Jag Chhawal Publications

@article{pmid38607627,

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

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

doi = {10.1001/jamanetworkopen.2024.6221},

issn = {2574-3805},

year  = {2024},

date = {2024-04-01},

journal = {JAMA Netw Open},

volume = {7},

number = {4},

pages = {e246221},

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

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pubstate = {published},

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}

@article{pmid37991182,

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

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

doi = {10.1097/SLA.0000000000006159},

issn = {1528-1140},

year  = {2024},

date = {2024-03-01},

urldate = {2024-03-01},

journal = {Ann Surg},

volume = {279},

issue = {3},

pages = {429-436},

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

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pubstate = {published},

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}

@article{pmid38470046,

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

author = {Elliot B Tapper and Jagpreet Chhatwal},

doi = {10.14309/ajg.0000000000002696},

issn = {1572-0241},

year  = {2024},

date = {2024-03-01},

journal = {Am J Gastroenterol},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38492923,

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

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

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

issn = {1524-4733},

year  = {2024},

date = {2024-03-01},

journal = {Value Health},

abstract = {OBJECTIVE: In 2018, Rwanda launched a national program to eliminate the hepatitis C virus (HCV). We aim to assess the impact of the program to date and identify strategies to achieve the World Health Organization's HCV elimination goals by 2030.nnMETHODS: We developed a microsimulation model to simulate Rwanda's HCV epidemic from 2015 through 2050 and evaluated temporal trends in HCV infection, prevalence, mortality, and the total cost of care for scenarios that could achieve HCV elimination by 2030.nnRESULTS: Between 2018 and 2022, over 7 million people were screened for HCV, and 60,000 were treated. The study projected that Rwanda could achieve HCV elimination as early as 2027. A feasible strategy of an annual screening rate of 15% and a treatment rate of 100% would achieve all WHO elimination goals by 2028, requiring screening an additional 4 million people and treating 23,900 patients by 2030. The elimination strategy costs $25 million for screening and diagnosis and $21 million for treatment from 2015 to 2050. The national program would avert 4,900 hepatocellular carcinoma cases and 6,700 HCV-related deaths and save the health system $25.33 million from 2015 to 2050.nnCONCLUSIONS: Rwanda is poised to become one of the first countries in the world to eliminate HCV. Rwanda's program serves as a blueprint for other countries in the African region. By rapid screening and treatment scale-up (e.g., by leveraging HIV platforms) and by drug price negotiations, HCV elimination is not only feasible but can be cost-saving in low-income settings.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37463414,

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

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

doi = {10.14309/ajg.0000000000002405},

issn = {1572-0241},

year  = {2024},

date = {2024-02-05},

urldate = {2023-07-01},

journal = {Am J Gastroenterol},

volume = {119},

issue = {2},

pages = {270-277},

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

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37302445,

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

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

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

issn = {1542-7714},

year  = {2024},

date = {2024-01-01},

urldate = {2024-01-01},

journal = {Clin Gastroenterol Hepatol},

volume = {22},

issue = {1},

pages = {91-101},

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

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37500964,

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

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

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

issn = {1432-1084},

year  = {2023},

date = {2023-12-01},

urldate = {2023-07-01},

journal = {Eur Radiol},

volume = {33},

number = {12},

pages = {9152-9166},

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

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pubstate = {published},

tppubtype = {article}

}

@article{pmid37439935,

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

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

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

issn = {1432-1084},

year  = {2023},

date = {2023-12-01},

urldate = {2023-07-01},

journal = {Eur Radiol},

volume = {33},

number = {12},

pages = {9167-9181},

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

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37703336,

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

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

doi = {10.1093/infdis/jiad227},

issn = {1537-6613},

year  = {2023},

date = {2023-09-13},

urldate = {2023-09-01},

journal = {J Infect Dis},

volume = {228},

number = {Supplement_3},

pages = {S160--S167},

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

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37703345,

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

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

doi = {10.1093/infdis/jiad138},

issn = {1537-6613},

year  = {2023},

date = {2023-09-13},

urldate = {2023-09-01},

journal = {J Infect Dis},

volume = {228},

number = {Supplement_3},

pages = {S189--S197},

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

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37461007,

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

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

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

issn = {1472-6963},

year  = {2023},

date = {2023-07-17},

urldate = {2023-07-01},

journal = {BMC Health Serv Res},

volume = {23},

number = {1},

pages = {760},

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

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37294571,

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

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

doi = {10.1001/jamanetworkopen.2023.14925},

issn = {2574-3805},

year  = {2023},

date = {2023-06-01},

journal = {JAMA Netw Open},

volume = {6},

number = {6},

pages = {e2314925},

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

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37204402,

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

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

doi = {10.1097/HC9.0000000000000146},

issn = {2471-254X},

year  = {2023},

date = {2023-05-19},

urldate = {2023-06-01},

journal = {Hepatol Commun},

volume = {7},

number = {6},

pages = {e0146},

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

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36549175,

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

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

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

issn = {1095-6859},

year  = {2023},

date = {2023-02-01},

urldate = {2022-12-01},

journal = {Gynecol Oncol},

volume = {169},

pages = {113--117},

abstract = {OBJECTIVE: Cervical cancer (CC) disproportionately affects women based on socioeconomic status and racial/ethnic background. There is limited research in quantifying and visualizing whether substantial geographical disparities in the US exist with respect to CC burden, and especially with respect to recurrent or metastatic CC (r/mCC) disease burden. Identifying regions with higher r/mCC burden may help inform effective healthcare resource allocation and navigating patients to appropriate care.



METHODS: We conducted a retrospective analysis of the 2015-2020 MarketScan® Commercial and Supplemental Medicare claims data; r/mCC burden was estimated as the number of patients initiating r/mCC systemic therapy over CC-diagnosed patients for each of the 410 metropolitan statistical areas (MSAs) considered. We developed a public, web-based tool, the Cervical Cancer Geographical Disease Burden Analyzer (Cervical Cancer Geo-Analyzer, http://www.geo-analyzer.org), that allows users to visualize r/mCC burden across MSAs over multiple years.



RESULTS: There was considerable variation in r/mCC burden across MSAs, with a range of 0-83.3%. Burden increased in Boston-Cambridge-Newton, MA (r/mCC to CC ratio: 41% in 2018 to 50% in 2020), and Sacramento-Roseville-Arden-Arcade, CA (33% in 2018 to 50% in 2020). On the other hand, while r/mCC burden remained high, it decreased in Grand Rapids, MI (55% in 2018 to 31% in 2020) and San Francisco-Oakland-Hayward, CA (40% in 2018 to 26% in 2020). There were regions with sparse or no data, suggesting a need for more representative data capture.



CONCLUSION: The Cervical Geo-Analyzer is a tool to visualize areas with high need for CC interventions. It also builds the foundation for further work to understand local risk factors of disease burden, identify populations of interest, characterize health disparities of CC or r/mCC and inform targeted interventions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36113098,

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

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

doi = {10.1177/0272989X221125418},

issn = {1552-681X},

year  = {2023},

date = {2023-01-01},

journal = {Med Decis Making},

volume = {43},

number = {1},

pages = {68--77},

abstract = {BACKGROUND: Metamodels can address some of the limitations of complex simulation models by formulating a mathematical relationship between input parameters and simulation model outcomes. Our objective was to develop and compare the performance of a machine learning (ML)-based metamodel against a conventional metamodeling approach in replicating the findings of a complex simulation model.



METHODS: We constructed 3 ML-based metamodels using random forest, support vector regression, and artificial neural networks and a linear regression-based metamodel from a previously validated microsimulation model of the natural history hepatitis C virus (HCV) consisting of 40 input parameters. Outcomes of interest included societal costs and quality-adjusted life-years (QALYs), the incremental cost-effectiveness (ICER) of HCV treatment versus no treatment, cost-effectiveness analysis curve (CEAC), and expected value of perfect information (EVPI). We evaluated metamodel performance using root mean squared error (RMSE) and Pearson's  on the normalized data.



RESULTS: The  values for the linear regression metamodel for QALYs without treatment, QALYs with treatment, societal cost without treatment, societal cost with treatment, and ICER were 0.92, 0.98, 0.85, 0.92, and 0.60, respectively. The corresponding  values for our ML-based metamodels were 0.96, 0.97, 0.90, 0.95, and 0.49 for support vector regression; 0.99, 0.83, 0.99, 0.99, and 0.82 for artificial neural network; and 0.99, 0.99, 0.99, 0.99, and 0.98 for random forest. Similar trends were observed for RMSE. The CEAC and EVPI curves produced by the random forest metamodel matched the results of the simulation output more closely than the linear regression metamodel.



CONCLUSIONS: ML-based metamodels generally outperformed traditional linear regression metamodels at replicating results from complex simulation models, with random forest metamodels performing best.



HIGHLIGHTS: Decision-analytic models are frequently used by policy makers and other stakeholders to assess the impact of new medical technologies and interventions. However, complex models can impose limitations on conducting probabilistic sensitivity analysis and value-of-information analysis, and may not be suitable for developing online decision-support tools.Metamodels, which accurately formulate a mathematical relationship between input parameters and model outcomes, can replicate complex simulation models and address the above limitation.The machine learning-based random forest model can outperform linear regression in replicating the findings of a complex simulation model. Such a metamodel can be used for conducting cost-effectiveness and value-of-information analyses or developing online decision support tools.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36506039,

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

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

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

issn = {2352-5789},

year  = {2022},

date = {2022-12-13},

urldate = {2022-12-13},

journal = {Gynecol Oncol Rep},

volume = {44},

number = {Suppl 1},

pages = {101121},

abstract = {PURPOSE: Contemporary, real-world data on eligible patients receiving treatment following progression on first-line (1L) recurrent or metastatic cervical cancer (r/mCC) therapy are needed to inform treatment algorithms and identify potential gaps in the r/mCC care continuum.



METHODS: This study estimated the prevalence and predictors of second-line (2L) r/mCC therapy among 1L-treated patients using the 2015-2020 IBM MarketScan® commercial claims database. Women ≥ 18 years diagnosed with cervical cancer and treated with first-line systemic therapies were identified and followed for 12 months from their 1L therapy end date. Women with claims for a new therapy after 60 days but no later than 365 days from the end of 1L treatment were identified as those who progressed and received 2L therapy for r/mCC. Descriptive statistics examined baseline cohort characteristics and multivariable logistic regression model examined the factors associated with receiving 2L treatment.



RESULTS: We identified 384 1L-treated patients with r/mCC with ≥ 12 months of follow-up post-1L treatment. During follow-up, over half (51.0 %) of the 1L-treated r/mCC patients received 2L treatment. Patients from the South and Midwest had a lower likelihood of receiving 2L treatment compared with those living in the Northeast (adjusted odds ratio [aOR] = 0.43; 0.23-0.84) and (aOR = 0.52; 0.28-0.95, respectively). Patients not treated with bevacizumab in 1L were also less likely to receive 2L therapy (aOR = 0.65; 0.43-0.99).



CONCLUSION: Additional research and targeted outreach efforts are needed to understand geography-, population-, or practice-specific barriers impacting access to 2L therapy among patients with r/mCC.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36327437,

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

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

doi = {10.14309/ajg.0000000000001968},

issn = {1572-0241},

year  = {2022},

date = {2022-11-01},

journal = {Am J Gastroenterol},

volume = {117},

number = {11},

pages = {1834--1844},

abstract = {INTRODUCTION: There are limited data on the effect and evolution of risk factors for hepatocellular carcinoma (HCC) in patients with virologically cured hepatitis C virus (HCV) infection.



METHODS: We conducted a retrospective cohort study of patients with HCV who achieved sustained virological response with direct-acting antivirals from 130 Veterans Administration hospitals during 2014-2018, followed through 2021. Cox proportional hazards models were constructed at 3 landmark times (baseline and 12 and 24 months after sustained virological response) to examine associations between demographic, clinical, and behavioral factors and HCC risk, stratified by cirrhosis status.



