-12-01},
journal = {Drug Alcohol Depend},
volume = {217},
pages = {108336},
abstract = {BACKGROUND: The HEALing Communities Study (HCS) is designed to implement and evaluate the Communities That HEAL (CTH) intervention, a conceptually driven framework to assist communities in selecting and adopting evidence-based practices to reduce opioid overdose deaths. The goal of the HCS is to produce generalizable information for policy makers and community stakeholders seeking to implement CTH or a similar community intervention. To support this objective, one aim of the HCS is a health economics study (HES), the results of which will inform decisions around fiscal feasibility and sustainability relevant to other community settings.nnMETHODS: The HES is integrated into the HCS design: an unblinded, multisite, parallel arm, cluster randomized, wait list-controlled trial of the CTH intervention implemented in 67 communities in four U.S. states: Kentucky, Massachusetts, New York, and Ohio. The objectives of the HES are to estimate the economic costs to communities of implementing and sustaining CTH; estimate broader societal costs associated with CTH; estimate the cost-effectiveness of CTH for overdose deaths avoided; and use simulation modeling to evaluate the short- and long-term health and economic impact of CTH, including future overdose deaths avoided and quality-adjusted life years saved, and to develop a simulation policy tool for communities that seek to implement CTH or a similar community intervention.nnDISCUSSION: The HCS offers an unprecedented opportunity to conduct health economics research on solutions to the opioid crisis and to increase understanding of the impact and value of complex, community-level interventions.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: The HEALing Communities Study (HCS) is designed to implement and evaluate the Communities That HEAL (CTH) intervention, a conceptually driven framework to assist communities in selecting and adopting evidence-based practices to reduce opioid overdose deaths. The goal of the HCS is to produce generalizable information for policy makers and community stakeholders seeking to implement CTH or a similar community intervention. To support this objective, one aim of the HCS is a health economics study (HES), the results of which will inform decisions around fiscal feasibility and sustainability relevant to other community settings.nnMETHODS: The HES is integrated into the HCS design: an unblinded, multisite, parallel arm, cluster randomized, wait list-controlled trial of the CTH intervention implemented in 67 communities in four U.S. states: Kentucky, Massachusetts, New York, and Ohio. The objectives of the HES are to estimate the economic costs to communities of implementing and sustaining CTH; estimate broader societal costs associated with CTH; estimate the cost-effectiveness of CTH for overdose deaths avoided; and use simulation modeling to evaluate the short- and long-term health and economic impact of CTH, including future overdose deaths avoided and quality-adjusted life years saved, and to develop a simulation policy tool for communities that seek to implement CTH or a similar community intervention.nnDISCUSSION: The HCS offers an unprecedented opportunity to conduct health economics research on solutions to the opioid crisis and to increase understanding of the impact and value of complex, community-level interventions.
Ebrahim, Senan; Ashworth, Henry; Noah, Cray; Kadambi, Adesh; Toumi, Asmae; Chhatwal, Jagpreet
Reduction of COVID-19 Incidence and Nonpharmacologic Interventions: Analysis Using a US County-Level Policy Data Set Journal Article
In: J Med Internet Res, vol. 22, no. 12, pp. e24614, 2020, ISSN: 1438-8871.
@article{pmid33302253,
title = {Reduction of COVID-19 Incidence and Nonpharmacologic Interventions: Analysis Using a US County-Level Policy Data Set},
author = {Senan Ebrahim and Henry Ashworth and Cray Noah and Adesh Kadambi and Asmae Toumi and Jagpreet Chhatwal},
doi = {10.2196/24614},
issn = {1438-8871},
year = {2020},
date = {2020-12-01},
journal = {J Med Internet Res},
volume = {22},
number = {12},
pages = {e24614},
abstract = {BACKGROUND: Worldwide, nonpharmacologic interventions (NPIs) have been the main tool used to mitigate the COVID-19 pandemic. This includes social distancing measures (closing businesses, closing schools, and quarantining symptomatic persons) and contact tracing (tracking and following exposed individuals). While preliminary research across the globe has shown these policies to be effective, there is currently a lack of information on the effectiveness of NPIs in the United States.nnOBJECTIVE: The purpose of this study was to create a granular NPI data set at the county level and then analyze the relationship between NPI policies and changes in reported COVID-19 cases.nnMETHODS: Using a standardized crowdsourcing methodology, we collected time-series data on 7 key NPIs for 1320 US counties.nnRESULTS: This open-source data set is the largest and most comprehensive collection of county NPI policy data and meets the need for higher-resolution COVID-19 policy data. Our analysis revealed a wide variation in county-level policies both within and among states (P<.001). We identified a correlation between workplace closures and lower growth rates of COVID-19 cases (P=.004). We found weak correlations between shelter-in-place enforcement and measures of Democratic local voter proportion (R=0.21) and elected leadership (R=0.22).nnCONCLUSIONS: This study is the first large-scale NPI analysis at the county level demonstrating a correlation between NPIs and decreased rates of COVID-19. Future work using this data set will explore the relationship between county-level policies and COVID-19 transmission to optimize real-time policy formulation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Worldwide, nonpharmacologic interventions (NPIs) have been the main tool used to mitigate the COVID-19 pandemic. This includes social distancing measures (closing businesses, closing schools, and quarantining symptomatic persons) and contact tracing (tracking and following exposed individuals). While preliminary research across the globe has shown these policies to be effective, there is currently a lack of information on the effectiveness of NPIs in the United States.nnOBJECTIVE: The purpose of this study was to create a granular NPI data set at the county level and then analyze the relationship between NPI policies and changes in reported COVID-19 cases.nnMETHODS: Using a standardized crowdsourcing methodology, we collected time-series data on 7 key NPIs for 1320 US counties.nnRESULTS: This open-source data set is the largest and most comprehensive collection of county NPI policy data and meets the need for higher-resolution COVID-19 policy data. Our analysis revealed a wide variation in county-level policies both within and among states (P<.001). We identified a correlation between workplace closures and lower growth rates of COVID-19 cases (P=.004). We found weak correlations between shelter-in-place enforcement and measures of Democratic local voter proportion (R=0.21) and elected leadership (R=0.22).nnCONCLUSIONS: This study is the first large-scale NPI analysis at the county level demonstrating a correlation between NPIs and decreased rates of COVID-19. Future work using this data set will explore the relationship between county-level policies and COVID-19 transmission to optimize real-time policy formulation.
Tordrup, David; Hutin, Yvan; Stenberg, Karin; Lauer, Jeremy A; Hutton, David W; Toy, Mehlika; Scott, Nick; Chhatwal, Jagpreet; Ball, Andrew
In: Value Health, vol. 23, no. 12, pp. 1552–1560, 2020, ISSN: 1524-4733.
@article{pmid33248510,
title = {Cost-Effectiveness of Testing and Treatment for Hepatitis B Virus and Hepatitis C Virus Infections: An Analysis by Scenarios, Regions, and Income},
author = {David Tordrup and Yvan Hutin and Karin Stenberg and Jeremy A Lauer and David W Hutton and Mehlika Toy and Nick Scott and Jagpreet Chhatwal and Andrew Ball},
doi = {10.1016/j.jval.2020.06.015},
issn = {1524-4733},
year = {2020},
date = {2020-12-01},
journal = {Value Health},
volume = {23},
number = {12},
pages = {1552--1560},
abstract = {OBJECTIVES: Testing and treatment for hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are highly effective, high-impact interventions. This article aims to estimate the cost-effectiveness of scaling up these interventions by scenarios, regions, and income groups.nnMETHODS: We modeled costs and impacts of hepatitis elimination in 67 low- and middle-income countries from 2016 to 2030. Costs included testing and treatment commodities, healthcare consultations, and future savings from cirrhosis and hepatocellular carcinomas averted. We modeled disease progression to estimate disability-adjusted life-years (DALYs) averted. We estimated incremental cost-effectiveness ratios (ICERs) by regions and World Bank income groups, according to 3 scenarios: flatline (status quo), progress (testing/treatment according to World Health Organization guidelines), and ambitious (elimination).nnRESULTS: Compared with no action, current levels of testing and treatment had an ICER of $807/DALY for HBV and -$62/DALY (cost-saving) for HCV. Scaling up to progress scenario, both interventions had ICERs less than the average gross domestic product/capita of countries (HBV: $532/DALY; HCV: $613/DALY). Scaling up from flatline to elimination led to higher ICERs across countries (HBV: $927/DALY; HCV: $2528/DALY, respectively) that remained lower than the average gross domestic product/capita. Sensitivity analysis indicated discount rates and commodity costs were main factors driving results.nnCONCLUSIONS: Scaling up testing and treatment for HBV and HCV infection as per World Health Organization guidelines is a cost-effective intervention. Elimination leads to a much larger impact though ICERs are higher. Price reduction strategies are needed to achieve elimination given the substantial budget impact at current commodity prices.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: Testing and treatment for hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are highly effective, high-impact interventions. This article aims to estimate the cost-effectiveness of scaling up these interventions by scenarios, regions, and income groups.nnMETHODS: We modeled costs and impacts of hepatitis elimination in 67 low- and middle-income countries from 2016 to 2030. Costs included testing and treatment commodities, healthcare consultations, and future savings from cirrhosis and hepatocellular carcinomas averted. We modeled disease progression to estimate disability-adjusted life-years (DALYs) averted. We estimated incremental cost-effectiveness ratios (ICERs) by regions and World Bank income groups, according to 3 scenarios: flatline (status quo), progress (testing/treatment according to World Health Organization guidelines), and ambitious (elimination).nnRESULTS: Compared with no action, current levels of testing and treatment had an ICER of $807/DALY for HBV and -$62/DALY (cost-saving) for HCV. Scaling up to progress scenario, both interventions had ICERs less than the average gross domestic product/capita of countries (HBV: $532/DALY; HCV: $613/DALY). Scaling up from flatline to elimination led to higher ICERs across countries (HBV: $927/DALY; HCV: $2528/DALY, respectively) that remained lower than the average gross domestic product/capita. Sensitivity analysis indicated discount rates and commodity costs were main factors driving results.nnCONCLUSIONS: Scaling up testing and treatment for HBV and HCV infection as per World Health Organization guidelines is a cost-effective intervention. Elimination leads to a much larger impact though ICERs are higher. Price reduction strategies are needed to achieve elimination given the substantial budget impact at current commodity prices.
Butala, Neel M; Patel, Nilay K; Chhatwal, Jagpreet; Vahdat, Vahab; Pomerantsev, Eugene V; Albaghdadi, Mazen; Sakhuja, Rahul; Rosenzweig, Anthony; Elmariah, Sammy
Patient and Provider Risk in Managing ST-Elevation Myocardial Infarction During the COVID-19 Pandemic: A Decision Analysis Journal Article
In: Circ Cardiovasc Interv, vol. 13, no. 11, pp. e010027, 2020, ISSN: 1941-7632.
@article{pmid33167699,
title = {Patient and Provider Risk in Managing ST-Elevation Myocardial Infarction During the COVID-19 Pandemic: A Decision Analysis},
author = {Neel M Butala and Nilay K Patel and Jagpreet Chhatwal and Vahab Vahdat and Eugene V Pomerantsev and Mazen Albaghdadi and Rahul Sakhuja and Anthony Rosenzweig and Sammy Elmariah},
doi = {10.1161/CIRCINTERVENTIONS.120.010027},
issn = {1941-7632},
year = {2020},
date = {2020-11-01},
journal = {Circ Cardiovasc Interv},
volume = {13},
number = {11},
pages = {e010027},
abstract = {BACKGROUND: The optimal treatment strategy for treating ST-segment-elevation myocardial infarction (STEMI) in context of the coronavirus disease 2019 (COVID-19) pandemic is unclear given the potential risk of occupational exposure during primary percutaneous coronary intervention (PPCI). We quantified the impact of different STEMI treatment strategies on patient outcomes and provider risk in context of the COVID-19 pandemic.nnMETHODS: Using a decision-analytic framework, we evaluated the effect of PPCI versus the pharmaco-invasive strategy for managing STEMI on 30-day patient mortality and individual provider infection risk based on presence of cardiogenic shock, suspected coronary territory, and presence of known or presumptive COVID-19 infection.nnRESULTS: For patients with low suspicion for COVID-19, PPCI had mortality benefit over the pharmaco-invasive strategy, and the risk of cardiac catheterization laboratory provider infection remained very low (<0.25%) across all subgroups. For patients with presumptive COVID-19 with cardiogenic shock, PPCI offered substantial mortality benefit to patients relative to the pharmaco-invasive strategy (7.9% absolute decrease in 30-day mortality), but also greater risk of provider infection (2.3% absolute increase in risk of provider infection). For patients with presumptive COVID-19 with nonanterior STEMI without cardiogenic shock, PPCI offered a 0.4% absolute mortality benefit over the pharmaco-invasive strategy with a 0.2% greater absolute risk of provider infection, and the tradeoff between patient and provider risk with PPCI became more apparent in sensitivity analysis with more severe COVID-19 infections.nnCONCLUSIONS: Usual care with PPCI remains the appropriate treatment strategy in the majority of cases presenting with STEMI in the setting of the COVID-19 pandemic. However, utilization of a pharmaco-invasive strategy in selected patients with STEMI with presumptive COVID-19 and low likelihood of mortality from STEMI and use of preventive strategies such as preprocedural intubation in high risk patients when PPCI is the preferred strategy may be reasonable to reduce provider risk of COVID-19 infection.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: The optimal treatment strategy for treating ST-segment-elevation myocardial infarction (STEMI) in context of the coronavirus disease 2019 (COVID-19) pandemic is unclear given the potential risk of occupational exposure during primary percutaneous coronary intervention (PPCI). We quantified the impact of different STEMI treatment strategies on patient outcomes and provider risk in context of the COVID-19 pandemic.nnMETHODS: Using a decision-analytic framework, we evaluated the effect of PPCI versus the pharmaco-invasive strategy for managing STEMI on 30-day patient mortality and individual provider infection risk based on presence of cardiogenic shock, suspected coronary territory, and presence of known or presumptive COVID-19 infection.nnRESULTS: For patients with low suspicion for COVID-19, PPCI had mortality benefit over the pharmaco-invasive strategy, and the risk of cardiac catheterization laboratory provider infection remained very low (<0.25%) across all subgroups. For patients with presumptive COVID-19 with cardiogenic shock, PPCI offered substantial mortality benefit to patients relative to the pharmaco-invasive strategy (7.9% absolute decrease in 30-day mortality), but also greater risk of provider infection (2.3% absolute increase in risk of provider infection). For patients with presumptive COVID-19 with nonanterior STEMI without cardiogenic shock, PPCI offered a 0.4% absolute mortality benefit over the pharmaco-invasive strategy with a 0.2% greater absolute risk of provider infection, and the tradeoff between patient and provider risk with PPCI became more apparent in sensitivity analysis with more severe COVID-19 infections.nnCONCLUSIONS: Usual care with PPCI remains the appropriate treatment strategy in the majority of cases presenting with STEMI in the setting of the COVID-19 pandemic. However, utilization of a pharmaco-invasive strategy in selected patients with STEMI with presumptive COVID-19 and low likelihood of mortality from STEMI and use of preventive strategies such as preprocedural intubation in high risk patients when PPCI is the preferred strategy may be reasonable to reduce provider risk of COVID-19 infection.
Chen, Qiushi; Ayer, Turgay; Adee, Madeline G; Wang, Xiaojie; Kanwal, Fasiha; Chhatwal, Jagpreet
In: JAMA Netw Open, vol. 3, no. 11, pp. e2021173, 2020, ISSN: 2574-3805.
@article{pmid33206188,
title = {Assessment of Incidence of and Surveillance Burden for Hepatocellular Carcinoma Among Patients With Hepatitis C in the Era of Direct-Acting Antiviral Agents},
author = {Qiushi Chen and Turgay Ayer and Madeline G Adee and Xiaojie Wang and Fasiha Kanwal and Jagpreet Chhatwal},
doi = {10.1001/jamanetworkopen.2020.21173},
issn = {2574-3805},
year = {2020},
date = {2020-11-01},
journal = {JAMA Netw Open},
volume = {3},
number = {11},
pages = {e2021173},
abstract = {IMPORTANCE: In the US, hepatocellular carcinoma (HCC), primarily associated with hepatitis C virus (HCV) infection, is the fastest rising cause of cancer-related death. Wider use of highly effective direct-acting antiviral agents (DAAs) substantially reduces the burden of chronic HCV infection, but the subsequent impacts with HCV-associated HCC remain unknown.nnOBJECTIVE: To assess projected changes in the incidence rate of and surveillance burden for HCC in the era of DAA treatment for HCV.nnDESIGN, SETTING, AND PARTICIPANTS: This decision analytical model study was performed from January 2019 to February 2020, using an individual-level state-transition simulation model to simulate disease progression, screening, and different waves of antiviral treatments for HCV in the US from 2012 to 2040.nnINTERVENTIONS: Current clinical management for chronic HCV infection.nnMAIN OUTCOMES AND MEASURES: Model outcomes were projected temporal trends and age distribution of incident HCC cases and candidates for HCC surveillance among patients with viremia and patients with virologically cured HCV.nnRESULTS: The simulation model projected that the annual incidence of HCC among patients with viremia and patients with virologically cured HCV will continue increasing to 24 000 (95% uncertainty interval [UI], 18 000-31 000) cases until 2021. In patients with virologically cured HCV, incident HCC cases are projected to increase from 1000 (95% UI, 500-2100) in 2012 to the peak of 7000 (95% UI, 5000-9600) in 2031 with a subsequent decrease to 6000 (95% UI, 4300-8300) by 2040. The proportion of incident HCC cases that occur in individuals with virologically cured HCV is estimated to increase from 5.3% in 2012 to 45.8% in 2040. The number of candidates for HCC surveillance in the population with virologically cured HCV is projected to increase from 106 000 (95% UI, 70 000-178 000) in 2012 to the peak of 649 000 (95% UI, 512 000-824 000) in 2030 and decrease to 539 000 (95% UI, 421 000-687 000) by 2040, while the proportion of all candidates for surveillance who are virologically cured is estimated to increase from 8.5% to 64.6% during the same period. The average age of HCC incidence and surveillance candidates is estimated to increase from 55 in 2012 to 72 and 71, respectively, by 2040.nnCONCLUSIONS AND RELEVANCE: The results of this study suggest that the burden of HCC will shift from patients with viremia to patients with virologically cured HCV, and to older populations. Appropriate management may be warranted for early detection of HCC in patients who may no longer be receiving specialty care for liver conditions.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
IMPORTANCE: In the US, hepatocellular carcinoma (HCC), primarily associated with hepatitis C virus (HCV) infection, is the fastest rising cause of cancer-related death. Wider use of highly effective direct-acting antiviral agents (DAAs) substantially reduces the burden of chronic HCV infection, but the subsequent impacts with HCV-associated HCC remain unknown.nnOBJECTIVE: To assess projected changes in the incidence rate of and surveillance burden for HCC in the era of DAA treatment for HCV.nnDESIGN, SETTING, AND PARTICIPANTS: This decision analytical model study was performed from January 2019 to February 2020, using an individual-level state-transition simulation model to simulate disease progression, screening, and different waves of antiviral treatments for HCV in the US from 2012 to 2040.nnINTERVENTIONS: Current clinical management for chronic HCV infection.nnMAIN OUTCOMES AND MEASURES: Model outcomes were projected temporal trends and age distribution of incident HCC cases and candidates for HCC surveillance among patients with viremia and patients with virologically cured HCV.nnRESULTS: The simulation model projected that the annual incidence of HCC among patients with viremia and patients with virologically cured HCV will continue increasing to 24 000 (95% uncertainty interval [UI], 18 000-31 000) cases until 2021. In patients with virologically cured HCV, incident HCC cases are projected to increase from 1000 (95% UI, 500-2100) in 2012 to the peak of 7000 (95% UI, 5000-9600) in 2031 with a subsequent decrease to 6000 (95% UI, 4300-8300) by 2040. The proportion of incident HCC cases that occur in individuals with virologically cured HCV is estimated to increase from 5.3% in 2012 to 45.8% in 2040. The number of candidates for HCC surveillance in the population with virologically cured HCV is projected to increase from 106 000 (95% UI, 70 000-178 000) in 2012 to the peak of 649 000 (95% UI, 512 000-824 000) in 2030 and decrease to 539 000 (95% UI, 421 000-687 000) by 2040, while the proportion of all candidates for surveillance who are virologically cured is estimated to increase from 8.5% to 64.6% during the same period. The average age of HCC incidence and surveillance candidates is estimated to increase from 55 in 2012 to 72 and 71, respectively, by 2040.nnCONCLUSIONS AND RELEVANCE: The results of this study suggest that the burden of HCC will shift from patients with viremia to patients with virologically cured HCV, and to older populations. Appropriate management may be warranted for early detection of HCC in patients who may no longer be receiving specialty care for liver conditions.
Julien, Jovan; Ayer, Turgay; Bethea, Emily D; Tapper, Elliot B; Chhatwal, Jagpreet
Projected prevalence and mortality associated with alcohol-related liver disease in the USA, 2019-40: a modelling study Journal Article
In: Lancet Public Health, vol. 5, no. 6, pp. e316–e323, 2020, ISSN: 2468-2667.
@article{pmid32504584,
title = {Projected prevalence and mortality associated with alcohol-related liver disease in the USA, 2019-40: a modelling study},
author = {Jovan Julien and Turgay Ayer and Emily D Bethea and Elliot B Tapper and Jagpreet Chhatwal},
doi = {10.1016/S2468-2667(20)30062-1},
issn = {2468-2667},
year = {2020},
date = {2020-06-01},
journal = {Lancet Public Health},
volume = {5},
number = {6},
pages = {e316--e323},
abstract = {BACKGROUND: Alcohol-related liver disease is the leading indication for liver transplantation in the USA. After remaining stable for over three decades, the number of deaths due to alcohol-related liver disease has been increasing as a result of increased high-risk drinking. We aimed to project trends in alcohol-related cirrhosis and deaths in the USA up to 2040 and assess the effect of potential changes in alcohol consumption on those trends.nnMETHODS: In this modelling study, we developed a multicohort state-transition (Markov) model of high-risk alcohol drinking patterns and alcohol-related liver disease in high-risk drinking populations born in 1900-2016 in the USA projected up to 2040. We used data from the National Epidemiologic Survey on Alcohol and Related Conditions, National Institute of Alcohol Abuse and Alcoholism, US National Death Index, National Vital Statistics System, and published studies. We modelled trends in alcohol-related liver disease under three projected scenarios: the status quo scenario, in which current trends continued; a moderate intervention scenario, in which trends in high-risk drinking reduced to 2001 levels under some hypothetical moderate intervention; and a strong intervention, in which trends in high-risk drinking decreased by 3·5% per year under some hypothetical strong intervention. The primary outcome was to project deaths associated with alcohol-related liver disease from 2019 to 2040 for each pattern of alcohol consumption under the different scenarios.nnFINDINGS: Our model closely reproduced the observed trends in deaths due to alcohol-related liver disease from 2005 to 2018. Under the status quo scenario, age-standardised deaths due to alcohol-related liver disease are expected to increase from 8·23 (95% uncertainty interval [UI] 7·92-9·29) per 100 000 person-years in 2019 to 15·20 (13·93-16·19) per 100 000 person-years in 2040, and from 2019 to 2040, 1 003 400 (95% CI 896 800-1 036 200) people are projected to die from alcohol-related liver disease, resulting in 1 128 400 (1 113 200-1 308 400) DALYs by 2040. Under the moderate intervention scenario, age-standardised deaths due to alcohol-related liver disease would increase to 14·49 (95% UI 12·55-14·57) per 100 000 person-years by 2040, with 968 100 (95% UI 845 600-975 900) individuals projected to die between 2019 and 2040-35 300 fewer deaths than under the status quo scenario (a 3·5% decrease). Whereas, under the strong intervention scenario, age-standardised deaths due to alcohol-related liver disease would peak at 8·65 (95% UI 8·12-9·51) per 100 000 person-years in 2024 and decrease to 7·60 (6·96-8·10) per 100 000 person-years in 2040, with 704 300 (95% CI 632 700-731 500) individuals projected to die from alcohol-related liver disease in the USA between 2019 and 2040-299 100 fewer deaths than under the status quo scenario (a 29·8% decrease).nnINTERPRETATION: Without substantial changes in drinking culture or interventions to address high-risk drinking, the disease burden and deaths due to alcohol-related liver disease will worsen in the USA. Additional interventions are urgently needed to reduce mortality and morbidity associated with alcohol-related liver disease.nnFUNDING: American Cancer Society and the Robert Wood Johnson Health Policy Research Fellowship.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Alcohol-related liver disease is the leading indication for liver transplantation in the USA. After remaining stable for over three decades, the number of deaths due to alcohol-related liver disease has been increasing as a result of increased high-risk drinking. We aimed to project trends in alcohol-related cirrhosis and deaths in the USA up to 2040 and assess the effect of potential changes in alcohol consumption on those trends.nnMETHODS: In this modelling study, we developed a multicohort state-transition (Markov) model of high-risk alcohol drinking patterns and alcohol-related liver disease in high-risk drinking populations born in 1900-2016 in the USA projected up to 2040. We used data from the National Epidemiologic Survey on Alcohol and Related Conditions, National Institute of Alcohol Abuse and Alcoholism, US National Death Index, National Vital Statistics System, and published studies. We modelled trends in alcohol-related liver disease under three projected scenarios: the status quo scenario, in which current trends continued; a moderate intervention scenario, in which trends in high-risk drinking reduced to 2001 levels under some hypothetical moderate intervention; and a strong intervention, in which trends in high-risk drinking decreased by 3·5% per year under some hypothetical strong intervention. The primary outcome was to project deaths associated with alcohol-related liver disease from 2019 to 2040 for each pattern of alcohol consumption under the different scenarios.nnFINDINGS: Our model closely reproduced the observed trends in deaths due to alcohol-related liver disease from 2005 to 2018. Under the status quo scenario, age-standardised deaths due to alcohol-related liver disease are expected to increase from 8·23 (95% uncertainty interval [UI] 7·92-9·29) per 100 000 person-years in 2019 to 15·20 (13·93-16·19) per 100 000 person-years in 2040, and from 2019 to 2040, 1 003 400 (95% CI 896 800-1 036 200) people are projected to die from alcohol-related liver disease, resulting in 1 128 400 (1 113 200-1 308 400) DALYs by 2040. Under the moderate intervention scenario, age-standardised deaths due to alcohol-related liver disease would increase to 14·49 (95% UI 12·55-14·57) per 100 000 person-years by 2040, with 968 100 (95% UI 845 600-975 900) individuals projected to die between 2019 and 2040-35 300 fewer deaths than under the status quo scenario (a 3·5% decrease). Whereas, under the strong intervention scenario, age-standardised deaths due to alcohol-related liver disease would peak at 8·65 (95% UI 8·12-9·51) per 100 000 person-years in 2024 and decrease to 7·60 (6·96-8·10) per 100 000 person-years in 2040, with 704 300 (95% CI 632 700-731 500) individuals projected to die from alcohol-related liver disease in the USA between 2019 and 2040-299 100 fewer deaths than under the status quo scenario (a 29·8% decrease).nnINTERPRETATION: Without substantial changes in drinking culture or interventions to address high-risk drinking, the disease burden and deaths due to alcohol-related liver disease will worsen in the USA. Additional interventions are urgently needed to reduce mortality and morbidity associated with alcohol-related liver disease.nnFUNDING: American Cancer Society and the Robert Wood Johnson Health Policy Research Fellowship.