RESULTS: Among 92,567 patients (32% cirrhosis), 3,247 cases of HCC were diagnosed during a mean follow-up of 2.5 years. In patients with cirrhosis, male sex (hazard ratios [HR]: 1.89, 1.93, and 1.99), cirrhosis duration ≥5 years (HR: 1.71, 1.79, and 1.34), varices (HR: 1.73, 1.60, and 1.56), baseline albumin (HR: 0.48, 0.47, and 0.49), and change in albumin (HR: 0.82 and 0.90) predicted HCC risk at each landmark time. HCV genotype 3, previous treatment, bilirubin, smoking, and race influenced HCC risk at baseline, but their effects attenuated over time. In patients without cirrhosis, diabetes (HR: 1.54, 1.42, and 1.47) and hypertension (HR: 1.59, 1.65, and 1.74) were associated with HCC risk at all landmark times. Changes in fibrosis-4 scores over time were associated with HCC risk both in patients with and without cirrhosis.



DISCUSSION: Risk factors for HCC were different in patients with and without cirrhosis and some also evolved during follow-up. These factors can help with risk stratification and HCC surveillance decisions in patients with cured HCV.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35945907,

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

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

doi = {10.1002/hep4.2045},

issn = {2471-254X},

year  = {2022},

date = {2022-08-01},

journal = {Hepatol Commun},

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

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Mueller2022,

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

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

url = {https://pubmed.ncbi.nlm.nih.gov/35157959/},

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

issn = {1600-0641},

year  = {2022},

date = {2022-07-01},

urldate = {2022-02-01},

journal = {Journal of hepatology},

volume = {77},

issue = {1},

pages = {55-62},

abstract = {Successful treatment of chronic hepatitis C with oral direct-acting antiviral (DAA) leads to virological cure, however, the subsequent risk of hepatocellular carcinoma (HCC) persists. Our objective was to evaluate the cost-effectiveness of biannual surveillance for HCC in patients cured of hepatitis C and the optimal age to stop surveillance. We developed a microsimulation model of the natural history of HCC in hepatitis C individuals with advanced fibrosis or cirrhosis who achieved virological cure with oral DAAs. We used published data on HCC incidence, tumor progression, real-world HCC surveillance adherence, and costs and utilities of different health states. We compared biannual HCC surveillance using ultrasound and alpha-fetoprotein for varying durations of surveillance (from 5 years to lifetime) versus no surveillance. In virologically-cured patients with cirrhosis, the ICER of biannual surveillance remained below $150,000 per additional quality-adjusted life year (QALY) (range: $79,500-$94,800) when surveillance was stopped at age 70, irrespective of the start age (40-65). Compared with no surveillance, surveillance per 1000 cirrhosis patients detected 130 additional HCCs in 'very early'/early stage and yielded 51 additional QALYs. In virologically-cured patients with advanced fibrosis, the ICER of biannual surveillance remained below $150,000/QALY (range: $124,600-$129,800) when surveillance was stopped at age 60, irrespective of the start age (40-50). Compared with no surveillance, surveillance per 1000 advanced fibrosis patients detected 24 additional HCCs in 'very early'/early stage and yielded 12 additional QALYs. Biannual surveillance for HCC in virologically-cured hepatitis C patients is cost-effective until the age of 70 for cirrhosis patients, and until the age of 60 for patients with stable advanced fibrosis. Individuals who are cured of hepatitis C using oral antiviral drugs remain at risk of developing liver cancer. The value of lifelong screening for liver cancer in these individuals is not known. By simulating the life course of hepatitis C cured individuals, we found that ultrasound-based bi-annual screening for liver cancer is cost-effective up to age 70 in those having cirrhosis and up to age 60 in those having stable advanced fibrosis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Julien2021,

title = {Effect of Increased Alcohol Consumption During COVID-19 Pandemic on Alcohol-related Liver Disease: A Modeling Study.},

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

url = {https://pubmed.ncbi.nlm.nih.gov/34878683/},

doi = {10.1002/hep.32272},

issn = {1527-3350},

year  = {2022},

date = {2022-06-01},

urldate = {2021-12-01},

journal = {Hepatology (Baltimore, Md.)},

volume = {75},

issue = {6},

pages = {1480-1490},

abstract = {Alcohol consumption increased during the coronavirus disease-2019 (COVID-19) pandemic in 2020 in the U.S. We projected the effect of increased alcohol consumption on alcohol-related liver disease (ALD) and mortality. We extended a previously validated microsimulation model that estimated the short- and long-term effect of increased drinking during the COVID-19 pandemic in individuals in the US born between 1920-2012. We modeled short- and long-term outcomes of current drinking patterns during COVID-19 (status quo) using survey data of changes in alcohol consumption in a nationally representative sample between February and November 2020. We compared these outcomes with a counter-factual scenario wherein no COVID-19 occurs and drinking patterns do not change. One-year increase in alcohol consumption during the COVID-19 pandemic is estimated to result in 8,000 [95% UI 7,500-8,600] additional ALD-related deaths, 18,700 [95% UI 17,600-19,900] cases of decompensated cirrhosis, and 1,000 [95% UI 1,000-1,100] cases of HCC, and 8.9 million disability-adjusted life-years between 2020 and 2040. Between 2020 and 2023, alcohol consumption changes due to COVID-19 will lead to 100 [100-200] additional deaths and 2,800 [2,700-2,900] additional decompensated cirrhosis cases. A sustained increase in alcohol consumption for more than 1 year could result in additional morbidity and mortality. A short-term increase in alcohol consumption during the COVID-19 pandemic can substantially increase long-term ALD-related morbidity and mortality. Our findings highlight the need for individuals and policymakers to make informed decisions to mitigate the impact of high-risk alcohol drinking in the US.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35393253,

title = {COVID-19 Health Economics: Looking Back and Scoping the Future},

author = {Maarten J Postma and Jagpreet Chhatwal},

doi = {10.1016/j.jval.2022.03.008},

issn = {1524-4733},

year  = {2022},

date = {2022-05-01},

urldate = {2022-04-01},

journal = {Value Health},

volume = {25},

number = {5},

pages = {695-696},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35977324,

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

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

doi = {10.1001/jamahealthforum.2022.0760},

issn = {2689-0186},

year  = {2022},

date = {2022-04-01},

journal = {JAMA Health Forum},

volume = {3},

number = {4},

pages = {e220760},

abstract = {Importance: A key question for policy makers and the public is what to expect from the COVID-19 pandemic going forward as states lift nonpharmacologic interventions (NPIs), such as indoor mask mandates, to prevent COVID-19 transmission.



Objective: To project COVID-19 deaths between March 1, 2022, and December 31, 2022, in each of the 50 US states, District of Columbia, and Puerto Rico assuming different dates of lifting of mask mandates and NPIs.



Design Setting and Participants: This simulation modeling study used the COVID-19 Policy Simulator compartmental model to project COVID-19 deaths from March 1, 2022, to December 31, 2022, using simulated populations in the 50 US states, District of Columbia, and Puerto Rico. Projected current epidemiologic trends for each state until December 31, 2022, assuming the current pace of vaccination is maintained into the future and modeling different dates of lifting NPIs.



Exposures: Date of lifting statewide NPI mandates as March 1, April 1, May 1, June 1, or July 1, 2022.



Main Outcomes and Measures: Projected COVID-19 incident deaths from March to December 2022.



Results: With the high transmissibility of current circulating SARS-CoV-2 variants, the simulated lifting of NPIs in March 2022 was associated with resurgences of COVID-19 deaths in nearly every state. In comparison, delaying by even 1 month to lift NPIs in April 2022 was estimated to mitigate the amplitude of the surge. For most states, however, no amount of delay was estimated to be sufficient to prevent a surge in deaths completely. The primary factor associated with recurrent epidemics in the simulation was the assumed high effective reproduction number of unmitigated viral transmission. With a lower level of transmissibility similar to those of the ancestral strains, the model estimated that most states could remove NPIs in March 2022 and likely not see recurrent surges.



Conclusions and Relevance: This simulation study estimated that the SARS-CoV-2 virus would likely continue to take a major toll in the US, even as cases continued to decrease. Because of the high transmissibility of the recent Delta and Omicron variants, premature lifting of NPIs could pose a substantial threat of rebounding surges in morbidity and mortality. At the same time, continued delay in lifting NPIs may not prevent future surges.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35394862,

title = {Evaluation of individual and ensemble probabilistic forecasts of COVID-19 mortality in the United States},

author = {Estee Y Cramer and Evan L Ray and Velma K Lopez and Turgay Ayer and Madeline Adee and Jagpreet Chhatwal and Ozden O Dalgic and Mary A Ladd and Benjamin P Linas and Peter Mueller and Jade Xiao and 283 Authors and Nicholas G Reich},

doi = {10.1073/pnas.2113561119},

issn = {1091-6490},

year  = {2022},

date = {2022-04-01},

urldate = {2022-04-01},

journal = {Proc Natl Acad Sci U S A},

volume = {119},

number = {15},

pages = {e2113561119},

abstract = {SignificanceThis paper compares the probabilistic accuracy of short-term forecasts of reported deaths due to COVID-19 during the first year and a half of the pandemic in the United States. Results show high variation in accuracy between and within stand-alone models and more consistent accuracy from an ensemble model that combined forecasts from all eligible models. This demonstrates that an ensemble model provided a reliable and comparatively accurate means of forecasting deaths during the COVID-19 pandemic that exceeded the performance of all of the models that contributed to it. This work strengthens the evidence base for synthesizing multiple models to support public-health action.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Markby2021,

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

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

url = {https://pubmed.ncbi.nlm.nih.gov/34817928/},

doi = {10.1111/liv.15112},

issn = {1478-3231},

year  = {2022},

date = {2022-03-01},

urldate = {2021-11-01},

journal = {Liver international : official journal of the International Association for the Study of the Liver},

volume = {42},

issue = {3},

pages = {532-540},

abstract = {India has a significant burden of hepatitis C virus (HCV) infection and has committed to achieving national elimination by 2030. This will require a substantial scale-up in testing and treatment. The "HEAD-Start Project Delhi" aimed to enhance HCV diagnosis and treatment pathways among the general population. A prospective study was conducted at 5 district hospitals (Arm 1: one-stop shop), 15 polyclinics (Arm 2: referral for viral load (VL) testing and treatment), and 62 screening camps (Arm 3: referral for treatment). HCV prevalence, retention in the HCV care cascade, and turn-around time were measured. Between January and September 2019, 37,425 participants were screened for HCV. The median (IQR) age of participants was 35 (26-48) years, with 50.4% male and 49.6% female. A significantly higher proportion of participants in Arm 1 (93.7%) and Arm 3 (90.3%) received a VL test compared with Arm 2 (52.5%, P \< 0.001). Of those confirmed positive, treatment was initiated at significantly higher rates for participants in both Arms 1 (85.6%) and 2 (73.7%) compared to Arm 3 (41.8%, P \< 0.001). Arm 1 was found to be a cost-saving strategy compared to Arm 2, Arm 3, and no action. Delivery of all services at a single site (district hospitals) resulted in a higher yield of HCV seropositive cases and retention compared with sites where participants were referred elsewhere for VL testing and/or treatment. The highest level of retention in the care cascade was also associated with the shortest turn-around times.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35272954,

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

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

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

issn = {1524-4733},

year  = {2022},

date = {2022-03-01},

journal = {Value Health},

abstract = {OBJECTIVES: Hepatitis C virus (HCV) affects 58 million worldwide and > 79% of people remain undiagnosed. Rapid diagnostic tests (RDTs) for HCV can help improve diagnosis and treatment rates. Nevertheless, the high price and infrastructure needed to use current molecular HCV RDT options present a barrier to widespread use-particularly in low- and middle-income countries. We evaluated the performance and cost-effectiveness of a theoretical core antigen (cAg) RDT for HCV viremia confirmation, which requires fewer resources.



METHODS: We adapted a previously validated microsimulation model to simulate HCV disease progression and outcomes under different HCV testing algorithms in Georgia and Malaysia. We compared standard of care testing with laboratory-based ribonucleic acid HCV to a cAg-based RDT for HCV confirmation. We simulated a cohort of 10 000 adults in each country, with an HCV-ribonucleic acid prevalence of 5.40% in Georgia and 1.54% in Malaysia. We projected the cumulative healthcare costs, quality-adjusted life-years, and diagnosis coverage rates over a lifetime horizon.