Tapper, Elliot B; Chhatwal, Jagpreet
We are Not Meeting the Needs of Pharmacoeconomic Models of Nonalcoholic Steatohepatitis, But We Can Journal Article
In: Pharmacoeconomics, vol. 38, no. 5, pp. 427–429, 2020, ISSN: 1179-2027.
@article{pmid32086769,
title = {We are Not Meeting the Needs of Pharmacoeconomic Models of Nonalcoholic Steatohepatitis, But We Can},
author = {Elliot B Tapper and Jagpreet Chhatwal},
doi = {10.1007/s40273-020-00892-9},
issn = {1179-2027},
year = {2020},
date = {2020-05-01},
journal = {Pharmacoeconomics},
volume = {38},
number = {5},
pages = {427--429},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Ozturk, Arinc; Mohammadi, Ramin; Pierce, Theodore T; Kamarthi, Sagar; Dhyani, Manish; Grajo, Joseph R; Corey, Kathleen E; Chung, Raymond T; Bhan, Atul K; Chhatwal, Jagpreet; Samir, Anthony E
In: Ultrasound Med Biol, vol. 46, no. 4, pp. 972–980, 2020, ISSN: 1879-291X.
@article{pmid32005510,
title = {Diagnostic Accuracy of Shear Wave Elastography as a Non-invasive Biomarker of High-Risk Non-alcoholic Steatohepatitis in Patients with Non-alcoholic Fatty Liver Disease},
author = {Arinc Ozturk and Ramin Mohammadi and Theodore T Pierce and Sagar Kamarthi and Manish Dhyani and Joseph R Grajo and Kathleen E Corey and Raymond T Chung and Atul K Bhan and Jagpreet Chhatwal and Anthony E Samir},
doi = {10.1016/j.ultrasmedbio.2019.12.020},
issn = {1879-291X},
year = {2020},
date = {2020-04-01},
journal = {Ultrasound Med Biol},
volume = {46},
number = {4},
pages = {972--980},
abstract = {In this study, we evaluated the diagnostic accuracy of shear wave elastography (SWE) for differentiating high-risk non-alcoholic steatohepatitis (hrNASH) from non-alcoholic fatty liver and low-risk non-alcoholic steatohepatitis (NASH). Patients with non-alcoholic fatty liver disease scheduled for liver biopsy underwent pre-biopsy SWE. Ten SWE measurements were obtained. Biopsy samples were reviewed using the NASH Clinical Research Network Scoring System and patients with hrNASH were identified. Receiver operating characteristic curves for SWE-based hrNASH diagnosis were charted. One hundred sixteen adult patients underwent liver biopsy at our institution for the evaluation of non-alcoholic fatty liver disease. The area under the receiver operating characteristic curve of SWE for hrNASH diagnosis was 0.73 (95% confidence interval: 0.61-0.84, p < 0.001). The Youden index-based optimal stiffness cutoff value for hrNASH diagnosis was calculated as 8.4 kPa (1.67 m/s), with a sensitivity of 77% and specificity of 66%. SWE may be useful for the detection of NASH patients at risk of long-term liver-specific morbidity and mortality.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In this study, we evaluated the diagnostic accuracy of shear wave elastography (SWE) for differentiating high-risk non-alcoholic steatohepatitis (hrNASH) from non-alcoholic fatty liver and low-risk non-alcoholic steatohepatitis (NASH). Patients with non-alcoholic fatty liver disease scheduled for liver biopsy underwent pre-biopsy SWE. Ten SWE measurements were obtained. Biopsy samples were reviewed using the NASH Clinical Research Network Scoring System and patients with hrNASH were identified. Receiver operating characteristic curves for SWE-based hrNASH diagnosis were charted. One hundred sixteen adult patients underwent liver biopsy at our institution for the evaluation of non-alcoholic fatty liver disease. The area under the receiver operating characteristic curve of SWE for hrNASH diagnosis was 0.73 (95% confidence interval: 0.61-0.84, p < 0.001). The Youden index-based optimal stiffness cutoff value for hrNASH diagnosis was calculated as 8.4 kPa (1.67 m/s), with a sensitivity of 77% and specificity of 66%. SWE may be useful for the detection of NASH patients at risk of long-term liver-specific morbidity and mortality.
Zhuo, Yueran; Hayashi, Tomoyuki; Chen, Qiushi; Aggarwal, Rakesh; Hutin, Yvan; Chhatwal, Jagpreet
Estimating the price at which hepatitis C treatment with direct-acting antivirals would be cost-saving in Japan Journal Article
In: Sci Rep, vol. 10, no. 1, pp. 4089, 2020, ISSN: 2045-2322.
@article{pmid32139872,
title = {Estimating the price at which hepatitis C treatment with direct-acting antivirals would be cost-saving in Japan},
author = {Yueran Zhuo and Tomoyuki Hayashi and Qiushi Chen and Rakesh Aggarwal and Yvan Hutin and Jagpreet Chhatwal},
doi = {10.1038/s41598-020-60986-4},
issn = {2045-2322},
year = {2020},
date = {2020-03-01},
journal = {Sci Rep},
volume = {10},
number = {1},
pages = {4089},
abstract = {In Japan, 1.5-2 million people are chronically infected with hepatitis C virus (HCV) infection. New direct-acting antiviral agents (DAA) offer an unprecedented opportunity to cure HCV. While the price of HCV treatment decreased recently in most countries, it remains one of the highest in Japan. Our objective was to evaluate the cost-effectiveness of HCV treatment in patients of different age groups and to estimate the price at which DAAs become cost-saving in Japan. A previously developed microsimulation model was adapted to the Japanese population and updated with Japan-specific health utilities and costs. Our model showed that compared with no treatment, the incremental cost-effectiveness ratio (ICER) of DAAs at a price USD 41,046 per treatment was USD 9,080 per quality-adjusted life year (QALY) gained in 60-year-old patients. HCV treatment became cost-effective after 9 years of starting treatment. However, if the price of DAAs is reduced by 55-85% (USD 6,730 to 17,720), HCV treatment would be cost-saving within a 5 to 20-year time horizon, which should serve to increase the uptake of DAA-based HCV treatment. The payers of health care in Japan could examine ways to procure DAAs at a price where they would be cost-saving.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In Japan, 1.5-2 million people are chronically infected with hepatitis C virus (HCV) infection. New direct-acting antiviral agents (DAA) offer an unprecedented opportunity to cure HCV. While the price of HCV treatment decreased recently in most countries, it remains one of the highest in Japan. Our objective was to evaluate the cost-effectiveness of HCV treatment in patients of different age groups and to estimate the price at which DAAs become cost-saving in Japan. A previously developed microsimulation model was adapted to the Japanese population and updated with Japan-specific health utilities and costs. Our model showed that compared with no treatment, the incremental cost-effectiveness ratio (ICER) of DAAs at a price USD 41,046 per treatment was USD 9,080 per quality-adjusted life year (QALY) gained in 60-year-old patients. HCV treatment became cost-effective after 9 years of starting treatment. However, if the price of DAAs is reduced by 55-85% (USD 6,730 to 17,720), HCV treatment would be cost-saving within a 5 to 20-year time horizon, which should serve to increase the uptake of DAA-based HCV treatment. The payers of health care in Japan could examine ways to procure DAAs at a price where they would be cost-saving.
Hatzakis, Angelos; Lazarus, Jeffrey V; Cholongitas, Evangelos; Baptista-Leite, Ricardo; Boucher, Charles; Busoi, Cristian-Silviu; Deuffic-Burban, Sylvie; Chhatwal, Jagpreet; Esmat, Gamal; Hutchinson, Sharon; Malliori, Minerva-Melpomeni; Maticic, Mojca; Mozalevskis, Antons; Negro, Francesco; Papandreou, George A; Papatheodoridis, George V; Peck-Radosavljevic, Markus; Razavi, Homie; Reic, Tatjana; Schatz, Eberhard; Tozun, Nurdan; Younossi, Zobair; Manns, Michael P
Securing sustainable funding for viral hepatitis elimination plans Journal Article
In: Liver Int, vol. 40, no. 2, pp. 260–270, 2020, ISSN: 1478-3231.
@article{pmid31808281,
title = {Securing sustainable funding for viral hepatitis elimination plans},
author = {Angelos Hatzakis and Jeffrey V Lazarus and Evangelos Cholongitas and Ricardo Baptista-Leite and Charles Boucher and Cristian-Silviu Busoi and Sylvie Deuffic-Burban and Jagpreet Chhatwal and Gamal Esmat and Sharon Hutchinson and Minerva-Melpomeni Malliori and Mojca Maticic and Antons Mozalevskis and Francesco Negro and George A Papandreou and George V Papatheodoridis and Markus Peck-Radosavljevic and Homie Razavi and Tatjana Reic and Eberhard Schatz and Nurdan Tozun and Zobair Younossi and Michael P Manns},
doi = {10.1111/liv.14282},
issn = {1478-3231},
year = {2020},
date = {2020-02-01},
journal = {Liver Int},
volume = {40},
number = {2},
pages = {260--270},
abstract = {The majority of people infected with chronic hepatitis C virus (HCV) in the European Union (EU) remain undiagnosed and untreated. During recent years, immigration to EU has further increased HCV prevalence. It has been estimated that, out of the 4.2 million adults affected by HCV infection in the 31 EU/ European Economic Area (EEA) countries, as many as 580 000 are migrants. Additionally, HCV is highly prevalent and under addressed in Eastern Europe. In 2013, the introduction of highly effective treatments for HCV with direct-acting antivirals created an unprecedented opportunity to cure almost all patients, reduce HCV transmission and eliminate the disease. However, in many settings, HCV elimination poses a serious challenge for countries' health spending. On 6 June 2018, the Hepatitis B and C Public Policy Association held the 2nd EU HCV Policy summit. It was emphasized that key stakeholders should work collaboratively since only a few countries in the EU are on track to achieve HCV elimination by 2030. In particular, more effort is needed for universal screening. The micro-elimination approach in specific populations is less complex and less costly than country-wide elimination programmes and is an important first step in many settings. Preliminary data suggest that implementation of the World Health Organization (WHO) Global Health Sector Strategy on Viral Hepatitis can be cost saving. However, innovative financing mechanisms are needed to raise funds upfront for scaling up screening, treatment and harm reduction interventions that can lead to HCV elimination by 2030, the stated goal of the WHO.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The majority of people infected with chronic hepatitis C virus (HCV) in the European Union (EU) remain undiagnosed and untreated. During recent years, immigration to EU has further increased HCV prevalence. It has been estimated that, out of the 4.2 million adults affected by HCV infection in the 31 EU/ European Economic Area (EEA) countries, as many as 580 000 are migrants. Additionally, HCV is highly prevalent and under addressed in Eastern Europe. In 2013, the introduction of highly effective treatments for HCV with direct-acting antivirals created an unprecedented opportunity to cure almost all patients, reduce HCV transmission and eliminate the disease. However, in many settings, HCV elimination poses a serious challenge for countries' health spending. On 6 June 2018, the Hepatitis B and C Public Policy Association held the 2nd EU HCV Policy summit. It was emphasized that key stakeholders should work collaboratively since only a few countries in the EU are on track to achieve HCV elimination by 2030. In particular, more effort is needed for universal screening. The micro-elimination approach in specific populations is less complex and less costly than country-wide elimination programmes and is an important first step in many settings. Preliminary data suggest that implementation of the World Health Organization (WHO) Global Health Sector Strategy on Viral Hepatitis can be cost saving. However, innovative financing mechanisms are needed to raise funds upfront for scaling up screening, treatment and harm reduction interventions that can lead to HCV elimination by 2030, the stated goal of the WHO.
2019
Sonawane, Kalyani; Nyitray, Alan G; Nemutlu, Gizem S; Swartz, Michael D; Chhatwal, Jagpreet; Deshmukh, Ashish A
Prevalence of Human Papillomavirus Infection by Number of Vaccine Doses Among US Women Journal Article
In: JAMA Netw Open, vol. 2, no. 12, pp. e1918571, 2019, ISSN: 2574-3805.
@article{pmid31880792,
title = {Prevalence of Human Papillomavirus Infection by Number of Vaccine Doses Among US Women},
author = {Kalyani Sonawane and Alan G Nyitray and Gizem S Nemutlu and Michael D Swartz and Jagpreet Chhatwal and Ashish A Deshmukh},
doi = {10.1001/jamanetworkopen.2019.18571},
issn = {2574-3805},
year = {2019},
date = {2019-12-01},
journal = {JAMA Netw Open},
volume = {2},
number = {12},
pages = {e1918571},
abstract = {This cross-sectional study investigates the prevalence of human papillomavirus (HPV) infection among US women who received between 0 and 3 doses of HPV vaccine.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This cross-sectional study investigates the prevalence of human papillomavirus (HPV) infection among US women who received between 0 and 3 doses of HPV vaccine.
Dalgic, Ozden O; Samur, Sumeyye; Spaulding, Anne C; Llerena, Susana; Cobo, Carmen; Ayer, Turgay; Roberts, Mark S; Crespo, Javier; Chhatwal, Jagpreet
Improved Health Outcomes from Hepatitis C Treatment Scale-Up in Spain's Prisons: A Cost-Effectiveness Study Journal Article
In: Sci Rep, vol. 9, no. 1, pp. 16849, 2019, ISSN: 2045-2322.
@article{pmid31727921,
title = {Improved Health Outcomes from Hepatitis C Treatment Scale-Up in Spain's Prisons: A Cost-Effectiveness Study},
author = {Ozden O Dalgic and Sumeyye Samur and Anne C Spaulding and Susana Llerena and Carmen Cobo and Turgay Ayer and Mark S Roberts and Javier Crespo and Jagpreet Chhatwal},
doi = {10.1038/s41598-019-52564-0},
issn = {2045-2322},
year = {2019},
date = {2019-11-01},
journal = {Sci Rep},
volume = {9},
number = {1},
pages = {16849},
abstract = {Hepatitis C virus (HCV) is 15 times more prevalent among persons in Spain's prisons than in the community. Recently, Spain initiated a pilot program, JAILFREE-C, to treat HCV in prisons using direct-acting antivirals (DAAs). Our aim was to identify a cost-effective strategy to scale-up HCV treatment in all prisons. Using a validated agent-based model, we simulated the HCV landscape in Spain's prisons considering disease transmission, screening, treatment, and prison-community dynamics. Costs and disease outcomes under status quo were compared with strategies to scale-up treatment in prisons considering prioritization (HCV fibrosis stage vs. HCV prevalence of prisons), treatment capacity (2,000/year vs. unlimited) and treatment initiation based on sentence lengths (>6 months vs. any). Scaling-up treatment by treating all incarcerated persons irrespective of their sentence length provided maximum health benefits-preventing 10,200 new cases of HCV, and 8,300 HCV-related deaths between 2019-2050; 90% deaths prevented would have occurred in the community. Compared with status quo, this strategy increased quality-adjusted life year (QALYs) by 69,700 and costs by €670 million, yielding an incremental cost-effectiveness ratio of €9,600/QALY. Scaling-up HCV treatment with DAAs for the entire Spanish prison population, irrespective of sentence length, is cost-effective and would reduce HCV burden.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Hepatitis C virus (HCV) is 15 times more prevalent among persons in Spain's prisons than in the community. Recently, Spain initiated a pilot program, JAILFREE-C, to treat HCV in prisons using direct-acting antivirals (DAAs). Our aim was to identify a cost-effective strategy to scale-up HCV treatment in all prisons. Using a validated agent-based model, we simulated the HCV landscape in Spain's prisons considering disease transmission, screening, treatment, and prison-community dynamics. Costs and disease outcomes under status quo were compared with strategies to scale-up treatment in prisons considering prioritization (HCV fibrosis stage vs. HCV prevalence of prisons), treatment capacity (2,000/year vs. unlimited) and treatment initiation based on sentence lengths (>6 months vs. any). Scaling-up treatment by treating all incarcerated persons irrespective of their sentence length provided maximum health benefits-preventing 10,200 new cases of HCV, and 8,300 HCV-related deaths between 2019-2050; 90% deaths prevented would have occurred in the community. Compared with status quo, this strategy increased quality-adjusted life year (QALYs) by 69,700 and costs by €670 million, yielding an incremental cost-effectiveness ratio of €9,600/QALY. Scaling-up HCV treatment with DAAs for the entire Spanish prison population, irrespective of sentence length, is cost-effective and would reduce HCV burden.
Jahn, Beate; Todorovic, Jovan; Bundo, Marvin; Sroczynski, Gaby; Conrads-Frank, Annette; Rochau, Ursula; Endel, Gottfried; Wilbacher, Ingrid; Malbaski, Nikoletta; Popper, Niki; Chhatwal, Jagpreet; Greenberg, Dan; Mauskopf, Josephine; Siebert, Uwe
Budget Impact Analysis of Cancer Screening: A Methodological Review Journal Article
In: Appl Health Econ Health Policy, vol. 17, no. 4, pp. 493–511, 2019, ISSN: 1179-1896.
@article{pmid31016686,
title = {Budget Impact Analysis of Cancer Screening: A Methodological Review},
author = {Beate Jahn and Jovan Todorovic and Marvin Bundo and Gaby Sroczynski and Annette Conrads-Frank and Ursula Rochau and Gottfried Endel and Ingrid Wilbacher and Nikoletta Malbaski and Niki Popper and Jagpreet Chhatwal and Dan Greenberg and Josephine Mauskopf and Uwe Siebert},
doi = {10.1007/s40258-019-00475-6},
issn = {1179-1896},
year = {2019},
date = {2019-08-01},
journal = {Appl Health Econ Health Policy},
volume = {17},
number = {4},
pages = {493--511},
abstract = {BACKGROUND: Budget impact analyses (BIAs) describe changes in intervention- and disease-related costs of new technologies. Evidence on the quality of BIAs for cancer screening is lacking.nnOBJECTIVES: We systematically reviewed the literature and methods to assess how closely BIA guidelines are followed when BIAs are performed for cancer-screening programs.nnDATA SOURCES: Systematic searches were conducted in MEDLINE, EMBASE, EconLit, CRD (Centre for Reviews and Dissemination, University of York), and CEA registry of the Tufts Medical Center.nnSTUDY ELIGIBILITY CRITERIA: Eligible studies were BIAs evaluating cancer-screening programs published in English, 2010-2018.nnSYNTHESIS METHODS: Standardized evidence tables were generated to extract and compare study characteristics outlined by the ISPOR BIA Task Force.nnRESULTS: Nineteen studies were identified evaluating screening for breast (5), colorectal (6), cervical (3), lung (1), prostate (3), and skin (1) cancers. Model designs included decision-analytic models (13) and simple cost calculators (6). From all studies, only 53% reported costs for a minimum of 3 years, 58% compared to a mix of screening options, 42% reported model validation, and 37% reported uncertainty analysis for participation rates. The quality of studies appeared to be independent of cancer site.nnLIMITATIONS: "Gray" literature was not searched, misinterpretation is possible due to limited information in publications, and focus was on international methodological guidelines rather than regional guidelines.nnCONCLUSIONS: Our review highlights considerable variability in the extent to which BIAs evaluating cancer-screening programs followed recommended guidelines. The annual budget impact at least over the next 3-5 years should be estimated. Validation and uncertainty analysis should always be conducted. Continued dissemination efforts of existing best-practice guidelines are necessary to ensure high-quality analyses.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Budget impact analyses (BIAs) describe changes in intervention- and disease-related costs of new technologies. Evidence on the quality of BIAs for cancer screening is lacking.nnOBJECTIVES: We systematically reviewed the literature and methods to assess how closely BIA guidelines are followed when BIAs are performed for cancer-screening programs.nnDATA SOURCES: Systematic searches were conducted in MEDLINE, EMBASE, EconLit, CRD (Centre for Reviews and Dissemination, University of York), and CEA registry of the Tufts Medical Center.nnSTUDY ELIGIBILITY CRITERIA: Eligible studies were BIAs evaluating cancer-screening programs published in English, 2010-2018.nnSYNTHESIS METHODS: Standardized evidence tables were generated to extract and compare study characteristics outlined by the ISPOR BIA Task Force.nnRESULTS: Nineteen studies were identified evaluating screening for breast (5), colorectal (6), cervical (3), lung (1), prostate (3), and skin (1) cancers. Model designs included decision-analytic models (13) and simple cost calculators (6). From all studies, only 53% reported costs for a minimum of 3 years, 58% compared to a mix of screening options, 42% reported model validation, and 37% reported uncertainty analysis for participation rates. The quality of studies appeared to be independent of cancer site.nnLIMITATIONS: "Gray" literature was not searched, misinterpretation is possible due to limited information in publications, and focus was on international methodological guidelines rather than regional guidelines.nnCONCLUSIONS: Our review highlights considerable variability in the extent to which BIAs evaluating cancer-screening programs followed recommended guidelines. The annual budget impact at least over the next 3-5 years should be estimated. Validation and uncertainty analysis should always be conducted. Continued dissemination efforts of existing best-practice guidelines are necessary to ensure high-quality analyses.
Spaulding, Anne C; Graham, Camilla S; Akiyama, Matthew J; Chhatwal, Jagpreet; Nijhawan, Ank E; Ninburg, Michael H; Rich, Josiah D; Strick, Lara B; Taylor, Lynn E; Trooskin, Stacey B; Westergaard, Ryan P; Sabol, William J
Letter to the Editor: Hepatitis C Virus Prevalence Estimates Among Incarcerated Persons Miscellaneous
2019, ISSN: 1527-3350.
@misc{pmid30938455,
title = {Letter to the Editor: Hepatitis C Virus Prevalence Estimates Among Incarcerated Persons},
author = {Anne C Spaulding and Camilla S Graham and Matthew J Akiyama and Jagpreet Chhatwal and Ank E Nijhawan and Michael H Ninburg and Josiah D Rich and Lara B Strick and Lynn E Taylor and Stacey B Trooskin and Ryan P Westergaard and William J Sabol},
doi = {10.1002/hep.30636},
issn = {1527-3350},
year = {2019},
date = {2019-08-01},
journal = {Hepatology},
volume = {70},
number = {2},
pages = {758--759},
keywords = {},
pubstate = {published},
tppubtype = {misc}
}
Lee, Brian P; Samur, Sumeyye; Dalgic, Ozden O; Bethea, Emily D; Lucey, Michael R; Weinberg, Ethan; Hsu, Christine; Rinella, Mary E; Im, Gene Y; Fix, Oren K; Therapondos, George; Han, Hyosun; Victor, David W; Voigt, Michael D; Eswaran, Sheila; Terrault, Norah A; Chhatwal, Jagpreet
Model to Calculate Harms and Benefits of Early vs Delayed Liver Transplantation for Patients With Alcohol-Associated Hepatitis Journal Article
In: Gastroenterology, vol. 157, no. 2, pp. 472–480.e5, 2019, ISSN: 1528-0012.
@article{pmid30998988,
title = {Model to Calculate Harms and Benefits of Early vs Delayed Liver Transplantation for Patients With Alcohol-Associated Hepatitis},
author = {Brian P Lee and Sumeyye Samur and Ozden O Dalgic and Emily D Bethea and Michael R Lucey and Ethan Weinberg and Christine Hsu and Mary E Rinella and Gene Y Im and Oren K Fix and George Therapondos and Hyosun Han and David W Victor and Michael D Voigt and Sheila Eswaran and Norah A Terrault and Jagpreet Chhatwal},
doi = {10.1053/j.gastro.2019.04.012},
issn = {1528-0012},
year = {2019},
date = {2019-08-01},
journal = {Gastroenterology},
volume = {157},
number = {2},
pages = {472--480.e5},
abstract = {BACKGROUND & AIMS: Early liver transplantation (without requiring a minimum period of sobriety) for severe alcohol-associated hepatitis (AH) is controversial: many centers delay eligibility until a specific period of sobriety (such as 6 months) has been achieved. To inform ongoing debate and policy, we modeled long-term outcomes of early vs delayed liver transplantation for patients with AH.nnMETHODS: We developed a mathematical model to simulate early vs delayed liver transplantation for patients with severe AH and different amounts of alcohol use after transplantation: abstinence, slip (alcohol use followed by sobriety), or sustained use. Mortality of patients before transplantation was determined by joint-effect model (based on Model for End-Stage Liver Disease [MELD] and Lille scores). We estimated life expectancies of patients receiving early vs delayed transplantation (6-month wait before placement on the waitlist) and life years lost attributable to alcohol use after receiving the liver transplant.nnRESULTS: Patients offered early liver transplantation were estimated to have an average life expectancy of 6.55 life years, compared with an average life expectancy of 1.46 life years for patients offered delayed liver transplantation (4.49-fold increase). The net increase in life expectancy from offering early transplantation was highest for patients with Lille scores of 0.50-0.82 and MELD scores of 32 or more. Patients who were offered early transplantation and had no alcohol use afterward were predicted to survive 10.85 years compared with 3.62 years for patients with sustained alcohol use after transplantation (7.23 life years lost). Compared with delayed transplantation, early liver transplantation increased survival times in all simulated scenarios and combinations of Lille and MELD scores.nnCONCLUSIONS: In a modeling study of assumed carefully selected patients with AH, early vs delayed liver transplantation (6 months of abstinence from alcohol before transplantation) increased survival times of patients, regardless of estimated risk of sustained alcohol use after transplantation. These findings support early liver transplantation for patients with severe AH. The net increase in life expectancy was maintained in all simulated extreme scenarios but should be confirmed in prospective studies. Sustained alcohol use after transplantation significantly reduced but did not eliminate the benefits of early transplantation. Strategies are needed to prevent and treat posttransplantation use of alcohol.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND & AIMS: Early liver transplantation (without requiring a minimum period of sobriety) for severe alcohol-associated hepatitis (AH) is controversial: many centers delay eligibility until a specific period of sobriety (such as 6 months) has been achieved. To inform ongoing debate and policy, we modeled long-term outcomes of early vs delayed liver transplantation for patients with AH.nnMETHODS: We developed a mathematical model to simulate early vs delayed liver transplantation for patients with severe AH and different amounts of alcohol use after transplantation: abstinence, slip (alcohol use followed by sobriety), or sustained use. Mortality of patients before transplantation was determined by joint-effect model (based on Model for End-Stage Liver Disease [MELD] and Lille scores). We estimated life expectancies of patients receiving early vs delayed transplantation (6-month wait before placement on the waitlist) and life years lost attributable to alcohol use after receiving the liver transplant.nnRESULTS: Patients offered early liver transplantation were estimated to have an average life expectancy of 6.55 life years, compared with an average life expectancy of 1.46 life years for patients offered delayed liver transplantation (4.49-fold increase). The net increase in life expectancy from offering early transplantation was highest for patients with Lille scores of 0.50-0.82 and MELD scores of 32 or more. Patients who were offered early transplantation and had no alcohol use afterward were predicted to survive 10.85 years compared with 3.62 years for patients with sustained alcohol use after transplantation (7.23 life years lost). Compared with delayed transplantation, early liver transplantation increased survival times in all simulated scenarios and combinations of Lille and MELD scores.nnCONCLUSIONS: In a modeling study of assumed carefully selected patients with AH, early vs delayed liver transplantation (6 months of abstinence from alcohol before transplantation) increased survival times of patients, regardless of estimated risk of sustained alcohol use after transplantation. These findings support early liver transplantation for patients with severe AH. The net increase in life expectancy was maintained in all simulated extreme scenarios but should be confirmed in prospective studies. Sustained alcohol use after transplantation significantly reduced but did not eliminate the benefits of early transplantation. Strategies are needed to prevent and treat posttransplantation use of alcohol.