RESULTS: Compared with the standard of care testing, the cAg-based RDT would increase quality-adjusted life-years by 270 in Georgia and 259 in Malaysia per 10 000 people. The high diagnosis rate and treatment rate of the cAg-based RDT result in substantial cost savings because of averted HCV sequelae management costs. Cost savings are $281 000 for Georgia and $781 000 for Malaysia.



CONCLUSIONS: We found that a cAg-based RDT for HCV could improve the diagnosis rate and result in cost savings. Such a test could have a substantial impact on the feasibility and cost of HCV elimination.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Adee2022,

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

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

url = {https://pubmed.ncbi.nlm.nih.gov/35177757/},

doi = {10.1038/s41598-022-07001-0},

issn = {2045-2322},

year  = {2022},

date = {2022-02-01},

journal = {Scientific reports},

volume = {12},

issue = {1},

pages = {3101},

keywords = {},

pubstate = {epublish},

tppubtype = {article}

}

@article{pmid36098969,

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

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

doi = {10.1001/jamanetworkopen.2022.30426},

issn = {2574-3805},

year  = {2022},

date = {2022-01-01},

journal = {JAMA Netw Open},

volume = {5},

number = {9},

pages = {e2230426},

abstract = {Importance: Quantitative assessment of disease progression in patients with nonalcoholic fatty liver disease (NAFLD) has not been systematically examined using competing liver-related and non-liver-related mortality.



Objective: To estimate long-term outcomes in NAFLD, accounting for competing liver-related and non-liver-related mortality associated with the different fibrosis stages of NAFLD using a simulated patient population.



Design, Setting, and Participants: This decision analytical modeling study used individual-level state-transition simulation analysis and was conducted from September 1, 2017, to September 1, 2021. A publicly available interactive tool, dubbed NAFLD Simulator, was developed that simulates the natural history of NAFLD by age and fibrosis stage at the time of (hypothetical) diagnosis defined by liver biopsy. Model health states were defined by fibrosis states F0 to F4, decompensated cirrhosis, hepatocellular carcinoma (HCC), and liver transplant. Simulated patients could experience nonalcoholic steatohepatitis resolution, and their fibrosis stage could progress or regress. Transition probabilities between states were estimated from the literature as well as calibration, and the model reproduced the outcomes of a large observational study.



Exposure: Simulated natural history of NAFLD.



Main Outcomes and Measures: Main outcomes were life expectancy; all cause, liver-related, and non-liver-related mortality; and cumulative incidence of decompensated cirrhosis and/or HCC.



Results: The model included 1 000 000 simulated patients with a mean (range) age of 49 (18-75) years at baseline, including 66% women. The life expectancy of patients aged 49 years was 25.3 (95% CI, 20.1-29.8) years for those with F0, 25.1 (95% CI, 20.1-29.4) years for those with F1, 23.6 (95% CI, 18.3-28.2) years for those with F2, 21.1 (95% CI, 15.6-26.3) years for those with F3, and 13.8 (95% CI, 10.3-17.6) years for those with F4 at the time of diagnosis. The estimated 10-year liver-related mortality was 0.1% (95% uncertainty interval [UI], <0.1%-0.2%) in F0, 0.2% (95% UI, 0.1%-0.4%) in F1, 1.0% (95% UI, 0.6%-1.7%) in F2, 4.0% (95% UI, 2.5%-5.9%) in F3, and 29.3% (95% UI, 21.8%-35.9%) in F4. The corresponding 10-year non-liver-related mortality was 1.8% (95% UI, 0.6%-5.0%) in F0, 2.4% (95% UI, 0.8%-6.3%) in F1, 5.2% (95% UI, 2.0%-11.9%) in F2, 9.7% (95% UI, 4.3%-18.1%) in F3, and 15.6% (95% UI, 10.1%-21.7%) in F4. Among patients aged 65 years, estimated 10-year non-liver-related mortality was higher than liver-related mortality in all fibrosis stages (eg, F2: 16.7% vs 0.8%; F3: 28.8% vs 3.0%; F4: 40.8% vs 21.9%).



Conclusions and Relevance: This decision analytic model study simulated stage-specific long-term outcomes, including liver- and non-liver-related mortality in patients with NAFLD. Depending on age and fibrosis stage, non-liver-related mortality was higher than liver-related mortality in patients with NAFLD. By translating surrogate markers into clinical outcomes, the NAFLD Simulator could be used as an educational tool among patients and clinicians to increase awareness of the health consequences of NAFLD.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Damgacioglu2021,

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

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

url = {https://pubmed.ncbi.nlm.nih.gov/34927126/},

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

issn = {2667-193X},

year  = {2021},

date = {2021-12-01},

journal = {Lancet Regional Health. Americas},

pages = {100143},

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

keywords = {},

pubstate = {aheadofprint},

tppubtype = {article}

}

@article{pmid34952885,

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

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

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

issn = {2044-6055},

year  = {2021},

date = {2021-12-01},

journal = {BMJ Open},

volume = {11},

number = {12},

pages = {e055142},

abstract = {INTRODUCTION: To achieve the elimination of hepatitis C virus (HCV), substantial scale-up in access to testing and treatment is needed. This will require innovation and simplification of the care pathway, through decentralisation of testing and treatment to primary care settings and task-shifting to non-specialists. The objective of this study was to evaluate the feasibility and effectiveness of decentralisation of HCV testing and treatment using rapid diagnostic tests (RDTs) in primary healthcare clinics (PHCs) among high-risk populations, with referral of seropositive patients for confirmatory viral load testing and treatment.



METHODS: This observational study was conducted between December 2018 and October 2019 at 25 PHCs in three regions in Malaysia. Each PHC was linked to one or more hospitals, for referral of seropositive participants for confirmatory testing and pretreatment evaluation. Treatment was provided in PHCs for non-cirrhotic patients and at hospitals for cirrhotic patients.



RESULTS: During the study period, a total of 15 366 adults were screened at the 25 PHCs, using RDTs for HCV antibodies. Of the 2020 (13.2%) HCV antibody-positive participants, 1481/2020 (73.3%) had a confirmatory viral load test, 1241/1481 (83.8%) were HCV RNA-positive, 991/1241 (79.9%) completed pretreatment assessment, 632/991 (63.8%) initiated treatment, 518/632 (82.0%) completed treatment, 352/518 (68.0%) were eligible for a sustained virological response (SVR) cure assessment, 209/352 (59.4%) had an SVR cure assessment, and SVR was achieved in 202/209 (96.7%) patients. A significantly higher proportion of patients referred to PHCs initiated treatment compared with those who had treatment initiated at hospitals (71.0% vs 48.8%, p<0.001).



CONCLUSIONS: This study demonstrated the effectiveness and feasibility of a simplified decentralised HCV testing and treatment model in primary healthcare settings, targeting high-risk groups in Malaysia. There were good outcomes across most steps of the cascade of care when treatment was provided at PHCs compared with hospitals.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Adee2021a,

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

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

url = {https://pubmed.ncbi.nlm.nih.gov/34725356/},

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

issn = {2045-2322},

year  = {2021},

date = {2021-11-01},

journal = {Scientific reports},

volume = {11},

pages = {21382},

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

keywords = {},

pubstate = {epublish},

tppubtype = {article}

}

@article{Khurshid2021a,

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 Choi and Chin Hur and Patrick T. Ellinor and David D. McManus and Jagpreet Chhatwal and Steven A. Lubitz},

url = {https://pubmed.ncbi.nlm.nih.gov/34476979/},

doi = {10.1161/JAHA.120.020330},

issn = {2047-9980},

year  = {2021},

date = {2021-09-21},

urldate = {2021-09-21},

journal = {Journal of the American Heart Association},

volume = {10},

number = {18},

pages = {e021144},

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}

}

@article{Khurshid2021,

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},

url = {https://pubmed.ncbi.nlm.nih.gov/34387130/},

doi = {10.1161/JAHA.121.021144},

issn = {2047-9980},

year  = {2021},

date = {2021-08-01},

journal = {Journal of the American Heart Association},

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}

}

@article{Toumi2021,

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},

url = {https://pubmed.ncbi.nlm.nih.gov/34402891/},

doi = {10.1001/jamanetworkopen.2021.19621},

issn = {2574-3805},

year  = {2021},

date = {2021-08-01},

urldate = {2021-08-01},

journal = {JAMA network open},

volume = {4},

pages = {e2119621},

abstract = {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. 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. 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. Hosting NFL or NCAA games. 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. 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. 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}

}

@article{Toumi2020,

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},

url = {https://pubmed.ncbi.nlm.nih.gov/33280499/},

doi = {10.1089/thy.2020.0643},

issn = {1557-9077},

year  = {2021},

date = {2021-06-18},

urldate = {2021-06-18},

journal = {Thyroid : official journal of the American Thyroid Association},

volume = {31},

number = {6},

pages = {941-949},

abstract = {\textbf{Background:} 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 post-operative 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. \textbf{Methods:} 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 before and after the release of the 2015 ATA guidelines. \textbf{Results:} A total of 220,088 patients who underwent thyroid surgery were included in the analysis. Approximately 80% of thyroid lobectomies (TL) were performed in the outpatient setting vs. 70% of total thyroidectomies (TT). Longitudinal analysis showed a statistically significant changepoint for TT proportion occurring in November 2015. The proportion of TT as compared to 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. \textbf{Conclusions:} 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}

}

@article{Chhatwal2021,

title = {Health Economics of Interventions to Tackle the Coronavirus 2019 Pandemic.},

author = {Jagpreet Chhatwal and Maarten J Postma},

url = {https://pubmed.ncbi.nlm.nih.gov/33933227/},

doi = {10.1016/j.jval.2021.03.002},

issn = {1524-4733},

year  = {2021},

date = {2021-05-01},

journal = {Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research},

volume = {24},

pages = {605--606},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Adee2021,

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},

url = {https://pubmed.ncbi.nlm.nih.gov/33868647/},

doi = {10.1002/cld.1109},

issn = {2046-2484},

year  = {2021},

date = {2021-03-01},

urldate = {2021-03-01},

journal = {Clinical liver disease},

volume = {17},

pages = {99--106},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Hornberger2021,

title = {\"{O}pioid Misuse: A Global Crisis."},

author = {John Hornberger and Jagpreet Chhatwal},

url = {https://pubmed.ncbi.nlm.nih.gov/33518020/},

doi = {10.1016/j.jval.2020.12.003},

issn = {1524-4733},

year  = {2021},

date = {2021-02-01},

journal = {Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research},

volume = {24},

number = {2},

pages = {145--146},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Linas2021,

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 Cerd\'{a} and Katherine Keyes and Jagpreet Chhatwal},

url = {https://pubmed.ncbi.nlm.nih.gov/33298298/},

doi = {10.1016/j.jsat.2020.108158},

issn = {1873-6483},

year  = {2021},

date = {2021-01-01},

urldate = {2021-01-01},

journal = {Journal of substance abuse treatment},

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}

}

@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 = {2021-01-01},

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}

}

@article{pmid34952885b,

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

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

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

issn = {2044-6055},

year  = {2021},

date = {2021-01-01},

journal = {BMJ Open},

volume = {11},

number = {12},

pages = {e055142},

abstract = {INTRODUCTION: To achieve the elimination of hepatitis C virus (HCV), substantial scale-up in access to testing and treatment is needed. This will require innovation and simplification of the care pathway, through decentralisation of testing and treatment to primary care settings and task-shifting to non-specialists. The objective of this study was to evaluate the feasibility and effectiveness of decentralisation of HCV testing and treatment using rapid diagnostic tests (RDTs) in primary healthcare clinics (PHCs) among high-risk populations, with referral of seropositive patients for confirmatory viral load testing and treatment.



METHODS: This observational study was conducted between December 2018 and October 2019 at 25 PHCs in three regions in Malaysia. Each PHC was linked to one or more hospitals, for referral of seropositive participants for confirmatory testing and pretreatment evaluation. Treatment was provided in PHCs for non-cirrhotic patients and at hospitals for cirrhotic patients.