Jahn, Beate; Kurzthaler, Christina; Chhatwal, Jagpreet; Elbasha, Elamin H; Conrads-Frank, Annette; Rochau, Ursula; Sroczynski, Gaby; Urach, Christoph; Bundo, Marvin; Popper, Niki; Siebert, Uwe
In: Med Decis Making, vol. 39, no. 5, pp. 509–522, 2019, ISSN: 1552-681X.
@article{pmid31253053,
title = {Alternative Conversion Methods for Transition Probabilities in State-Transition Models: Validity and Impact on Comparative Effectiveness and Cost-Effectiveness},
author = {Beate Jahn and Christina Kurzthaler and Jagpreet Chhatwal and Elamin H Elbasha and Annette Conrads-Frank and Ursula Rochau and Gaby Sroczynski and Christoph Urach and Marvin Bundo and Niki Popper and Uwe Siebert},
doi = {10.1177/0272989X19851095},
issn = {1552-681X},
year = {2019},
date = {2019-07-01},
journal = {Med Decis Making},
volume = {39},
number = {5},
pages = {509--522},
abstract = {. In state-transition models (STMs), decision problems are conceptualized using health states and transitions among those health states after predefined time cycles. The naive, commonly applied method (C) for cycle length conversion transforms all transition probabilities separately. In STMs with more than 2 health states, this method is not accurate. Therefore, we aim to describe and compare the performance of method C with that of alternative matrix transformation methods. . We compare 2 alternative matrix transformation methods (Eigenvalue method [E], Schure-Padé method [SP]) to method C applied in an STM of 3 different treatment strategies for women with breast cancer. We convert the given annual transition matrix into a monthly-cycle matrix and evaluate induced transformation errors for the transition matrices and the long-term outcomes: life years, quality-adjusted life-years, costs and incremental cost-effectiveness ratios, and the performance related to the decisions. In addition, we applied these transformation methods to randomly generated annual transition matrices with 4, 7, 10, and 20 health states. . In theory, there is no generally applicable correct transformation method. Based on our simulations, SP resulted in the smallest transformation-induced discrepancies for generated annual transition matrices for 2 treatment strategies. E showed slightly smaller discrepancies than SP in the strategy, where one of the direct transitions between health states was excluded. For long-term outcomes, the largest discrepancy occurred for estimated costs applying method C. For higher dimensional models, E performs best. . In our modeling examples, matrix transformations (E, SP) perform better than transforming all transition probabilities separately (C). Transition probabilities based on alternative conversion methods should therefore be applied in sensitivity analyses.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
. In state-transition models (STMs), decision problems are conceptualized using health states and transitions among those health states after predefined time cycles. The naive, commonly applied method (C) for cycle length conversion transforms all transition probabilities separately. In STMs with more than 2 health states, this method is not accurate. Therefore, we aim to describe and compare the performance of method C with that of alternative matrix transformation methods. . We compare 2 alternative matrix transformation methods (Eigenvalue method [E], Schure-Padé method [SP]) to method C applied in an STM of 3 different treatment strategies for women with breast cancer. We convert the given annual transition matrix into a monthly-cycle matrix and evaluate induced transformation errors for the transition matrices and the long-term outcomes: life years, quality-adjusted life-years, costs and incremental cost-effectiveness ratios, and the performance related to the decisions. In addition, we applied these transformation methods to randomly generated annual transition matrices with 4, 7, 10, and 20 health states. . In theory, there is no generally applicable correct transformation method. Based on our simulations, SP resulted in the smallest transformation-induced discrepancies for generated annual transition matrices for 2 treatment strategies. E showed slightly smaller discrepancies than SP in the strategy, where one of the direct transitions between health states was excluded. For long-term outcomes, the largest discrepancy occurred for estimated costs applying method C. For higher dimensional models, E performs best. . In our modeling examples, matrix transformations (E, SP) perform better than transforming all transition probabilities separately (C). Transition probabilities based on alternative conversion methods should therefore be applied in sensitivity analyses.
Chhatwal, Jagpreet; Chen, Qiushi; Bethea, Emily D; Hur, Chin; Spaulding, Anne C; Kanwal, Fasiha
In: Aliment Pharmacol Ther, vol. 50, no. 1, pp. 66–74, 2019, ISSN: 1365-2036.
@article{pmid31115920,
title = {The impact of direct-acting anti-virals on the hepatitis C care cascade: identifying progress and gaps towards hepatitis C elimination in the United States},
author = {Jagpreet Chhatwal and Qiushi Chen and Emily D Bethea and Chin Hur and Anne C Spaulding and Fasiha Kanwal},
doi = {10.1111/apt.15291},
issn = {1365-2036},
year = {2019},
date = {2019-07-01},
journal = {Aliment Pharmacol Ther},
volume = {50},
number = {1},
pages = {66--74},
abstract = {BACKGROUND: The hepatitis C virus (HCV) care cascade has changed dramatically following the introduction of direct-acting anti-virals (DAAs). Up-to-date estimates of the cascade are needed to monitor progress, identify key gaps and inform policy.nnAIM: To estimate the current and future HCV care cascade in the United States, nationally and in select subpopulations of interest.nnMETHODS: We used a previously validated mathematical model to simulate the landscape of HCV in the United States from 2011 onwards, accounting for HCV screening policy updates, newer HCV treatments and rising HCV incidence.nnRESULTS: By the end of 2018, of 4.29 million HCV persons alive, 2.71 million (63%) were actively viremic, 2.24 million (52%) aware and 1.58 million (37%) cured. By 2030, under the status quo, of 3.65 million HCV persons alive, 1.88 million (51%) would be viremic, 2.25 million (62%) aware and 1.77 million (49%) cured. The HCV care cascade in 2018 differed substantially by subpopulation: of 1.34 million incarcerated HCV persons, 96% were viremic, 36% aware and 4% cured; of 0.87 million HCV persons in Medicare, 31% were viremic, 72% aware and 69% cured; and of 0.37 million HCV persons in Medicaid, 49% were viremic, 54% aware and 51% cured. Implementing universal screening, providing unrestricted treatment and controlling HCV incidence were factors found to have the largest effect on improving the HCV care cascade.nnCONCLUSIONS: Since the launch of DAAs, the HCV care cascade has shifted towards higher awareness and treatment rates; however, additional interventions are needed to move towards HCV elimination.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: The hepatitis C virus (HCV) care cascade has changed dramatically following the introduction of direct-acting anti-virals (DAAs). Up-to-date estimates of the cascade are needed to monitor progress, identify key gaps and inform policy.nnAIM: To estimate the current and future HCV care cascade in the United States, nationally and in select subpopulations of interest.nnMETHODS: We used a previously validated mathematical model to simulate the landscape of HCV in the United States from 2011 onwards, accounting for HCV screening policy updates, newer HCV treatments and rising HCV incidence.nnRESULTS: By the end of 2018, of 4.29 million HCV persons alive, 2.71 million (63%) were actively viremic, 2.24 million (52%) aware and 1.58 million (37%) cured. By 2030, under the status quo, of 3.65 million HCV persons alive, 1.88 million (51%) would be viremic, 2.25 million (62%) aware and 1.77 million (49%) cured. The HCV care cascade in 2018 differed substantially by subpopulation: of 1.34 million incarcerated HCV persons, 96% were viremic, 36% aware and 4% cured; of 0.87 million HCV persons in Medicare, 31% were viremic, 72% aware and 69% cured; and of 0.37 million HCV persons in Medicaid, 49% were viremic, 54% aware and 51% cured. Implementing universal screening, providing unrestricted treatment and controlling HCV incidence were factors found to have the largest effect on improving the HCV care cascade.nnCONCLUSIONS: Since the launch of DAAs, the HCV care cascade has shifted towards higher awareness and treatment rates; however, additional interventions are needed to move towards HCV elimination.
Chen, Qiushi; Ayer, Turgay; Bethea, Emily; Kanwal, Fasiha; Wang, Xiaojie; Roberts, Mark; Zhuo, Yueran; Fagiuoli, Stefano; Petersen, Jorg; Chhatwal, Jagpreet
Changes in hepatitis C burden and treatment trends in Europe during the era of direct-acting antivirals: a modelling study Journal Article
In: BMJ Open, vol. 9, no. 6, pp. e026726, 2019, ISSN: 2044-6055.
@article{pmid31189677,
title = {Changes in hepatitis C burden and treatment trends in Europe during the era of direct-acting antivirals: a modelling study},
author = {Qiushi Chen and Turgay Ayer and Emily Bethea and Fasiha Kanwal and Xiaojie Wang and Mark Roberts and Yueran Zhuo and Stefano Fagiuoli and Jorg Petersen and Jagpreet Chhatwal},
doi = {10.1136/bmjopen-2018-026726},
issn = {2044-6055},
year = {2019},
date = {2019-06-01},
journal = {BMJ Open},
volume = {9},
number = {6},
pages = {e026726},
abstract = {OBJECTIVES: Oral direct-acting antivirals (DAAs) for hepatitis C virus (HCV) have dramatically changed the treatment paradigm. Our aim was to project temporal trends in HCV diagnosis, treatment and disease burden in France, Germany, Italy, Spain and the UK.nnDESIGN: A mathematical simulation model of natural history of HCV infection.nnPARTICIPANTS: HCV-infected patients defined based on country-specific age, fibrosis and genotype distributions.nnINTERVENTIONS: HCV screening practice and availability of different waves of DAA treatment in each country.nnOUTCOME MEASURES: Temporal trends in the number of patients who achieve sustained virological response (SVR), fail treatment (by drug regimen) and develop advanced sequelae from 2014 to 2030 in each country.nnRESULTS: We projected that 1 324 000 individuals would receive treatment from 2014 to 2030 in the five European countries and 12 000-37 000 of them would fail to achieve SVR. By 2021, the number of individuals cured of HCV would supersede the number of actively infected individuals in France, Germany, Spain and the UK. Under status quo, the diagnosis rate would reach between 65% and 75% and treatment coverage between 65% and 74% by 2030 in these countries. The number of patients who fail treatment would decrease over time, with the majority of those who fail treatment having been exposed to non-structural protein 5A inhibitors.nnCONCLUSIONS: In the era of DAAs, the number of people with HCV who achieved a cure will exceed the number of viraemic patients, but many patients will remain undiagnosed, untreated, fail multiple treatments and develop advanced sequelae. Scaling-up screening and treatment capacity, and timely and effective retreatment are needed to avail the full benefits of DAAs and to meet HCV elimination targets set by WHO.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: Oral direct-acting antivirals (DAAs) for hepatitis C virus (HCV) have dramatically changed the treatment paradigm. Our aim was to project temporal trends in HCV diagnosis, treatment and disease burden in France, Germany, Italy, Spain and the UK.nnDESIGN: A mathematical simulation model of natural history of HCV infection.nnPARTICIPANTS: HCV-infected patients defined based on country-specific age, fibrosis and genotype distributions.nnINTERVENTIONS: HCV screening practice and availability of different waves of DAA treatment in each country.nnOUTCOME MEASURES: Temporal trends in the number of patients who achieve sustained virological response (SVR), fail treatment (by drug regimen) and develop advanced sequelae from 2014 to 2030 in each country.nnRESULTS: We projected that 1 324 000 individuals would receive treatment from 2014 to 2030 in the five European countries and 12 000-37 000 of them would fail to achieve SVR. By 2021, the number of individuals cured of HCV would supersede the number of actively infected individuals in France, Germany, Spain and the UK. Under status quo, the diagnosis rate would reach between 65% and 75% and treatment coverage between 65% and 74% by 2030 in these countries. The number of patients who fail treatment would decrease over time, with the majority of those who fail treatment having been exposed to non-structural protein 5A inhibitors.nnCONCLUSIONS: In the era of DAAs, the number of people with HCV who achieved a cure will exceed the number of viraemic patients, but many patients will remain undiagnosed, untreated, fail multiple treatments and develop advanced sequelae. Scaling-up screening and treatment capacity, and timely and effective retreatment are needed to avail the full benefits of DAAs and to meet HCV elimination targets set by WHO.
Chhatwal, Jagpreet; Chen, Qiushi; Wang, Xiaojie; Ayer, Turgay; Zhuo, Yueran; Janjua, Naveed Z; Kanwal, Fasiha
Assessment of the Feasibility and Cost of Hepatitis C Elimination in Pakistan Journal Article
In: JAMA Netw Open, vol. 2, no. 5, pp. e193613, 2019, ISSN: 2574-3805.