RESULTS: During the study period, a total of 15 366 adults were screened at the 25 PHCs, using RDTs for HCV antibodies. Of the 2020 (13.2%) HCV antibody-positive participants, 1481/2020 (73.3%) had a confirmatory viral load test, 1241/1481 (83.8%) were HCV RNA-positive, 991/1241 (79.9%) completed pretreatment assessment, 632/991 (63.8%) initiated treatment, 518/632 (82.0%) completed treatment, 352/518 (68.0%) were eligible for a sustained virological response (SVR) cure assessment, 209/352 (59.4%) had an SVR cure assessment, and SVR was achieved in 202/209 (96.7%) patients. A significantly higher proportion of patients referred to PHCs initiated treatment compared with those who had treatment initiated at hospitals (71.0% vs 48.8%, p<0.001).



CONCLUSIONS: This study demonstrated the effectiveness and feasibility of a simplified decentralised HCV testing and treatment model in primary healthcare settings, targeting high-risk groups in Malaysia. There were good outcomes across most steps of the cascade of care when treatment was provided at PHCs compared with hospitals.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Tordrup2020,

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},

url = {https://pubmed.ncbi.nlm.nih.gov/33248510/},

doi = {10.1016/j.jval.2020.06.015},

issn = {1524-4733},

year  = {2020},

date = {2020-12-01},

journal = {Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research},

volume = {23},

pages = {1552--1560},

abstract = {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. 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). 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. 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}

}

@article{Ebrahim2020,

title = {Generation and analysis of U.S. county-level policy dataset demonstrates correlations of COVID-19 policies with reduced incidence.},

author = {Senan Ebrahim and Henry Ashworth and Cray Noah and Adesh Kadambi and Asmae Toumi and Jagpreet Chhatwal},

url = {https://pubmed.ncbi.nlm.nih.gov/33302253/},

doi = {10.2196/24614},

issn = {1438-8871},

year  = {2020},

date = {2020-12-01},

urldate = {2020-12-01},

journal = {Journal of medical Internet research},

abstract = {Worldwide, non-pharmacologic interventions (NPIs) have been the main tool used to mitigate the Coronavirus Disease (COVID-19) pandemic. While preliminary research across the globe has shown NPI policy to be effective, there is currently a lack of information on NPI effectiveness in the United States. The purpose of this study was to create a granular NPI dataset at the county level and then analyze the relationship between NPI policies and changes in reported COVID-19 cases. Using a standardized crowdsourcing methodology, we collected time series data on seven key NPIs for 1,320 U.S. counties. This open source dataset is the largest and most comprehensive county NPI policy dataset 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). 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 dataset will explore the relationship between county-level policies and COVID-19 transmission to optimize real-time policy formulation.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{QChen2020,

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 Adee and Xiaojie Wang and Fasiha Kanwal and Jagpreet Chhatwal},

url = {https://pubmed.ncbi.nlm.nih.gov/33206188/},

doi = {10.1001/jamanetworkopen.2020.21173},

issn = {2574-3805},

year  = {2020},

date = {2020-11-01},

journal = {JAMA network open},

volume = {3},

pages = {e2021173},

abstract = {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. To assess projected changes in the incidence rate of and surveillance burden for HCC in the era of DAA treatment for HCV. 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. Current clinical management for chronic HCV infection. 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. 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. 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}

}

@article{Butala2020,

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},

url = {https://pubmed.ncbi.nlm.nih.gov/33167699/},

doi = {10.1161/CIRCINTERVENTIONS.120.010027},

issn = {1941-7632},

year  = {2020},

date = {2020-11-01},

journal = {Circulation. Cardiovascular interventions},

volume = {13},

pages = {e010027},

abstract = {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. 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. 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. 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}

}

@article{Aldridge2020,

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},

url = {https://pubmed.ncbi.nlm.nih.gov/33152672/},

doi = {10.1016/j.drugalcdep.2020.108336},

issn = {1879-0046},

year  = {2020},

date = {2020-10-01},

journal = {Drug and alcohol dependence},

volume = {217},

pages = {108336},

abstract = {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. 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. 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}

}

@article{Julien2020,

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 Bethea and Elliot B. Tapper and Jagpreet Chhatwal},

url = {https://pubmed.ncbi.nlm.nih.gov/32504584/},

doi = {10.1016/S2468-2667(20)30062-1},

issn = {2468-2667},

year  = {2020},

date = {2020-06-01},

journal = {The Lancet. Public health},

volume = {5},

pages = {e316--e323},

abstract = {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. 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. 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). 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. American Cancer Society and the Robert Wood Johnson Health Policy Research Fellowship.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Ozturk2020,

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},

url = {https://www.ncbi.nlm.nih.gov/pubmed/32005510},

doi = {10.1016/j.ultrasmedbio.2019.12.020},

issn = {1879-291X},

year  = {2020},

date = {2020-04-01},

journal = {Ultrasound in medicine \& biology},

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}

}

@article{Zhuo2020,

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},

url = {https://www.ncbi.nlm.nih.gov/pubmed/32139872},

doi = {10.1038/s41598-020-60986-4},

issn = {2045-2322},

year  = {2020},

date = {2020-03-01},

urldate = {2020-03-01},

journal = {Scientific reports},

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}

}

@article{Tapper2020,

title = {We are Not Meeting the Needs of Pharmacoeconomic Models of Nonalcoholic Steatohepatitis, But We Can.},

author = {Elliot B Tapper and Jagpreet Chhatwal},

url = {https://www.ncbi.nlm.nih.gov/pubmed/32086769},

doi = {10.1007/s40273-020-00892-9},

issn = {1179-2027},

year  = {2020},

date = {2020-02-01},

journal = {PharmacoEconomics},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Hatzakis2019,

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},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31808281},

doi = {10.1111/liv.14282},

issn = {1478-3231},

year  = {2019},

date = {2019-12-01},

journal = {Liver international : official journal of the International Association for the Study of the Liver},

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}

}

@article{Dalgic2019a,

title = {Improved Health Outcomes from Hepatitis C Treatment Scale-Up in Spain's Prisons: A Cost-Effectiveness Study.},

author = {Ozden Onur Dalgic and Sumeyye K. Samur and Anne C Spaulding and Susana Llerena and Carmen Cobo and Turgay Ayer and Mark S Roberts and Javier Crespo and Jagpreet Chhatwal},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31727921},

doi = {10.1038/s41598-019-52564-0},

issn = {2045-2322},

year  = {2019},

date = {2019-11-01},

urldate = {2019-11-01},

journal = {Scientific reports},

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}

}

@article{Spaulding2019a,

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},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30938455},

doi = {10.1002/hep.30636},

issn = {1527-3350},

year  = {2019},

date = {2019-08-01},

journal = {Hepatology (Baltimore, Md.)},

volume = {70},

pages = {758--759},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Miksch2019,

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},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31454373},

doi = {10.1371/journal.pone.0221564},

issn = {1932-6203},

year  = {2019},

date = {2019-08-01},

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}

}

@article{Jahn2019,

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},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31016686},

doi = {10.1007/s40258-019-00475-6},

issn = {1179-1896},

year  = {2019},

date = {2019-08-01},

journal = {Applied health economics and health policy},

volume = {17},

number = {4},

pages = {493-511},

abstract = {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. We systematically reviewed the literature and methods to assess how closely BIA guidelines are followed when BIAs are performed for cancer-screening programs. 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. Eligible studies were BIAs evaluating cancer-screening programs published in English, 2010-2018. Standardized evidence tables were generated to extract and compare study characteristics outlined by the ISPOR BIA Task Force. 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. "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. 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}

}

@article{LeeBP2019,

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 K. Samur and Ozden Onur Dalgic and Emily 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},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30998988},

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},

abstract = {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. 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. Patients offered early liver transplantation were estimated to have an average life expectancy of 6.55 life-years, compared to an average life expectancy of 1.46 life-years for patients offered delayed liver transplants (4.49-fold increase). Net survival benefit from 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 to 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. 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 following transplant. These findings support early liver transplantation for patients with severe AH. The survival benefit was maintained in all simulated extreme scenarios, but should be confirmed in prospective studies. Sustained alcohol use following transplantation significantly reduced but did not eliminate the benefits of early transplantation-strategies are needed to prevent and treat post-transplantation use of alcohol.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2019a,

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 Bethea and Chin Hur and Anne C Spaulding and Fasiha Kanwal},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31115920},

doi = {10.1111/apt.15291},

issn = {1365-2036},

year  = {2019},

date = {2019-07-01},

journal = {Alimentary pharmacology \& therapeutics},

volume = {50},

number = {1},

pages = {66-74},

abstract = {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. To estimate the current and future HCV care cascade in the United States, nationally and in select subpopulations of interest. 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. 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. 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}

}

@article{Jahn2019a,

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},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31253053},

doi = {10.1177/0272989X19851095},

issn = {1552-681X},

year  = {2019},

date = {2019-07-01},

urldate = {2019-07-01},

journal = {Medical decision making : an international journal of the Society for Medical Decision 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-Pad\'{e} 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}

}

@article{Chen2019,

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},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31189677},

doi = {10.1136/bmjopen-2018-026726},

issn = {2044-6055},

year  = {2019},

date = {2019-06-01},

journal = {BMJ open},

volume = {9},

pages = {e026726},

abstract = {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. A mathematical simulation model of natural history of HCV infection. HCV-infected patients defined based on country-specific age, fibrosis and genotype distributions. HCV screening practice and availability of different waves of DAA treatment in each country. 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. 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. 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}

}

@article{Chhatwal2019,

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},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31074817},

doi = {10.1001/jamanetworkopen.2019.3613},

issn = {2574-3805},

year  = {2019},

date = {2019-05-01},

urldate = {2019-05-01},

journal = {JAMA network open},

volume = {2},

pages = {e193613},

abstract = {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. To investigate whether and under what conditions HCV elimination is feasible in Pakistan and to estimate the cost of such elimination. 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. 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. 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. 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. 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}

}

@article{Klebanoff2019,

title = {Cost-effectiveness Analysis of Bariatric Surgery for Patients With Nonalcoholic Steatohepatitis Cirrhosis.},

author = {Matthew Klebanoff and Kathleen E Corey and Sumeyye K. Samur and Jin Choi and Lee M Kaplan and Jagpreet Chhatwal and Chin Hur},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30794300},

doi = {10.1001/jamanetworkopen.2019.0047},

issn = {2574-3805},

year  = {2019},

date = {2019-02-01},

journal = {JAMA network open},

volume = {2},

number = {2},

pages = {e190047},

abstract = {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. To assess the cost-effectiveness of bariatric surgery in patients with NASH and compensated cirrhosis. 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. Life-years, quality-adjusted life-years (QALYs), costs (in 2017 $US), and incremental cost-effectiveness ratios (ICERs) were calculated. 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. 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}

}

@article{10.1001/jamanetworkopen.2018.7621,

title = {Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States},

author = {Qiushi Chen and Marc R. Larochelle and Davis Weaver and Anna Lietz and Peter P. Mueller and Sarah Fletcher Mercaldo and Sarah E. Wakeman and Kenneth A. Freedberg and Tiana Raphel and Amy Knudsen and Pari Pandharipande and Jagpreet Chhatwal},

url = {https://dx.doi.org/10.1001/jamanetworkopen.2018.7621},

doi = {10.1001/jamanetworkopen.2018.7621},

issn = {2574-3805},

year  = {2019},

date = {2019-02-01},

journal = {JAMA Network Open},

volume = {2},

number = {2},

pages = {e187621-e187621},

abstract = {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.To project effects of interventions to lower prescription opioid misuse on opioid overdose deaths from 2016 to 2025.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.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.Opioid overdose deaths from prescription and illicit opioids from 2016 to 2025 under each intervention.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%\textemdashfrom 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%.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}

}

@article{Sonawane2019,

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},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31880792},

doi = {10.1001/jamanetworkopen.2019.18571},

issn = {2574-3805},

year  = {2019},

date = {2019-01-01},

journal = {JAMA Network Open},

volume = {2},

number = {12},

pages = {e1918571-e1918571},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2018c,

title = {Universal screening for hepatitis C: an important step in virus elimination.},

author = {Jagpreet Chhatwal and Norman L Sussman},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30528843},

doi = {10.1016/j.cgh.2018.12.002},

issn = {1542-7714},

year  = {2018},

date = {2018-12-01},

urldate = {2018-12-01},

journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{CHHATWAL2018819,

title = {Hep C Calculator: an online tool for cost-effectiveness analysis of DAAs},

author = {Jagpreet Chhatwal and Qiushi Chen and Emily Bethea and Mary Ann Ladd and Peter P. Mueller and Yvan Hutin and Rakesh Aggarwal},

url = {http://www.sciencedirect.com/science/article/pii/S2468125318302814},

doi = {https://doi.org/10.1016/S2468-1253(18)30281-4},

issn = {2468-1253},

year  = {2018},

date = {2018-12-01},

urldate = {2018-12-01},

journal = {The Lancet Gastroenterology \& Hepatology},

volume = {3},

number = {12},

pages = {819},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Spaulding2018a,

title = {Funding Hepatitis C Treatment in Correctional Facilities by Using a Nominal Pricing Mechanism.},

author = {Anne C Spaulding and Jagpreet Chhatwal and Madeline Adee and Robert T Lawrence and Curt G Beckwith and William Oehsen},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30322323},

doi = {10.1177/1078345818805770},

issn = {1940-5200},

year  = {2018},

date = {2018-10-01},

journal = {Journal of correctional health care : the official journal of the National Commission on Correctional Health Care},

pages = {1078345818805770},

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}

}

@article{Suk2018,

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},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30646145},

doi = {10.1001/jamanetworkopen.2018.1999},

issn = {2574-3805},

year  = {2018},

date = {2018-09-01},

journal = {JAMA network open},

volume = {1},

pages = {e181999},

abstract = {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). 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. 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. 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. 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. 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}

}

@article{Sonawane2018,

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},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30238402},

doi = {10.1007/s11606-018-4674-5},

issn = {1525-1497},

year  = {2018},

date = {2018-09-01},

journal = {Journal of general internal medicine},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Bethea2018,

title = {Cost-effectiveness of Transplanting HCV-Infected Livers into Uninfected Recipients with Preemptive Antiviral Therapy.},

author = {Emily Bethea and Sumeyye K. Samur and Fasiha Kanwal and Turgay Ayer and Chin Hur and Mark S Roberts and Norah Terrault and Raymond T Chung and Jagpreet Chhatwal},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30138735},

doi = {10.1016/j.cgh.2018.08.042},

issn = {1542-7714},

year  = {2018},

date = {2018-08-01},

journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},

abstract = {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. 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 (HCV-negative or HCV-positive) liver. 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. 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 that may not accurately reflect disease severity, accepting any liver was cost effective, irrespective of MELD score. Using a Markov-based mathematical model, we found transplanting HCV-positive livers in HCV-negative patients with preemptive DAA therapy to be a cost-effective strategy that could improve health outcomes.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Deshmukh2018a,

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},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31361277},

doi = {10.1093/jncics/pky046},

issn = {2515-5091},

year  = {2018},

date = {2018-07-01},

journal = {JNCI cancer spectrum},

volume = {2},

pages = {pky046},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Goel2018,

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},

url = {https://www.ncbi.nlm.nih.gov/pubmed/29864213},

doi = {10.1111/jgh.14301},

issn = {1440-1746},

year  = {2018},

date = {2018-06-01},

journal = {Journal of gastroenterology and hepatology},

abstract = {Treatment of 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. To evaluate the cost-effectiveness of genotype-dependent versus pan-genotypic DAA treatments in India. A previously-validated microsimulation model, adapted to Indian population, was used to compare the costs and long-term outcomes of three scenarios: no treatment, and treatment with genotype-dependent and pan-genotypic regimens. Input parameters were derived from literature. Using a payer's perspective and life-time time horizon, quality-adjusted life years (QALYs), total costs, and incremental cost-effectiveness ratio (ICER) were calculated. Both deterministic and probabilistic sensitivity analyses were also conducted. At the current price (US$ 223 for 4 weeks), pan-genotypic regimen was cost-saving compared to no treatment. Compared with genotype-dependent regimens, it increased QALYs by 0.92 and increased costs by US$ 107, but was deemed cost-effective with an ICER of US$ 242 per QALY gained. Probabilistic sensitivity analysis also supported the cost-effectiveness of pan-genotypic regimen. At the reduced price of US$ 188 for 4 weeks, the pan-genotypic regimen will become cost-neutral to genotype-dependent regimens (current price: US$100 for 4 weeks). 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}

}

@article{Spaulding2018,

title = {Five Questions Concerning Managing Hepatitis C in the Justice System: Finding Practical Solutions for Hepatitis C Virus Elimination.},

author = {Anne C Spaulding and Madeline Adee and Robert T Lawrence and Jagpreet Chhatwal and William Oehsen},

url = {http://www.ncbi.nlm.nih.gov/pubmed/29778259},

doi = {10.1016/j.idc.2018.02.014},

issn = {1557-9824},

year  = {2018},

date = {2018-06-01},

journal = {Infectious disease clinics of North America},

volume = {32},

number = {2},

pages = {323--345},

abstract = {An estimated 30% of Americans with hepatitis C virus (HCV) pass through a jail or prison annually. One in 7 incarcerated persons is viremic. Screening and treatment is cost-effective and beneficial to society as a whole. Yet at current (2018) levels of funding for HCV management, prisons are not aggressively seeking cases; few incarcerated persons with HCV actually receive treatment. This article explores barriers to screening for and treating hepatitis C in state prisons, and ways that states may overcome these barriers, such as nominal pricing. While high prices for direct-acting antivirals discourage treatment, potential strategies exist to lower prices.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2017d,

title = {Transplanting Hepatitis C Virus-positive Livers Into Hepatitis C Virus-egative Patients With Preemptive Antiviral Treatment: A Modeling Study.},

author = {Jagpreet Chhatwal and Sumeyye K. Samur and Emily Bethea and Turgay Ayer and Fasiha Kanwal and Chin Hur and Mark S Roberts and Norah Terrault and Raymond T Chung},

url = {http://www.ncbi.nlm.nih.gov/pubmed/29222916},

doi = {10.1002/hep.29723},

issn = {1527-3350},

year  = {2018},

date = {2018-06-01},

journal = {Hepatology (Baltimore, Md.)},

volume = {67},

number = {6},

pages = {2085-2095},

abstract = {Under current guidelines hepatitis C virus (HCV)-positive livers are not transplanted into HCV-negative recipients because of adverse post-transplant outcomes associated with allograft HCV infection. However, HCV can now be cured post liver transplant (LT) using direct-acting antivirals (DAAs) with \>90% success; therefore, HCV-negative patients on the liver transplant (LT) waiting list may benefit from accepting HCV-positive organs with preemptive treatment. Our objective was to evaluate if and in which HCV-negative patients the potential benefit of accepting an HCV-positive (i.e., viremic) organ outweighed the risks associated with HCV allograft infection. We developed a Markov-based mathematical model that simulated a virtual trial of HCV-negative patients on the LT waiting list to compare long-term outcomes in patients: 1) willing to accept any (HCV-negative or HCV-positive) liver versus 2) those willing to accept only HCV-negative livers. Patients receiving HCV-positive livers were treated preemptively with 12 weeks of DAA therapy and had a higher risk of graft failure than those receiving HCV-negative livers. The model incorporated data from published studies and the United Network for Organ Sharing (UNOS). We found that accepting any liver regardless of HCV status versus accepting only HCV-negative livers resulted in an increase in life expectancy when MELD was ≥ 20, and the benefit was highest at MELD 28 (0.172 additional life years). The magnitude of clinical benefit was greater in UNOS regions with higher HCV-positive donor organ rates, i.e. Regions 1, 2, 3, 10, and 11. Sensitivity analysis demonstrated that model outcomes were robust. Transplanting HCV-positive livers into HCV-negative patients with preemptive DAA therapy could improve patient survival on the LT waiting list. Our analysis can help inform clinical trials and minimize patient harm. This article is protected by copyright. All rights reserved.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2018b,

title = {Estimation of Hepatitis C Disease Burden and Budget Impact of Treatment Using Health Economic Modeling.},

author = {Jagpreet Chhatwal and Qiushi Chen and Rakesh Aggarwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/29778266},

doi = {10.1016/j.idc.2018.02.008},

issn = {1557-9824},

year  = {2018},

date = {2018-06-01},

urldate = {2018-06-01},

journal = {Infectious disease clinics of North America},

volume = {32},

pages = {461--480},

abstract = {Oral direct-acting antiviral agents have revolutionized treatment of hepatitis C virus (HCV) infection. Nonetheless, barriers exist to elimination of HCV as a public health threat including low uptake of treatment, limited budget allocations for HCV treatment, and low awareness rates of HCV status among infected people. Mathematical modeling provides a systematic framework to analyze and compare potential solutions and elimination strategies by simulating the HCV epidemic under different conditions. Such models evaluate impact of interventions in advance of implementation. This article describes key components of developing an HCV burden model and illustrates its use by simulating the HCV epidemic in the United States.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Deshmukh2018,

title = {The Association Between Dietary Quality and Overall and Cancer-Specific Mortality Among Cancer Survivors, NHANES III.},

author = {Ashish A Deshmukh and Shervin M Shirvani and Anna Likhacheva and Jagpreet Chhatwal and Elizabeth Y Chiao and Kalyani Sonawane},

url = {https://www.ncbi.nlm.nih.gov/pubmed/29905226},

doi = {10.1093/jncics/pky022},

issn = {2515-5091},

year  = {2018},

date = {2018-04-01},

journal = {JNCI cancer spectrum},

volume = {2},

pages = {pky022},

abstract = {Given the recent emphasis on the totality of the diet by national guidelines, we examined the relationship between the quality of diet and overall and cancer-specific mortality among cancer survivors. From the Third National Health and Nutrition Examination Survey (NHANES III), 1191 participants diagnosed with cancer were identified. Healthy Eating Index (HEI) scores were utilized; higher HEI score indicated better adherence to dietary recommendations. During a median follow-up of 17.2 years, a total of 607 cancer-specific deaths occurred. A high-quality diet (highest-quartile HEI score) was associated with decreased risk of overall (hazard ratio [HR] = 0.59, 95% confidence interval [CI] = 0.45 to 0.77) and cancer-specific (HR = 0.35, 95% CI = 0.19 to 0.63) mortality when compared with a poor-quality diet (lowest-quartile HEI score). Among individual dietary components, the highest-quartile score for saturated fat intake was associated decreased cancer-specific mortality (HR = 0.55, 95% CI = 0.36 to 0.86). Our results highlight the importance of a "total diet" approach to improving survival among cancer patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2018a,

title = {Reply to Expanding Donor Pool for Liver Transplantation by Utilizing Hepatitis C Virus-Infected Donors for Uninfected Recipients.},

author = {Jagpreet Chhatwal and Emily Bethea and Sumeyye K. Samur and Raymond T Chung},

url = {http://www.ncbi.nlm.nih.gov/pubmed/29672882},

doi = {10.1002/hep.30042},

issn = {1527-3350},

year  = {2018},

date = {2018-04-01},

journal = {Hepatology (Baltimore, Md.)},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Bethea2017,

title = {Should we treat acute hepatitis C? A decision and cost-effectiveness analysis},

author = {Emily Bethea and Qiushi Chen and Chin Hur and Raymond T Chung and Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/29059461},