@article{pmid31074817,
title = {Assessment of the Feasibility and Cost of Hepatitis C Elimination in Pakistan},
author = {Jagpreet Chhatwal and Qiushi Chen and Xiaojie Wang and Turgay Ayer and Yueran Zhuo and Naveed Z Janjua and Fasiha Kanwal},
doi = {10.1001/jamanetworkopen.2019.3613},
issn = {2574-3805},
year = {2019},
date = {2019-05-01},
journal = {JAMA Netw Open},
volume = {2},
number = {5},
pages = {e193613},
abstract = {IMPORTANCE: Chronic hepatitis C virus (HCV) infection is a global health problem. The World Health Assembly recently pledged to eliminate HCV by 2030. However, in Pakistan, a country with one of the highest prevalence rates, the feasibility and cost of HCV elimination are not known.nnOBJECTIVES: To investigate whether and under what conditions HCV elimination is feasible in Pakistan and to estimate the cost of such elimination.nnDESIGN, SETTING, AND PARTICIPANTS: This decision analytical model study used a microsimulation model of the HCV epidemic in Pakistan from 2015 to 2030. Using Pakistan-specific variables, the model simulated the landscape of HCV in Pakistan and evaluated the minimum required screening and treatment rates needed to eliminate HCV in Pakistan. The study used simulated individuals chronically infected with HCV from 2015 to 2030. The analysis was performed in 2018.nnINTERVENTIONS: The status quo and 7 scenarios that can lead to HCV elimination in Pakistan by 2030, which were defined by different combinations of tests for screening, detection of viremia before treatment, and confirmation of treatment response.nnMAIN OUTCOMES AND MEASURES: Temporal trends in HCV infection prevalence, mortality, and disability-adjusted life-years and total cost of HCV infection care under the status quo and scenarios that can eliminate HCV by 2030.nnRESULTS: Under the status quo, from 2015 to 2030, 1.44 million people are projected to die of HCV infection; 48% of deaths would be among people younger than 50 years. To achieve HCV elimination in Pakistan, HCV testing would need to be scaled up to at least 25 million people to diagnose 900 000 persons and treatment to 700 000 people per year. Compared with the status quo, the elimination scenario would avert 323 000 liver-related deaths and 13.0 million HCV-associated disability-adjusted life-years from 2015 to 2030. The elimination scenario was associated with cost savings of $2.6 billion from 2018 to 2030 with use of a point-of-care test for population-wide antibody screening and detection of viremia and treatment response.nnCONCLUSIONS AND RELEVANCE: Substantial scale-up of HCV testing and treatment may be essential to eliminate HCV infection in Pakistan, and such a strategy may be associated with cost savings in the near future. Although HCV elimination in Pakistan may be ambitious, strategic planning and strong support from the government may aid in its elimination.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
IMPORTANCE: Chronic hepatitis C virus (HCV) infection is a global health problem. The World Health Assembly recently pledged to eliminate HCV by 2030. However, in Pakistan, a country with one of the highest prevalence rates, the feasibility and cost of HCV elimination are not known.nnOBJECTIVES: To investigate whether and under what conditions HCV elimination is feasible in Pakistan and to estimate the cost of such elimination.nnDESIGN, SETTING, AND PARTICIPANTS: This decision analytical model study used a microsimulation model of the HCV epidemic in Pakistan from 2015 to 2030. Using Pakistan-specific variables, the model simulated the landscape of HCV in Pakistan and evaluated the minimum required screening and treatment rates needed to eliminate HCV in Pakistan. The study used simulated individuals chronically infected with HCV from 2015 to 2030. The analysis was performed in 2018.nnINTERVENTIONS: The status quo and 7 scenarios that can lead to HCV elimination in Pakistan by 2030, which were defined by different combinations of tests for screening, detection of viremia before treatment, and confirmation of treatment response.nnMAIN OUTCOMES AND MEASURES: Temporal trends in HCV infection prevalence, mortality, and disability-adjusted life-years and total cost of HCV infection care under the status quo and scenarios that can eliminate HCV by 2030.nnRESULTS: Under the status quo, from 2015 to 2030, 1.44 million people are projected to die of HCV infection; 48% of deaths would be among people younger than 50 years. To achieve HCV elimination in Pakistan, HCV testing would need to be scaled up to at least 25 million people to diagnose 900 000 persons and treatment to 700 000 people per year. Compared with the status quo, the elimination scenario would avert 323 000 liver-related deaths and 13.0 million HCV-associated disability-adjusted life-years from 2015 to 2030. The elimination scenario was associated with cost savings of $2.6 billion from 2018 to 2030 with use of a point-of-care test for population-wide antibody screening and detection of viremia and treatment response.nnCONCLUSIONS AND RELEVANCE: Substantial scale-up of HCV testing and treatment may be essential to eliminate HCV infection in Pakistan, and such a strategy may be associated with cost savings in the near future. Although HCV elimination in Pakistan may be ambitious, strategic planning and strong support from the government may aid in its elimination.
Chhatwal, Jagpreet; Sussman, Norman L
Universal Screening for Hepatitis C: An Important Step in Virus Elimination Miscellaneous
2019, ISSN: 1542-7714.
@misc{pmid30528843,
title = {Universal Screening for Hepatitis C: An Important Step in Virus Elimination},
author = {Jagpreet Chhatwal and Norman L Sussman},
doi = {10.1016/j.cgh.2018.12.002},
issn = {1542-7714},
year = {2019},
date = {2019-04-01},
journal = {Clin Gastroenterol Hepatol},
volume = {17},
number = {5},
pages = {835--837},
keywords = {},
pubstate = {published},
tppubtype = {misc}
}
Bethea, Emily D; Samur, Sumeyye; Kanwal, Fasiha; Ayer, Turgay; Hur, Chin; Roberts, Mark S; Terrault, Norah; Chung, Raymond T; Chhatwal, Jagpreet
Cost Effectiveness of Transplanting HCV-Infected Livers Into Uninfected Recipients With Preemptive Antiviral Therapy Journal Article
In: Clin Gastroenterol Hepatol, vol. 17, no. 4, pp. 739–747.e8, 2019, ISSN: 1542-7714.
@article{pmid30138735,
title = {Cost Effectiveness of Transplanting HCV-Infected Livers Into Uninfected Recipients With Preemptive Antiviral Therapy},
author = {Emily D Bethea and Sumeyye Samur and Fasiha Kanwal and Turgay Ayer and Chin Hur and Mark S Roberts and Norah Terrault and Raymond T Chung and Jagpreet Chhatwal},
doi = {10.1016/j.cgh.2018.08.042},
issn = {1542-7714},
year = {2019},
date = {2019-03-01},
journal = {Clin Gastroenterol Hepatol},
volume = {17},
number = {4},
pages = {739--747.e8},
abstract = {BACKGROUND & AIMS: Guidelines do not recommend transplanting hepatitis C virus (HCV)-infected livers into HCV-uninfected recipients. Direct-acting antivirals (DAAs) can be used to treat donor-derived HCV infection. However, the added cost of DAA therapy is a barrier. We evaluated the cost effectiveness of transplanting HCV-positive livers into HCV-negative patients with preemptive DAA therapy.nnMETHODS: A previously validated Markov-based mathematical model was adapted to simulate a virtual trial of HCV-negative patients on the liver transplant waitlist. The model compared long-term clinical and economic outcomes in patients willing to accept only HCV-negative livers vs those willing to accept any liver (HCV negative or HCV positive). Recipients of HCV-positive livers received 12 weeks of preemptive DAA therapy. The model incorporated data from the United Network for Organ Sharing and published sources.nnRESULTS: For patients with a model for end-stage liver disease (MELD) score ≥ 22, accepting any liver vs waiting for only HCV-negative livers was cost effective, with incremental cost-effectiveness ratios ranging from $56,100 to $91,700/quality-adjusted life-year. For patients with a MELD score of 28 (the median MELD score of patients undergoing transplantation in the United States), accepting any liver was cost effective at an incremental cost-effectiveness ratio of $62,600/quality-adjusted life year. In patients with low MELD scores, which may not accurately reflect disease severity, accepting any liver was cost effective, irrespective of MELD score.nnCONCLUSIONS: Using a Markov-based mathematical model, we found transplanting HCV-positive livers into HCV-negative patients with preemptive DAA therapy to be a cost-effective strategy that could improve health outcomes.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND & AIMS: Guidelines do not recommend transplanting hepatitis C virus (HCV)-infected livers into HCV-uninfected recipients. Direct-acting antivirals (DAAs) can be used to treat donor-derived HCV infection. However, the added cost of DAA therapy is a barrier. We evaluated the cost effectiveness of transplanting HCV-positive livers into HCV-negative patients with preemptive DAA therapy.nnMETHODS: A previously validated Markov-based mathematical model was adapted to simulate a virtual trial of HCV-negative patients on the liver transplant waitlist. The model compared long-term clinical and economic outcomes in patients willing to accept only HCV-negative livers vs those willing to accept any liver (HCV negative or HCV positive). Recipients of HCV-positive livers received 12 weeks of preemptive DAA therapy. The model incorporated data from the United Network for Organ Sharing and published sources.nnRESULTS: For patients with a model for end-stage liver disease (MELD) score ≥ 22, accepting any liver vs waiting for only HCV-negative livers was cost effective, with incremental cost-effectiveness ratios ranging from $56,100 to $91,700/quality-adjusted life-year. For patients with a MELD score of 28 (the median MELD score of patients undergoing transplantation in the United States), accepting any liver was cost effective at an incremental cost-effectiveness ratio of $62,600/quality-adjusted life year. In patients with low MELD scores, which may not accurately reflect disease severity, accepting any liver was cost effective, irrespective of MELD score.nnCONCLUSIONS: Using a Markov-based mathematical model, we found transplanting HCV-positive livers into HCV-negative patients with preemptive DAA therapy to be a cost-effective strategy that could improve health outcomes.
Klebanoff, Matthew J; Corey, Kathleen E; Samur, Sumeyye; Choi, Jin G; Kaplan, Lee M; Chhatwal, Jagpreet; Hur, Chin
Cost-effectiveness Analysis of Bariatric Surgery for Patients With Nonalcoholic Steatohepatitis Cirrhosis Journal Article
In: JAMA Netw Open, vol. 2, no. 2, pp. e190047, 2019, ISSN: 2574-3805.
@article{pmid30794300,
title = {Cost-effectiveness Analysis of Bariatric Surgery for Patients With Nonalcoholic Steatohepatitis Cirrhosis},
author = {Matthew J Klebanoff and Kathleen E Corey and Sumeyye Samur and Jin G Choi and Lee M Kaplan and Jagpreet Chhatwal and Chin Hur},
doi = {10.1001/jamanetworkopen.2019.0047},
issn = {2574-3805},
year = {2019},
date = {2019-02-01},
journal = {JAMA Netw Open},
volume = {2},
number = {2},
pages = {e190047},
abstract = {IMPORTANCE: Obesity is the most common risk factor for nonalcoholic steatohepatitis (NASH), the progressive form of nonalcoholic fatty liver disease that can lead to cirrhosis and hepatocellular carcinoma. Weight loss can be an effective treatment for obesity and may slow the progression of advanced liver disease.nnOBJECTIVE: To assess the cost-effectiveness of bariatric surgery in patients with NASH and compensated cirrhosis.nnDESIGN, SETTING, AND PARTICIPANTS: This economic evaluation study used a Markov-based state-transition model to simulate the benefits and risks of laparoscopic sleeve gastrectomy (SG), laparoscopic Roux-en-Y gastric bypass (GB), and intensive lifestyle intervention (ILI) compared with usual care in patients with NASH and compensated cirrhosis and varying baseline weight (overweight, mild obesity, moderate obesity, and severe obesity). Patients faced varied risks of perioperative mortality and complications depending on the type of surgery they underwent. Data were collected on March 22, 2017.nnMAIN OUTCOMES AND MEASURES: Life-years, quality-adjusted life-years (QALYs), costs (in 2017 $US), and incremental cost-effectiveness ratios (ICERs) were calculated.nnRESULTS: Demographic characteristics of the patient population were based on a previously published prospective study (n = 161). Patients in the model were 41.0% female, and the base case age was 54 years. Compared with usual care, SG was associated with an increase in QALYs of 0.263 to 1.180 (bounds of ranges represent overweight to severe obesity); GB, 0.263 to 1.207; and ILI, 0.004 to 0.216. Sleeve gastrectomy was also associated with an increase in life-years of 0.693 to 1.930; GB, 0.694 to 1.947; and ILI, 0.012 to 0.114. With usual care, expected life-years in overweight, mild obesity, moderate obesity, and severe obesity were 12.939, 11.949, 10.976, and 10.095, respectively. With usual care, QALY in overweight was 6.418; mild obesity, 5.790; moderate obesity, 5.186; and severe obesity, 4.577. Sleeve gastrectomy was the most cost-effective option for patients across all weight classes assessed: ICER for SG in patients with overweight was $66 119 per QALY; mild obesity, $18 716 per QALY; moderate obesity, $10 274 per QALY; and severe obesity, $6563 per QALY. A threshold analysis on the procedure cost of GB found that for GB to be cost-effective, the cost of the surgery must be decreased from its baseline value of $28 734 by $4889 for mild obesity, by $3189 for moderate obesity, and by $2289 for severe obesity. In overweight patients, GB involved fewer QALYs than SG, and thus decreasing the cost of surgery would not result in cost-effectiveness.nnCONCLUSIONS AND RELEVANCE: Bariatric surgery could be highly cost-effective in patients with NASH compensated cirrhosis and obesity or overweight. The findings from this analysis suggest that it can inform clinical trials evaluating the effect of bariatric procedures in patients with NASH cirrhosis, including those with a lower body mass index.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
IMPORTANCE: Obesity is the most common risk factor for nonalcoholic steatohepatitis (NASH), the progressive form of nonalcoholic fatty liver disease that can lead to cirrhosis and hepatocellular carcinoma. Weight loss can be an effective treatment for obesity and may slow the progression of advanced liver disease.nnOBJECTIVE: To assess the cost-effectiveness of bariatric surgery in patients with NASH and compensated cirrhosis.nnDESIGN, SETTING, AND PARTICIPANTS: This economic evaluation study used a Markov-based state-transition model to simulate the benefits and risks of laparoscopic sleeve gastrectomy (SG), laparoscopic Roux-en-Y gastric bypass (GB), and intensive lifestyle intervention (ILI) compared with usual care in patients with NASH and compensated cirrhosis and varying baseline weight (overweight, mild obesity, moderate obesity, and severe obesity). Patients faced varied risks of perioperative mortality and complications depending on the type of surgery they underwent. Data were collected on March 22, 2017.nnMAIN OUTCOMES AND MEASURES: Life-years, quality-adjusted life-years (QALYs), costs (in 2017 $US), and incremental cost-effectiveness ratios (ICERs) were calculated.nnRESULTS: Demographic characteristics of the patient population were based on a previously published prospective study (n = 161). Patients in the model were 41.0% female, and the base case age was 54 years. Compared with usual care, SG was associated with an increase in QALYs of 0.263 to 1.180 (bounds of ranges represent overweight to severe obesity); GB, 0.263 to 1.207; and ILI, 0.004 to 0.216. Sleeve gastrectomy was also associated with an increase in life-years of 0.693 to 1.930; GB, 0.694 to 1.947; and ILI, 0.012 to 0.114. With usual care, expected life-years in overweight, mild obesity, moderate obesity, and severe obesity were 12.939, 11.949, 10.976, and 10.095, respectively. With usual care, QALY in overweight was 6.418; mild obesity, 5.790; moderate obesity, 5.186; and severe obesity, 4.577. Sleeve gastrectomy was the most cost-effective option for patients across all weight classes assessed: ICER for SG in patients with overweight was $66 119 per QALY; mild obesity, $18 716 per QALY; moderate obesity, $10 274 per QALY; and severe obesity, $6563 per QALY. A threshold analysis on the procedure cost of GB found that for GB to be cost-effective, the cost of the surgery must be decreased from its baseline value of $28 734 by $4889 for mild obesity, by $3189 for moderate obesity, and by $2289 for severe obesity. In overweight patients, GB involved fewer QALYs than SG, and thus decreasing the cost of surgery would not result in cost-effectiveness.nnCONCLUSIONS AND RELEVANCE: Bariatric surgery could be highly cost-effective in patients with NASH compensated cirrhosis and obesity or overweight. The findings from this analysis suggest that it can inform clinical trials evaluating the effect of bariatric procedures in patients with NASH cirrhosis, including those with a lower body mass index.
Chen, Qiushi; Larochelle, Marc R; Weaver, Davis T; Lietz, Anna P; Mueller, Peter P; Mercaldo, Sarah; Wakeman, Sarah E; Freedberg, Kenneth A; Raphel, Tiana J; Knudsen, Amy B; Pandharipande, Pari V; Chhatwal, Jagpreet
Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States Journal Article
In: JAMA Netw Open, vol. 2, no. 2, pp. e187621, 2019, ISSN: 2574-3805.
@article{pmid30707224,
title = {Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States},
author = {Qiushi Chen and Marc R Larochelle and Davis T Weaver and Anna P Lietz and Peter P Mueller and Sarah Mercaldo and Sarah E Wakeman and Kenneth A Freedberg and Tiana J Raphel and Amy B Knudsen and Pari V Pandharipande and Jagpreet Chhatwal},
doi = {10.1001/jamanetworkopen.2018.7621},
issn = {2574-3805},
year = {2019},
date = {2019-02-01},
journal = {JAMA Netw Open},
volume = {2},
number = {2},
pages = {e187621},
abstract = {IMPORTANCE: Deaths due to opioid overdose have tripled in the last decade. Efforts to curb this trend have focused on restricting the prescription opioid supply; however, the near-term effects of such efforts are unknown.nnOBJECTIVE: To project effects of interventions to lower prescription opioid misuse on opioid overdose deaths from 2016 to 2025.nnDESIGN, SETTING, AND PARTICIPANTS: This system dynamics (mathematical) model of the US opioid epidemic projected outcomes of simulated individuals who engage in nonmedical prescription or illicit opioid use from 2016 to 2025. The analysis was performed in 2018 by retrospectively calibrating the model from 2002 to 2015 data from the National Survey on Drug Use and Health and the Centers for Disease Control and Prevention.nnINTERVENTIONS: Comparison of interventions that would lower the incidence of prescription opioid misuse from 2016 to 2025 based on historical trends (a 7.5% reduction per year) and 50% faster than historical trends (an 11.3% reduction per year), vs a circumstance in which the incidence of misuse remained constant after 2015.nnMAIN OUTCOMES AND MEASURES: Opioid overdose deaths from prescription and illicit opioids from 2016 to 2025 under each intervention.nnRESULTS: Under the status quo, the annual number of opioid overdose deaths is projected to increase from 33 100 in 2015 to 81 700 (95% uncertainty interval [UI], 63 600-101 700) in 2025 (a 147% increase from 2015). From 2016 to 2025, 700 400 (95% UI, 590 200-817 100) individuals in the United States are projected to die from opioid overdose, with 80% of the deaths attributable to illicit opioids. The number of individuals using illicit opioids is projected to increase by 61%-from 0.93 million (95% UI, 0.83-1.03 million) in 2015 to 1.50 million (95% UI, 0.98-2.22 million) by 2025. Across all interventions tested, further lowering the incidence of prescription opioid misuse from 2015 levels is projected to decrease overdose deaths by only 3.0% to 5.3%.nnCONCLUSIONS AND RELEVANCE: This study's findings suggest that interventions targeting prescription opioid misuse such as prescription monitoring programs may have a modest effect, at best, on the number of opioid overdose deaths in the near future. Additional policy interventions are urgently needed to change the course of the epidemic.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
IMPORTANCE: Deaths due to opioid overdose have tripled in the last decade. Efforts to curb this trend have focused on restricting the prescription opioid supply; however, the near-term effects of such efforts are unknown.nnOBJECTIVE: To project effects of interventions to lower prescription opioid misuse on opioid overdose deaths from 2016 to 2025.nnDESIGN, SETTING, AND PARTICIPANTS: This system dynamics (mathematical) model of the US opioid epidemic projected outcomes of simulated individuals who engage in nonmedical prescription or illicit opioid use from 2016 to 2025. The analysis was performed in 2018 by retrospectively calibrating the model from 2002 to 2015 data from the National Survey on Drug Use and Health and the Centers for Disease Control and Prevention.nnINTERVENTIONS: Comparison of interventions that would lower the incidence of prescription opioid misuse from 2016 to 2025 based on historical trends (a 7.5% reduction per year) and 50% faster than historical trends (an 11.3% reduction per year), vs a circumstance in which the incidence of misuse remained constant after 2015.nnMAIN OUTCOMES AND MEASURES: Opioid overdose deaths from prescription and illicit opioids from 2016 to 2025 under each intervention.nnRESULTS: Under the status quo, the annual number of opioid overdose deaths is projected to increase from 33 100 in 2015 to 81 700 (95% uncertainty interval [UI], 63 600-101 700) in 2025 (a 147% increase from 2015). From 2016 to 2025, 700 400 (95% UI, 590 200-817 100) individuals in the United States are projected to die from opioid overdose, with 80% of the deaths attributable to illicit opioids. The number of individuals using illicit opioids is projected to increase by 61%-from 0.93 million (95% UI, 0.83-1.03 million) in 2015 to 1.50 million (95% UI, 0.98-2.22 million) by 2025. Across all interventions tested, further lowering the incidence of prescription opioid misuse from 2015 levels is projected to decrease overdose deaths by only 3.0% to 5.3%.nnCONCLUSIONS AND RELEVANCE: This study's findings suggest that interventions targeting prescription opioid misuse such as prescription monitoring programs may have a modest effect, at best, on the number of opioid overdose deaths in the near future. Additional policy interventions are urgently needed to change the course of the epidemic.
Miksch, Florian; Jahn, Beate; Espinosa, Kurt Junshean; Chhatwal, Jagpreet; Siebert, Uwe; Popper, Nikolas
Why should we apply ABM for decision analysis for infectious diseases?-An example for dengue interventions Journal Article
In: PLoS One, vol. 14, no. 8, pp. e0221564, 2019, ISSN: 1932-6203.
@article{pmid31454373,
title = {Why should we apply ABM for decision analysis for infectious diseases?-An example for dengue interventions},
author = {Florian Miksch and Beate Jahn and Kurt Junshean Espinosa and Jagpreet Chhatwal and Uwe Siebert and Nikolas Popper},
doi = {10.1371/journal.pone.0221564},
issn = {1932-6203},
year = {2019},
date = {2019-01-01},
journal = {PLoS One},
volume = {14},
number = {8},
pages = {e0221564},
abstract = {For the evaluation of infectious-diseases interventions, the transmissible nature of such diseases plays a central role. Agent-based models (ABM) allow for dynamic transmission modeling but publications are limited. We aim to provide an overview of important characteristics of ABM for decision-analytic modeling of infectious diseases. A case study of dengue epidemics illustrates model characteristics, conceptualization, calibration and model analysis. First, major characteristics of ABM are outlined and discussed based on ISPOR and ISPOR-SMDM Good Practice guidelines. Second, in our case study, we modeled a dengue outbreak in Cebu City (Philippines) to assess the impact interventions to control the relative growth of the mosquito population. Model outcomes include prevalence and incidence of infected persons. The modular ABM simulates persons and mosquitoes over an annual time horizon considering daily time steps. The model was calibrated and validated. ABM is a dynamic, individual-level modeling approach that is capable to reproduce direct and indirect effects of interventions for infectious diseases. The ability to replicate emerging behavior and to include human behavior or the behavior of other agents is a distinguishing modeling characteristic (e.g., compared to Markov models). Modeling behavior may, however, require extensive calibration and validation. The analyzed hypothetical effectiveness of dengue interventions showed that a reduced human-mosquito ratio of 1:2.5 during rainy seasons leads already to a substantial decrease of infected persons. ABM can support decision-analyses for infectious diseases including disease dynamics, emerging behavior, and providing a high level of reusability due to modularity.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
For the evaluation of infectious-diseases interventions, the transmissible nature of such diseases plays a central role. Agent-based models (ABM) allow for dynamic transmission modeling but publications are limited. We aim to provide an overview of important characteristics of ABM for decision-analytic modeling of infectious diseases. A case study of dengue epidemics illustrates model characteristics, conceptualization, calibration and model analysis. First, major characteristics of ABM are outlined and discussed based on ISPOR and ISPOR-SMDM Good Practice guidelines. Second, in our case study, we modeled a dengue outbreak in Cebu City (Philippines) to assess the impact interventions to control the relative growth of the mosquito population. Model outcomes include prevalence and incidence of infected persons. The modular ABM simulates persons and mosquitoes over an annual time horizon considering daily time steps. The model was calibrated and validated. ABM is a dynamic, individual-level modeling approach that is capable to reproduce direct and indirect effects of interventions for infectious diseases. The ability to replicate emerging behavior and to include human behavior or the behavior of other agents is a distinguishing modeling characteristic (e.g., compared to Markov models). Modeling behavior may, however, require extensive calibration and validation. The analyzed hypothetical effectiveness of dengue interventions showed that a reduced human-mosquito ratio of 1:2.5 during rainy seasons leads already to a substantial decrease of infected persons. ABM can support decision-analyses for infectious diseases including disease dynamics, emerging behavior, and providing a high level of reusability due to modularity.
Spaulding, Anne C; Chhatwal, Jagpreet; Adee, Madeline G; Lawrence, Robert T; Beckwith, Curt G; von Oehsen, William
Funding Hepatitis C Treatment in Correctional Facilities by Using a Nominal Pricing Mechanism Journal Article
In: J Correct Health Care, vol. 25, no. 1, pp. 15–24, 2019, ISSN: 1940-5200.
@article{pmid30322323,
title = {Funding Hepatitis C Treatment in Correctional Facilities by Using a Nominal Pricing Mechanism},
author = {Anne C Spaulding and Jagpreet Chhatwal and Madeline G Adee and Robert T Lawrence and Curt G Beckwith and William von Oehsen},
doi = {10.1177/1078345818805770},
issn = {1940-5200},
year = {2019},
date = {2019-01-01},
journal = {J Correct Health Care},
volume = {25},
number = {1},
pages = {15--24},
abstract = {The cost of treating all incarcerated people who have hepatitis C with direct-acting antiviral agents (DAAs) greatly stresses correctional facility budgets. Complex federal laws bar pharmaceutical companies from simply discounting expensive medications to prices that facilities can afford. This article discusses means by which correctional facilities may qualify under federal law as "safety-net providers" to allow sale of DAAs at a price <10% of the average manufacturer price (AMP). No new laws would need to be enacted to implement this strategy. Using fiscal year 2018 pricing data from the Georgia Department of Corrections, we derived an estimate for the AMP and then used this estimate to calculate a nominal price. The United States would save ∼$3 billion if manufacturers sold DAAs at a nominal price to correctional facilities. Use of this strategy would help solve the conundrum of how state and county governments can pay for hepatitis C treatment and would ultimately save money for society.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The cost of treating all incarcerated people who have hepatitis C with direct-acting antiviral agents (DAAs) greatly stresses correctional facility budgets. Complex federal laws bar pharmaceutical companies from simply discounting expensive medications to prices that facilities can afford. This article discusses means by which correctional facilities may qualify under federal law as "safety-net providers" to allow sale of DAAs at a price <10% of the average manufacturer price (AMP). No new laws would need to be enacted to implement this strategy. Using fiscal year 2018 pricing data from the Georgia Department of Corrections, we derived an estimate for the AMP and then used this estimate to calculate a nominal price. The United States would save ∼$3 billion if manufacturers sold DAAs at a nominal price to correctional facilities. Use of this strategy would help solve the conundrum of how state and county governments can pay for hepatitis C treatment and would ultimately save money for society.
Sonawane, Kalyani; Chhatwal, Jagpreet; Deshmukh, Ashish A
Folic Acid-Containing Dietary Supplement Consumption and Risk of Cardiovascular Diseases in Rheumatoid Arthritis Patients: NHANES 1999-2014 Journal Article
In: J Gen Intern Med, vol. 34, no. 1, pp. 15–16, 2019, ISSN: 1525-1497.