doi = {10.1002/hep.29611},

issn = {1527-3350},

year  = {2018},

date = {2018-03-01},

journal = {Hepatology (Baltimore, Md.)},

volume = {67},

number = {3},

pages = {837-846},

abstract = {It is not standard practice to treat patients with acute hepatitis C virus (HCV) infection. However, as the incidence of HCV in the United States continues to rise, it may be time to re-evaluate acute HCV management in the era of direct-acting antiviral agents (DAAs). In this study a microsimulation model was developed to analyze the tradeoffs between initiating HCV therapy in the acute versus chronic phase of infection. By simulating the lifetime clinical course of patients with acute HCV infection, we were able to project long-term outcomes such as quality-adjusted life years (QALYs) and costs. We found that treating acute HCV versus deferring treatment until the chronic phase increased QALYs by 0.02 and increased costs by $483 in patients not at risk of transmitting HCV. The resulting incremental cost effectiveness ratio (ICER) was $19,991 per QALY, demonstrating that treatment of acute HCV was cost-effective using a willingness-to-pay threshold of $100,000 per QALY. In patients at risk of transmitting HCV, treating acute HCV became cost-saving, increasing QALYs by 0.03 and decreasing costs by $3655. Immediate treatment of acute HCV with DAAs can improve clinical outcomes and be highly cost-effective or cost-saving compared with deferring treatment until the chronic phase of infection. If future studies continue to demonstrate effective HCV cure with shorter 6 week treatment duration, then it may be time to revisit current HCV guidelines to incorporate recommendations that account for the clinical and economic benefits of treating acute HCV in the era of DAAs. This article is protected by copyright. All rights reserved.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2018,

title = {Hepatitis C virus re-treatment in the era of direct-acting antivirals: projections in the USA.},

author = {Jagpreet Chhatwal and Qiushi Chen and T Ayer and Emily Bethea and F Kanwal and K V Kowdley and X Wang and M S Roberts and S C Gordon},

url = {https://www.ncbi.nlm.nih.gov/pubmed/29377245},

doi = {10.1111/apt.14527},

issn = {1365-2036},

year  = {2018},

date = {2018-01-01},

journal = {Alimentary pharmacology \& therapeutics},

abstract = {The introduction of oral direct-acting antivirals (DAAs) has dramatically changed the landscape of HCV treatment. However, a small percentage of patients fail to achieve sustained virologic response (SVR). Understanding the number of people who fail on DAAs and require re-treatment is important for budget impact and disease burden projections. To quantify the number of HCV patients who fail to achieve SVR on oral DAAs (NS5A vs. non-NS5A) and require re-treatment. We used a mathematical model to simulate clinical management of HCV in the USA, which included the implementation of HCV screening, treatment, and disease progression. We simulated different waves of DAA treatment and used real-world data to extract SVR rates and market shares of available therapies. Our model projected that the number of people living without viraemia (i.e. cured) would increase from 0.70 million in 2014 to 1.78 million by 2020. Between 2014 and 2020, 1.50 million people would receive treatment with DAAs, of whom 124 000 (8.3%) are projected to fail to achieve SVR. Among those treatment failures, 66 600 (53.7%) patients would fail treatment with NS5A inhibitors and 69 600 (56.1%) would have cirrhosis. During the same period, 34 200 people would progress to decompensated cirrhosis and 27 300 would develop hepatocellular carcinoma after failing to achieve SVR. Even in the era of highly effective DAAs, a significant number of patients will fail to achieve SVR and will require re-treatment options. Timely and effective re-treatment is essential to prevent the long-term sequelae of HCV.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Samur2017,

title = {Cost-Effectiveness of Pre versus Post Liver Transplant Hepatitis C Treatment with Direct-Acting Antivirals},

author = {Sumeyye K. Samur and Brian Kues and Turgay Ayer and Mark S Roberts and Fasiha Kanwal and Chin Hur and Drew Michael S Donnell and Raymond T Chung and Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/28634131},

doi = {10.1016/j.cgh.2017.06.024},

issn = {1542-7714},

year  = {2018},

date = {2018-01-01},

journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},

volume = {16},

number = {1},

pages = {115-122},

abstract = {Oral direct-acting antivirals (DAAs) for hepatitis C virus (HCV) treatment offer new hope to both pre- and post-liver transplant (LT) patients. However, whether to treat HCV patients pre- versus post-LT is not clear, as treatment can improve liver function but could reduce the chance of receiving a LT while on the waiting list. Our objective was to evaluate the cost-effectiveness of pre-LT versus post-LT HCV treatment with oral DAAs in decompensated cirrhotic patients on the LT waiting list. We used a validated mathematical model that simulated a virtual trial comparing long-term clinical and cost outcomes of pre-LT versus post-LT HCV treatment with oral DAAs. Model parameters were estimated from United Network for Organ Sharing (UNOS) data, SOLAR-1 and 2 trials, and published studies. For each strategy, we estimated the quality-adjusted life year (QALY), life expectancy, cost, and the incremental cost-effectiveness ratio. For lower MELD scores, QALYs were higher with pre-LT HCV treatment compared to post-LT treatment. Pre-LT HCV treatment was cost-saving in patients with MELD ≤15, and cost-effective in patients with MELD 16-21. In contrast, post-LT HCV treatment was cost-effective in patients with MELD 22-29 and cost-saving if MELD ≥30. Results varied by drug prices and by UNOS regions. For cirrhotic patients awaiting LT, pre-LT HCV treatment with DAAs is cost-effective/saving in patients with MELD≤21, whereas post-LT HCV treatment is cost-effective/saving in patients with MELD≥22.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Samur2017c,

title = {Reply to More Sensitivity Analysis of Share 35, Human Immunodeficiency Virus Co-infection, Delist, Hospital Cost on Cost Effectiveness of Direct-Acting Antiviral Agents for Liver Transplant Hepatitis C Virus Patients.},

author = {Sumeyye K. Samur and Emily Bethea and Raymond T Chung and Jagpreet Chhatwal},

url = {https://www.ncbi.nlm.nih.gov/pubmed/28864272},

doi = {10.1016/j.cgh.2017.08.030},

issn = {1542-7714},

year  = {2017},

date = {2017-12-01},

journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},

volume = {15},

pages = {1981},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Kabiri2017,

title = {Long-term disease and economic outcomes of prior authorization criteria for Hepatitis C treatment in Pennsylvania Medicaid.},

author = {Mina Kabiri and Jagpreet Chhatwal and Julie M Donohue and Mark S Roberts and A Everette James and Michael A Dunn and Walid F Gellad},

url = {http://www.ncbi.nlm.nih.gov/pubmed/27932263},

doi = {10.1016/j.hjdsi.2016.11.001},

issn = {2213-0772},

year  = {2017},

date = {2017-12-01},

journal = {Healthcare (Amsterdam, Netherlands)},

volume = {5},

number = {3},

pages = {105--111},

abstract = {Several highly effective but costly therapies for hepatitis C virus (HCV) are available. As a consequence of their high price, 36 state Medicaid programs limited treatment coverage to patients with more advanced HCV stages. States have only limited information available to predict the long-term impact of these decisions. We adapted a validated hepatitis C microsimulation model to the Pennsylvania Medicaid population to estimate the existing HCV prevalence in Pennsylvania Medicaid and estimate the impact of various HCV drug coverage policies on disease outcomes and costs. Outcome measures included rates of advanced-stage HCV outcomes and treatment and disease costs in both Medicaid and Medicare. We estimated that 46,700 individuals in Pennsylvania Medicaid were infected with HCV in 2015, 33% of whom were still undiagnosed. By expanding treatment to include mild fibrosis stage (Metavir F2), Pennsylvania Medicaid will spend an additional $273 million on medications in the next decade with no substantial reduction in the incidence of liver cancer or liver-related death. Medicaid patients who are not eligible for treatment under restricted policies would get treatment once they transition to the Medicare program, which would incur 10% reduction in HCV-related costs due to early treatment in Medicaid. Further expanding treatment to patients with early fibrosis stages (F0 or F1) would cost Medicaid an additional $693 million during the next decade but would reduce the number of individuals in need of treatment in Medicare by 46% and decrease Medicare treatment costs by 23%. In some scenarios, outcomes could worsen with eligibility expansion if there is inadequate capacity to treat all patients. Expansion of HCV treatment coverage to less severe stages of liver disease may not substantially improve liver related outcomes for patients in Pennsylvania Medicaid in scenarios in which coverage through Medicare is widely available.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2017e,

title = {Cost-Effectiveness and Decision Analysis in Clinical Gastroenterology and Hepatology: From Evidence to Informed Decision Making.},

author = {Jagpreet Chhatwal and Fasiha Kanwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/29246695},

doi = {10.1016/j.cgh.2017.12.010},

issn = {1542-7714},

year  = {2017},

date = {2017-12-01},

journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2017f,

title = {Reply to Societal Perspectives and Patient/Public Involvement in Direct-Acting Antiviral Agent Coverage of Hepatitis C Treatment in the United States.},

author = {Jagpreet Chhatwal},

url = {https://www.ncbi.nlm.nih.gov/pubmed/28782665},

doi = {10.1016/j.cgh.2017.07.031},

issn = {1542-7714},

year  = {2017},

date = {2017-11-01},

journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},

volume = {15},

pages = {1815},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Capan2017,

title = {From Data to Improved Decisions: Operations Research in Healthcare Delivery},

author = {Muge Capan and Anahita Khojandi and Brian T Denton and Kimberly D Williams and Turgay Ayer and Jagpreet Chhatwal and Murat Kurt and Jennifer Mason Lobo and Mark S Roberts and Greg Zaric and Shengfan Zhang and J Sanford Schwartz},

url = {http://www.ncbi.nlm.nih.gov/pubmed/28423982},

doi = {10.1177/0272989X17705636},

issn = {1552-681X},

year  = {2017},

date = {2017-11-01},

journal = {Medical decision making : an international journal of the Society for Medical Decision Making},

volume = {37},

number = {8},

pages = {849-859},

abstract = {The Operations Research Interest Group (ORIG) within the Society of Medical Decision Making (SMDM) is a multidisciplinary interest group of professionals that specializes in taking an analytical approach to medical decision making and healthcare delivery. ORIG is interested in leveraging mathematical methods associated with the field of Operations Research (OR) to obtain data-driven solutions to complex healthcare problems and encourage collaborations across disciplines. This paper introduces OR for the non-expert and draws attention to opportunities where OR can be utilized to facilitate solutions to healthcare problems. Decision making is the process of choosing between possible solutions to a problem with respect to certain metrics. OR concepts can help systematically improve decision making through efficient modeling techniques while accounting for relevant constraints. Depending on the problem, methods that are part of OR (e.g., linear programming, Markov Decision Processes) or methods that are derived from related fields (e.g., regression from statistics) can be incorporated into the solution approach. This paper highlights the characteristics of different OR methods that have been applied to healthcare decision making and provides examples of emerging research opportunities. We illustrate OR applications in healthcare using previous studies, including diagnosis and treatment of diseases, organ transplants, and patient flow decisions. Further, we provide a selection of emerging areas for utilizing OR. There is a timely need to inform practitioners and policy makers of the benefits of using OR techniques in solving healthcare problems. OR methods can support the development of sustainable long-term solutions across disease management, service delivery, and health policies by optimizing the performance of system elements and analyzing their interaction while considering relevant constraints.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{He2017,

title = {Systematic review: cost-effectiveness of direct-acting antivirals for treatment of hepatitis C genotypes 2-6},

author = {T He and M A Lopez-Olivo and Chin Hur and Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/28836278},

doi = {10.1111/apt.14271},

issn = {1365-2036},

year  = {2017},

date = {2017-10-01},

journal = {Alimentary pharmacology \& therapeutics},

volume = {46},

number = {8},

pages = {711-721},

abstract = {The availability of direct-acting antivirals (DAAs) has dramatically changed the landscape of hepatitis C virus (HCV) therapy; however, the cost and budget requirements for DAA treatment have been widely debated. To systematically review published studies evaluating the cost-effectiveness of DAAs for HCV genotype 2-6 infections, and synthesise and re-evaluate results with updated drug prices. We conducted a systematic search of various electronic databases, including Medline, EMBASE, Cochrane library and EconLit for cost-effectiveness studies published from 2011 to 2016. Studies evaluating DAAs for genotypes 2-6 were included. Reported costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were abstracted. We re-estimated ICERs by varying the price of DAAs from $20 000 to $100 000, and estimated the threshold price at which DAA regimens would be deemed cost-effective (ICER≤$100 000/QALY). A total of 92 ICERs for 7 different DAA regimens from 10 published articles were included. Among the abstracted 92 ICERs, 20 were for genotype 2, 40 for genotype 3, 30 for genotype 4, 2 for genotype 5 and none for genotype 6; therefore, only genotypes 2-5 were analysed. At the discounted price of $40 000, 87.0% analyses found DAA regiments to be cost-effective, and 7.6% found to be cost-saving. The median threshold price below which DAAs would be deemed cost-effective was between $144 400 and $225 000, and cost-saving between $17 300 and $25 400. HCV treatment with DAAs is highly cost-effective in patients with HCV genotypes 2-5 at a $100 000/QALY threshold. Timely HCV treatment would be an optimal strategy from both a public health and economic perspective.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Sonawane2017,