@article{pmid30238402,
title = {Folic Acid-Containing Dietary Supplement Consumption and Risk of Cardiovascular Diseases in Rheumatoid Arthritis Patients: NHANES 1999-2014},
author = {Kalyani Sonawane and Jagpreet Chhatwal and Ashish A Deshmukh},
doi = {10.1007/s11606-018-4674-5},
issn = {1525-1497},
year = {2019},
date = {2019-01-01},
journal = {J Gen Intern Med},
volume = {34},
number = {1},
pages = {15--16},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2018
Chhatwal, Jagpreet; Chen, Qiushi; Bethea, Emily D; Ladd, Mary Ann; Mueller, Peter P; Hutin, Yvan; Aggarwal, Rakesh
Hep C Calculator: an online tool for cost-effectiveness analysis of DAAs Miscellaneous
2018, ISSN: 2468-1253.
@misc{pmid30507463,
title = {Hep C Calculator: an online tool for cost-effectiveness analysis of DAAs},
author = {Jagpreet Chhatwal and Qiushi Chen and Emily D Bethea and Mary Ann Ladd and Peter P Mueller and Yvan Hutin and Rakesh Aggarwal},
doi = {10.1016/S2468-1253(18)30281-4},
issn = {2468-1253},
year = {2018},
date = {2018-12-01},
journal = {Lancet Gastroenterol Hepatol},
volume = {3},
number = {12},
pages = {819},
keywords = {},
pubstate = {published},
tppubtype = {misc}
}
Goel, Amit; Chen, Qiushi; Chhatwal, Jagpreet; Aggarwal, Rakesh
Cost-effectiveness of generic pan-genotypic sofosbuvir/velpatasvir versus genotype-dependent direct-acting antivirals for hepatitis C treatment Journal Article
In: J Gastroenterol Hepatol, vol. 33, no. 12, pp. 2029–2036, 2018, ISSN: 1440-1746.
@article{pmid29864213,
title = {Cost-effectiveness of generic pan-genotypic sofosbuvir/velpatasvir versus genotype-dependent direct-acting antivirals for hepatitis C treatment},
author = {Amit Goel and Qiushi Chen and Jagpreet Chhatwal and Rakesh Aggarwal},
doi = {10.1111/jgh.14301},
issn = {1440-1746},
year = {2018},
date = {2018-12-01},
journal = {J Gastroenterol Hepatol},
volume = {33},
number = {12},
pages = {2029--2036},
abstract = {BACKGROUND AND AIM: Treatment of hepatitis C virus (HCV) infection with low-cost generic direct-acting antivirals (DAAs) available in India and other developing countries needs determination of HCV genotype ("genotype-dependent" regimens). Generic velpatasvir, a DAA that obviates the need for genotype determination ("pan-genotypic" regimen), recently became available but is costlier. The aim of this study was to evaluate the cost-effectiveness of genotype-dependent versus pan-genotypic DAA treatments in India.nnMETHODS: A previously validated microsimulation model, adapted to Indian population, was used to compare the costs and long-term outcomes of three scenarios: no treatment, treatment with genotype-dependent regimens, and treatment with pan-genotypic regimen. Input parameters were derived from literature. Using a payer's perspective and lifetime time horizon, quality-adjusted life-years (QALYs), total costs, and incremental cost-effectiveness ratio were calculated. Both deterministic and probabilistic sensitivity analyses were also conducted.nnRESULTS: At the current price ($US223 for 4 weeks), pan-genotypic regimen was cost-saving compared with no treatment. Compared with genotype-dependent regimens, it increased QALYs by 0.92 and increased costs by $US107 but was deemed cost-effective with an incremental cost-effectiveness ratio of $US242 per QALY gained. Probabilistic sensitivity analysis also supported the cost-effectiveness of pan-genotypic regimen. At the reduced price of $US188 for 4 weeks, the pan-genotypic regimen will become cost-neutral to genotype-dependent regimens (current price: $US100 for 4 weeks).nnCONCLUSIONS: At current prices, velpatasvir-based pan-genotypic regimen is cost-effective for HCV treatment in India where generic drugs are available. A reduction in the prices of pan-genotypic regimen has the potential to make its use cost-saving while simplifying treatment in community-level programs aimed at HCV elimination.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND AND AIM: Treatment of hepatitis C virus (HCV) infection with low-cost generic direct-acting antivirals (DAAs) available in India and other developing countries needs determination of HCV genotype ("genotype-dependent" regimens). Generic velpatasvir, a DAA that obviates the need for genotype determination ("pan-genotypic" regimen), recently became available but is costlier. The aim of this study was to evaluate the cost-effectiveness of genotype-dependent versus pan-genotypic DAA treatments in India.nnMETHODS: A previously validated microsimulation model, adapted to Indian population, was used to compare the costs and long-term outcomes of three scenarios: no treatment, treatment with genotype-dependent regimens, and treatment with pan-genotypic regimen. Input parameters were derived from literature. Using a payer's perspective and lifetime time horizon, quality-adjusted life-years (QALYs), total costs, and incremental cost-effectiveness ratio were calculated. Both deterministic and probabilistic sensitivity analyses were also conducted.nnRESULTS: At the current price ($US223 for 4 weeks), pan-genotypic regimen was cost-saving compared with no treatment. Compared with genotype-dependent regimens, it increased QALYs by 0.92 and increased costs by $US107 but was deemed cost-effective with an incremental cost-effectiveness ratio of $US242 per QALY gained. Probabilistic sensitivity analysis also supported the cost-effectiveness of pan-genotypic regimen. At the reduced price of $US188 for 4 weeks, the pan-genotypic regimen will become cost-neutral to genotype-dependent regimens (current price: $US100 for 4 weeks).nnCONCLUSIONS: At current prices, velpatasvir-based pan-genotypic regimen is cost-effective for HCV treatment in India where generic drugs are available. A reduction in the prices of pan-genotypic regimen has the potential to make its use cost-saving while simplifying treatment in community-level programs aimed at HCV elimination.
Suk, Ryan; Mahale, Parag; Sonawane, Kalyani; Sikora, Andrew G; Chhatwal, Jagpreet; Schmeler, Kathleen M; Sigel, Keith; Cantor, Scott B; Chiao, Elizabeth Y; Deshmukh, Ashish A
Trends in Risks for Second Primary Cancers Associated With Index Human Papillomavirus-Associated Cancers Journal Article
In: JAMA Netw Open, vol. 1, no. 5, pp. e181999, 2018, ISSN: 2574-3805.
@article{pmid30646145,
title = {Trends in Risks for Second Primary Cancers Associated With Index Human Papillomavirus-Associated Cancers},
author = {Ryan Suk and Parag Mahale and Kalyani Sonawane and Andrew G Sikora and Jagpreet Chhatwal and Kathleen M Schmeler and Keith Sigel and Scott B Cantor and Elizabeth Y Chiao and Ashish A Deshmukh},
doi = {10.1001/jamanetworkopen.2018.1999},
issn = {2574-3805},
year = {2018},
date = {2018-09-01},
journal = {JAMA Netw Open},
volume = {1},
number = {5},
pages = {e181999},
abstract = {IMPORTANCE: In the last 4 decades, survival among patients with human papillomavirus (HPV)-associated cancers has improved, while the incidence of these cancers has increased among younger cohorts. Among survivors of HPV-associated cancers, persistent HPV infection may remain a risk factor for preventable HPV-associated second primary cancers (HPV-SPCs).nnOBJECTIVES: To investigate the risk of HPV-SPCs among survivors of HPV-associated index cancers and to test the hypothesis that the HPV-SPC risk among these persons has increased over the last 4 decades.nnDESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of 9 cancer registries of the Surveillance, Epidemiology, and End Results (SEER) database was conducted to identify patients with HPV-associated (cervical, vaginal, vulvar, oropharyngeal, anal, and penile) cancers diagnosed from January 1, 1973, through December 31, 2014. The dates of analysis were July 1, 2017, to January 31, 2018.nnMAIN OUTCOMES AND MEASURES: The HPV-SPC risk was quantified by calculating standard incidence ratios (SIRs) and excess absolute risks (EARs) per 10 000 person-years at risk (PYR). The HPV-SPC risk by time was estimated using Poisson regression.nnRESULTS: From 113 272 (73 085 female and 40 187 male) survivors of HPV-associated cancers, 1397 women and 1098 men developed HPV-SPCs. The SIRs for HPV-SPCs were 6.2 (95% CI, 5.9-6.6) among women and 15.8 (95% CI, 14.9-16.8) among men. The EARs were 18.2 per 10 000 PYR for women and 53.5 per 10 000 PYR for men. Among both women and men, those who had index oropharyngeal cancers had the highest HPV-SPC risk (SIR, 19.8 [95% CI, 18.4-21.4] and EAR, 80.6 per 10 000 PYR among women; SIR, 18.0 [95% CI, 16.9-19.1] and EAR, 61.5 per 10 000 PYR among men). Women who had index cervical cancers and men who had index anal cancers had the lowest HPV-SPC risk (SIR, 2.4 [95% CI, 2.2-2.7] and EAR, 4.5 per 10 000 PYR among women; SIR, 6.5 [95% CI, 4.7-8.8] and EAR, 18.5 per 10 000 PYR among men). Both women and men who had index HPV-associated cancers of any kind had a significantly higher risk of oropharyngeal HPV-SPCs. Over the last 4 decades, the risk of developing most types of HPV-SPCs after index cervical, vaginal, and vulvar cancers increased.nnCONCLUSIONS AND RELEVANCE: According to this study, the HPV-SPC risk among survivors of HPV-associated cancers is significant, implying that persistent HPV infection at multiple sites may be associated with HPV-SPCs. These findings have the potential to inform surveillance recommendations for survivors of HPV-associated cancers.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
IMPORTANCE: In the last 4 decades, survival among patients with human papillomavirus (HPV)-associated cancers has improved, while the incidence of these cancers has increased among younger cohorts. Among survivors of HPV-associated cancers, persistent HPV infection may remain a risk factor for preventable HPV-associated second primary cancers (HPV-SPCs).nnOBJECTIVES: To investigate the risk of HPV-SPCs among survivors of HPV-associated index cancers and to test the hypothesis that the HPV-SPC risk among these persons has increased over the last 4 decades.nnDESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of 9 cancer registries of the Surveillance, Epidemiology, and End Results (SEER) database was conducted to identify patients with HPV-associated (cervical, vaginal, vulvar, oropharyngeal, anal, and penile) cancers diagnosed from January 1, 1973, through December 31, 2014. The dates of analysis were July 1, 2017, to January 31, 2018.nnMAIN OUTCOMES AND MEASURES: The HPV-SPC risk was quantified by calculating standard incidence ratios (SIRs) and excess absolute risks (EARs) per 10 000 person-years at risk (PYR). The HPV-SPC risk by time was estimated using Poisson regression.nnRESULTS: From 113 272 (73 085 female and 40 187 male) survivors of HPV-associated cancers, 1397 women and 1098 men developed HPV-SPCs. The SIRs for HPV-SPCs were 6.2 (95% CI, 5.9-6.6) among women and 15.8 (95% CI, 14.9-16.8) among men. The EARs were 18.2 per 10 000 PYR for women and 53.5 per 10 000 PYR for men. Among both women and men, those who had index oropharyngeal cancers had the highest HPV-SPC risk (SIR, 19.8 [95% CI, 18.4-21.4] and EAR, 80.6 per 10 000 PYR among women; SIR, 18.0 [95% CI, 16.9-19.1] and EAR, 61.5 per 10 000 PYR among men). Women who had index cervical cancers and men who had index anal cancers had the lowest HPV-SPC risk (SIR, 2.4 [95% CI, 2.2-2.7] and EAR, 4.5 per 10 000 PYR among women; SIR, 6.5 [95% CI, 4.7-8.8] and EAR, 18.5 per 10 000 PYR among men). Both women and men who had index HPV-associated cancers of any kind had a significantly higher risk of oropharyngeal HPV-SPCs. Over the last 4 decades, the risk of developing most types of HPV-SPCs after index cervical, vaginal, and vulvar cancers increased.nnCONCLUSIONS AND RELEVANCE: According to this study, the HPV-SPC risk among survivors of HPV-associated cancers is significant, implying that persistent HPV infection at multiple sites may be associated with HPV-SPCs. These findings have the potential to inform surveillance recommendations for survivors of HPV-associated cancers.
Chhatwal, Jagpreet; Bethea, Emily D; Samur, Sumeyye; Chung, Raymond T
Reply Miscellaneous
2018, ISSN: 1527-3350.
@misc{pmid29672882,
title = {Reply},
author = {Jagpreet Chhatwal and Emily D Bethea and Sumeyye Samur and Raymond T Chung},
doi = {10.1002/hep.30042},
issn = {1527-3350},
year = {2018},
date = {2018-08-01},
journal = {Hepatology},
volume = {68},
number = {2},
pages = {793},
keywords = {},
pubstate = {published},
tppubtype = {misc}
}
Deshmukh, Ashish A; Shirvani, Shervin M; Likhacheva, Anna; Chhatwal, Jagpreet; Chiao, Elizabeth Y; Sonawane, Kalyani
Reply to L. Yaghjyan et al Journal Article
In: JNCI Cancer Spectr, vol. 2, no. 3, pp. pky046, 2018, ISSN: 2515-5091.
@article{pmid31361277,
title = {Reply to L. Yaghjyan et al},
author = {Ashish A Deshmukh and Shervin M Shirvani and Anna Likhacheva and Jagpreet Chhatwal and Elizabeth Y Chiao and Kalyani Sonawane},
doi = {10.1093/jncics/pky046},
issn = {2515-5091},
year = {2018},
date = {2018-07-01},
journal = {JNCI Cancer Spectr},
volume = {2},
number = {3},
pages = {pky046},
keywords = {},
pubstate = {published},
tppubtype = {article}
}