title = {Oral Human Papillomavirus Infection: Differences in Prevalence Between Sexes and Concordance With Genital Human Papillomavirus Infection, NHANES 2011 to 2014},

author = {Kalyani Sonawane and Ryan Suk and Elizabeth Y Chiao and Jagpreet Chhatwal and Peihua Qiu and Timothy Wilkin and Alan G Nyitray and Andrew G Sikora and Ashish A Deshmukh},

url = {http://www.ncbi.nlm.nih.gov/pubmed/29049523},

doi = {10.7326/M17-1363},

issn = {1539-3704},

year  = {2017},

date = {2017-10-01},

urldate = {2017-10-01},

journal = {Annals of internal medicine},

abstract = {The burden of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is disproportionately high among men, yet empirical evidence regarding the difference in prevalence of oral HPV infection between men and women is limited. Concordance of oral and genital HPV infection among men is unknown. To determine the prevalence of oral HPV infection, as well as the concordance of oral and genital HPV infection, among U.S. men and women. Nationally representative survey. Civilian noninstitutionalized population. Adults aged 18 to 69 years from NHANES (National Health and Nutritional Examination Survey, 2011 to 2014). Oral rinse, penile swab, and vaginal swab specimens were evaluated by polymerase chain reaction followed by type-specific hybridization. The overall prevalence of oral HPV infection was 11.5% (95% CI, 9.8% to 13.1%) in men and 3.2% (CI, 2.7% to 3.8%) in women (equating to 11 million men and 3.2 million women nationwide). High-risk oral HPV infection was more prevalent among men (7.3% [CI, 6.0% to 8.6%]) than women (1.4% [CI, 1.0% to 1.8%]). Oral HPV 16 was 6 times more common in men (1.8% [CI, 1.3% to 2.2%]) than women (0.3% [CI, 0.1% to 0.5%]) (1.7 million men vs. 0.27 million women). Among men and women who reported having same-sex partners, the prevalence of high-risk HPV infection was 12.7% (CI, 7.0% to 18.4%) and 3.6% (CI, 1.4% to 5.9%), respectively. Among men who reported having 2 or more same-sex oral sex partners, the prevalence of high-risk HPV infection was 22.2% (CI, 9.6% to 34.8%). Oral HPV prevalence among men with concurrent genital HPV infection was fourfold greater (19.3%) than among those without it (4.4%). Men had 5.4% (CI, 5.1% to 5.8%) greater predicted probability of high-risk oral HPV infection than women. The predicted probability of high-risk oral HPV infection was greatest among black participants, those who smoked more than 20 cigarettes daily, current marijuana users, and those who reported 16 or more lifetime vaginal or oral sex partners. Sexual behaviors were self-reported. Oral HPV infection is common among U.S. men. This study's findings provide several policy implications to guide future OPSCC prevention efforts to combat this disease. National Cancer Institute.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2017c,

title = {Hepatitis C screening: From modeling to public health policy},

author = {Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/29020269},

doi = {10.1093/cid/cix800},

issn = {1537-6591},

year  = {2017},

date = {2017-09-01},

journal = {Clinical infectious diseases : an official publication of the Infectious Diseases Society of America},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Deshmukh2017a,

title = {Management of precancerous anal intraepithelial lesions in human immunodeficiency virus-positive men who have sex with men: Clinical effectiveness and cost-effectiveness},

author = {Ashish A Deshmukh and Elizabeth Y Chiao and Scott B Cantor and Elizabeth A Stier and Stephen E Goldstone and Alan G Nyitray and Timothy Wilkin and Xiaojie Wang and Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/28950043},

doi = {10.1002/cncr.31035},

issn = {1097-0142},

year  = {2017},

date = {2017-09-01},

journal = {Cancer},

abstract = {Human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) are at disproportionately high risk for anal cancer. There is no definitive approach to the management of high-grade squamous intraepithelial lesions (HSIL), which are precursors of anal cancer, and evidence suggests that posttreatment adjuvant quadrivalent human papillomavirus (qHPV) vaccination improves HSIL treatment effectiveness. The objectives of this study were to evaluate the optimal HSIL management strategy with respect to clinical effectiveness and cost-effectiveness and to identify the optimal age for initiating HSIL management. A decision analytic model of the natural history of anal carcinoma and HSIL management strategies was constructed for HIV-positive MSM who were 27 years old or older. The model was informed by the Surveillance, Epidemiology, and End Results-Medicare database and published studies. Outcomes included the lifetime cost, life expectancy, quality-adjusted life expectancy, cumulative risk of cancer and cancer-related deaths, and cost-effectiveness from a societal perspective. Active monitoring was the most effective approach in patients 29 years or younger; thereafter, HSIL treatment plus adjuvant qHPV vaccination became most effective. When cost-effectiveness was considered (ie, an incremental cost-effectiveness ratio [ICER] \< $100,000/quality-adjusted life-year), do nothing was cost-effective until the age of 38 years, and HSIL treatment plus adjuvant qHPV vaccination was cost-effective beyond the age of 38 years (95% confidence interval, 34-43 years). The ICER decreased as the age at HSIL management increased. Outcomes were sensitive to the rate of HSIL regression or progression and the cost of high-resolution anoscopy and biopsy. The management of HSIL in HIV-positive MSM who are 38 years old or older with treatment plus adjuvant qHPV vaccination is likely to be cost-effective. The conservative approach of no treatment is likely to be cost-effective in younger patients. Cancer 2017. © 2017 American Cancer Society.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Deshmukh2017,

title = {Adjuvant HPV vaccination for anal cancer prevention in HIV-positive men who have sex with men: The time is now},

author = {Ashish A Deshmukh and Scott B Cantor and Elisabeth Fenwick and Elizabeth Y Chiao and Alan G Nyitray and Elizabeth A Stier and Stephen E Goldstone and Timothy Wilkin and Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/28807605},

doi = {10.1016/j.vaccine.2017.08.006},

issn = {1873-2518},

year  = {2017},

date = {2017-09-01},

urldate = {2017-09-01},

journal = {Vaccine},

volume = {35},

number = {38},

pages = {5102-5109},

abstract = {Outcomes of treating high-grade squamous intraepithelial lesions (HSIL), a precursor to anal cancer, remain uncertain. Emerging evidence shows that post HSIL treatment adjuvant quadrivalent human papillomavirus (qHPV) vaccination improves the effectiveness of treatment. However, no recommendations exist regarding the use of qHPV vaccine as an adjuvant form of therapy. Our objective was to determine whether post-treatment adjuvant vaccination should be adopted in HIV-infected MSM (individuals at highest risk for anal cancer) on the basis of cost-effectiveness determined using existing evidence or whether future research is needed. We developed a Markov (state-transition) cohort model to assess the cost-effectiveness of post-treatment adjuvant HPV vaccination of 27years or older HIV-infected MSM. We first estimated cost-effectiveness and then performed value-of-information (VOI) analysis to determine whether future research is required by estimating the expected value of perfect information (EVPI). We also estimated expected value of partial perfect information (EVPPI) to determine what new evidences should have highest priority. With the incremental cost-effectiveness ratio (ICER) of $71,937/QALY, "treatment plus vaccination" was the most cost-effective HSIL management strategy using the willingness-to-pay threshold of 100,000/QALY. We found that population-level EVPI for conducting future clinical research evaluating HSIL management approaches was US$12 million (range $6-$20 million). The EVPPI associated with adjuvant qHPV vaccination efficacy estimated in terms of hazards of decreasing HSIL recurrence was $0 implying that additional data from a future study evaluating efficacy of adjuvant qHPV vaccination will not change our policy conclusion that "treatment plus vaccination" was cost-effective. Both the ICER and EVPI were sensitive to HSIL treatment compliance. Post-treatment adjuvant qHPV vaccination in HIV-infected MSM aged 27 or above is likely to be cost-effective. Use of adjuvant qHPV vaccination could be considered as a potential strategy to reduce rising anal cancer burden among these high-risk individuals.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Samur2017b,

title = {Cost-effectiveness of pre- vs post-liver transplant hepatitis C treatment: Robustness of results},

author = {Sumeyye K. Samur and Emily Bethea and Raymond T Chung and Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/28864272},

doi = {10.1016/j.cgh.2017.08.030},

issn = {1542-7714},

year  = {2017},

date = {2017-08-01},

journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2017b,

title = {Hepatitis C Treatment is Cost-Saving Irrespective of the Perspective},

author = {Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/28782665},

doi = {10.1016/j.cgh.2017.07.031},

issn = {1542-7714},

year  = {2017},

date = {2017-08-01},

journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Klebanoff2017,

title = {Acceptance of Surgical Treatment for Adolescent Obesity-Reply},

author = {Matthew Klebanoff and Jagpreet Chhatwal and Chin Hur},

url = {http://www.ncbi.nlm.nih.gov/pubmed/28384656},

doi = {10.1001/jamasurg.2017.0471},

issn = {2168-6262},

year  = {2017},

date = {2017-08-01},

urldate = {2017-08-01},

journal = {JAMA surgery},

volume = {152},

number = {8},

pages = {802},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2017,

title = {Response to Optimal Timing for Hepatitis C Antiviral Therapy in the Peri-Transplant Period?},

author = {Jagpreet Chhatwal and Sumeyye K. Samur and Emily Bethea and Raymond T Chung},

url = {http://www.ncbi.nlm.nih.gov/pubmed/28586089},

doi = {10.1002/hep.29299},

issn = {1527-3350},

year  = {2017},

date = {2017-06-01},

journal = {Hepatology (Baltimore, Md.)},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chen2017b,

title = {Reply to C. Nabhan et al},

author = {Qiushi Chen and Nitin Jain and Christopher R Flowers and Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/28549223},

doi = {10.1200/JCO.2017.72.2769},

issn = {1527-7755},

year  = {2017},

date = {2017-06-01},

journal = {Journal of clinical oncology : official journal of the American Society of Clinical Oncology},

volume = {35},

pages = {1864--1865},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2016c,

title = {Direct-Acting Antiviral Agents for Patients With Hepatitis C Virus Genotype 1 Infection are Cost Saving},

author = {Jagpreet Chhatwal and Tianhua He and Chin Hur and Maria A. Lopez-Olivo},

url = {http://www.ncbi.nlm.nih.gov/pubmed/27650326},

doi = {10.1016/j.cgh.2016.09.015},

year  = {2017},

date = {2017-06-01},

journal = {Clin Gastroenterol Hepatol},

volume = {15},

number = {6},

pages = {829-837},

institution = {Department of General Internal Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.},

abstract = {Direct-acting antivirals (DAAs) are effective in treatment of hepatitis C virus (HCV) genotype 1 infection, but their cost and value have been debated. We performed a systematic review of published cost-effectiveness analyses of DAAs, synthesized their results with updated drug prices, and calculated the maximum price at which DAA therapy for HCV genotype 1 infection is cost effective (increased quality-adjusted life-years [QALYs]) and increased cost that the society is willing to pay) and cost saving (increased QALYs and decreased costs).We conducted a systematic review of the Pubmed, Medline, EMBASE, Cochrane library, EconLit, Database of Abstracts of Reviews of Effects, National Health Service Economic Evaluation Database, and Health Technology Assessment, and Tufts University databases for cost-effectiveness analyses published from 2011 through 2015. Our analysis included cost effectiveness of DAAs vs previous standard-of-care regimens (peginterferon and ribavirin, boceprevir and telaprevir), or no treatment, performed for patients with HCV genotype 1 infection. We excluded studies that were not written in English or those that did not report QALYs. Reported incremental cost-effectiveness ratios (ICERs) and treatment costs for each comparison were extracted; the threshold price was estimated for each analysis in which regimens were found to be cost effective (ICER≤$100,000/QALY) or cost saving (ICER$0)-those that decreased costs and increased QALYs.We identified 24 cost effectiveness studies that reported 170 ICERs for combinations of 11 drugs, from 11 countries. Of those, 81 ICERs were determined for 1(st) generation DAAs (boceprevir and telaprevir) and 89 ICERs were determined for 2(nd) generation DAAs (drugs approved after the 1(st) generation DAAs) as a primary intervention. The median threshold prices at which 1(st) generation and 2(nd) generation DAAs became cost-effective were estimated as $120,100 (inter-quartile range, $90,700-$176,800) and $227,200 (inter-quartile range, $142,800-$355,800), respectively. At the discounted price of $60,000, 71% of the analyses found 2(nd) generation DAAs to be cost saving and 22% to be cost effective.In a systematic review, we found treatment of HCV genotype 1 infection with 2(nd) generation DAAs to be cost effective when they cost less than and $227,200; these drugs produced cost savings at current discounts.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Klebanoff2017a,

title = {Bariatric surgery for nonalcoholic steatohepatitis: A clinical and cost-effectiveness analysis},

author = {Matthew Klebanoff and Kathleen E Corey and Jagpreet Chhatwal and Lee M Kaplan and Raymond T Chung and Chin Hur},

url = {http://www.ncbi.nlm.nih.gov/pubmed/27880977},

doi = {10.1002/hep.28958},

issn = {1527-3350},

year  = {2017},

date = {2017-04-01},

journal = {Hepatology (Baltimore, Md.)},

volume = {65},

pages = {1156--1164},

abstract = {Nonalcoholic steatohepatitis (NASH) affects 2%-3% of the US population and is expected to become the leading indication for liver transplantation in the next decade. Bariatric surgery may be an effective but expensive treatment for NASH. Using a state-transition model, our analysis assessed the effectiveness and cost-effectiveness of surgery to manage NASH. We simulated the benefits and harms of laparoscopic Roux-en-Y gastric bypass surgery in patients defined by weight class (overweight, mild obesity, moderate obesity, and severe obesity) and fibrosis stage (F0-F3). Comparators included intensive lifestyle intervention (ILI) and no treatment. Quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios were calculated. Our results showed that surgery and ILI in obese patients (with F0-F3) increased QALYs by 0.678-2.152 and 0.452-0.618, respectively, compared with no treatment. Incremental cost-effectiveness ratios for surgery in all F0-F3 patients with mild, moderate, or severe obesity were $48,836/QALY, $24,949/QALY, and $19,222/QALY, respectively. In overweight patients (with F0-F3), surgery increased QALYs by 0.050-0.824 and ILI increased QALYs by 0.031-0.164. In overweight patients, it was cost-effective to reserve treatment only for F3 patients; the incremental cost-effectiveness ratios for providing surgery or ILI only to F3 patients were $30,484/QALY and $25,367/QALY, respectively. Surgery was both effective and cost-effective for obese patients with NASH, regardless of fibrosis stage; in overweight patients, surgery increased QALYs for all patients regardless of fibrosis stage, but was cost-effective only for patients with F3 fibrosis; our results highlight the promise of bariatric surgery for treating NASH and underscore the need for clinical trials in this area. (Hepatology 2017;65:1156-1164).},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Samur2017a,

title = {Long-term clinical impact and cost-effectiveness of obeticholic acid for the treatment of primary biliary cholangitis},

author = {Sumeyye K. Samur and Matthew Klebanoff and Reiner Banken and Daniel S Pratt and Rick Chapman and Daniel A. Ollendorf and Anne M Loos and Kathleen Corey and Chin Hur and Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/27906472},

doi = {10.1002/hep.28932},

issn = {1527-3350},

year  = {2017},

date = {2017-03-01},

journal = {Hepatology (Baltimore, Md.)},

volume = {65},

pages = {920--928},

abstract = {Primary biliary cholangitis (PBC) is a chronic, progressive autoimmune liver disease that mainly affects middle-aged women. Obeticholic acid (OCA), which was recently approved by the Food and Drug Administration for PBC treatment, has demonstrated positive effects on biochemical markers of liver function. Our objective was to evaluate the long-term clinical impact and cost-effectiveness of OCA as a second-line treatment for PBC in combination with ursodeoxycholic acid (UDCA) in adults with an inadequate response to UDCA. We developed a mathematical model to simulate the lifetime course of PBC patients treated with OCA+UDCA versus UDCA alone. Efficacy data were derived from the phase 3 PBC OCA International Study of Efficacy trial, and the natural history of PBC was informed by published clinical studies. Model outcomes were validated using the PBC Global Study. We found that in comparison with UDCA, OCA+UDCA could decrease the 15-year cumulative incidences of decompensated cirrhosis from 12.2% to 4.5%, hepatocellular carcinoma from 9.1% to 4.0%, liver transplants from 4.5% to 1.2%, and liver-related deaths from 16.2% to 5.7% and increase 15-year transplant-free survival from 61.1% to 72.9%. The lifetime cost of PBC treatment would increase from $63,000 to $902,000 (1,330% increment). The discounted quality-adjusted life years with UDCA and OCA+UDCA were 10.74 and 11.78, respectively, and the corresponding costs were $142,300 and $633,900, resulting in an incremental cost-effectiveness ratio of $473,400/quality-adjusted life year gained. The results were most sensitive to the cost of OCA. OCA is a promising new therapy to substantially improve the long-term outcomes of PBC patients, but at its current annual price of $69,350, it is not cost-effective using a willingness-to-pay threshold of $100,000/quality-adjusted life year; pricing below $18,450/year is needed to make OCA cost-effective. (Hepatology 2017;65:920-928).},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2017a,

title = {Optimal timing of hepatitis C treatment for patients on the liver transplant waiting list},

author = {Jagpreet Chhatwal and Sumeyye K. Samur and Brian Kues and Turgay Ayer and Mark S Roberts and Fasiha Kanwal and Chin Hur and Drew Michael S Donnell and Raymond T Chung},

url = {http://www.ncbi.nlm.nih.gov/pubmed/27906468},

doi = {10.1002/hep.28926},

issn = {1527-3350},

year  = {2017},

date = {2017-03-01},

journal = {Hepatology (Baltimore, Md.)},

volume = {65},

pages = {777--788},

abstract = {The availability of oral direct-acting antivirals has altered the hepatitis C virus (HCV) treatment paradigm for both pre-liver transplant (LT) and post-LT patients. There is a perceived trade-off between pre-LT versus post-LT treatment of HCV-treatment may improve liver function but potentially decrease the likelihood of a necessary LT. Our objective was to identify LT-eligible patients with decompensated cirrhosis who would benefit (and not benefit) from pre-LT treatment based on their Model for End-Stage Liver Disease (MELD) scores. We simulated a virtual trial comparing long-term outcomes of pre-LT versus post-LT HCV treatment with oral direct-acting antivirals for patients with MELD scores between 10 and 40. We developed a Markov-based microsimulation model, which simulated the life course of patients on the transplant waiting list and after LT. Simulation of LT integrated data from recent trials of oral direct-acting antivirals (SOLAR 1 and 2), the United Network for Organ Sharing (UNOS), and other studies. The outcomes of the model included life expectancy, 1-year and 5-year patient survival, and mortality. Model-predicted patient survival was validated with UNOS data. We found that, at the national level, treating HCV before LT increased life expectancy if MELD was ≤27 but could decrease life expectancy at higher MELD scores. Depending on the UNOS region, the threshold MELD score to treat HCV pre-LT varied between 23 and 27 and was lower for UNOS regions 3, 10, and 11 and higher for regions 1, 2, 4, 5, 8, and 9. Sensitivity analysis showed that the thresholds were stable. Our findings suggest that the optimal MELD threshold below which decompensated cirrhosis patients should receive HCV treatment while awaiting LT is between 23 and 27, depending on the UNOS region. (Hepatology 2017;65:777-788).},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chen2017,

title = {Sensitivity Analysis in Sequential Decision Models},

author = {Qiushi Chen and Turgay Ayer and Jagpreet Chhatwal},

url = {https://www.ncbi.nlm.nih.gov/pubmed/27681992},

doi = {10.1177/0272989X16670605},

issn = {1552-681X},

year  = {2017},

date = {2017-02-01},

journal = {Medical decision making : an international journal of the Society for Medical Decision Making},

volume = {37},

pages = {243--252},

abstract = {Sequential decision problems are frequently encountered in medical decision making, which are commonly solved using Markov decision processes (MDPs). Modeling guidelines recommend conducting sensitivity analyses in decision-analytic models to assess the robustness of the model results against the uncertainty in model parameters. However, standard methods of conducting sensitivity analyses cannot be directly applied to sequential decision problems because this would require evaluating all possible decision sequences, typically in the order of trillions, which is not practically feasible. As a result, most MDP-based modeling studies do not examine confidence in their recommended policies. In this study, we provide an approach to estimate uncertainty and confidence in the results of sequential decision models. First, we provide a probabilistic univariate method to identify the most sensitive parameters in MDPs. Second, we present a probabilistic multivariate approach to estimate the overall confidence in the recommended optimal policy considering joint uncertainty in the model parameters. We provide a graphical representation, which we call a policy acceptability curve, to summarize the confidence in the optimal policy by incorporating stakeholders' willingness to accept the base case policy. For a cost-effectiveness analysis, we provide an approach to construct a cost-effectiveness acceptability frontier, which shows the most cost-effective policy as well as the confidence in that for a given willingness to pay threshold. We demonstrate our approach using a simple MDP case study. We developed a method to conduct sensitivity analysis in sequential decision models, which could increase the credibility of these models among stakeholders.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Klebanoff2016,

title = {Cost-effectiveness of Bariatric Surgery in Adolescents With Obesity},

author = {Matthew Klebanoff and Jagpreet Chhatwal and Jacob Nudel and Kathleen E. Corey and Lee M. Kaplan and Chin Hur},

url = {https://www.ncbi.nlm.nih.gov/pubmed/27784062},

doi = {10.1001/jamasurg.2016.3640},

year  = {2017},

date = {2017-02-01},

journal = {JAMA Surg},

volume = {152},

number = {2},

pages = {136-141},

institution = {Institute for Technology Assessment, Massachusetts General Hospital, Boston2Division of Gastroenterology, Massachusetts General Hospital, Boston4Harvard Medical School, Boston, Massachusetts.},

abstract = {Severe obesity affects 4% to 6% of US youth and is increasing in prevalence. Bariatric surgery for the treatment of adolescents with severe obesity is becoming more common, but data on cost-effectiveness are limited.To assess the cost-effectiveness of bariatric surgery for adolescents with obesity using recently published results from the Teen-Longitudinal Assessment of Bariatric Surgery study.A state-transition model was constructed to compare 2 strategies: no surgery and bariatric surgery. In the no surgery strategy, patients remained at their initial body mass index (calculated as weight in kilograms divided by height in meters squared) over time. In the bariatric surgery strategy, patients were subjected to risks of perioperative mortality and complications as well as initial morbidity but also experienced longer-term quality-of-life improvements associated with weight loss. Cohort demographic information-of the 228 patients included, the mean (SD) age was 17 (1.6) years, the mean (range) body mass index was 53 (34-88), and 171 (75.0%) were female-surgery-related outcomes, and base case time horizon (3 years) were based on data from the Teen-Longitudinal Assessment of Bariatric Surgery study. One-way and probabilistic sensitivity analyses were performed.Quality-adjusted life-years (QALYs), total costs (in US dollars adjusted to 2015-year values using the Consumer Price Index), and incremental cost-effectiveness ratios (ICERs). A willingness-to-pay threshold of $100 000 per QALY was used to assess cost-effectiveness.After 3 years, surgery led to a gain of 0.199 QALYs compared with no surgery at an incremental cost of $30 747, yielding an unfavorable ICER of $154 684 per QALY. When the clinical study results were extrapolated to 4 years, the ICER decreased to $114 078 per QALY and became cost-effective by 5 years with an ICER of $91 032 per QALY. Outcomes were robust in most 1-way and probabilistic sensitivity analyses.Bariatric surgery incurs substantial initial cost and morbidity. We found that surgery could be a cost-effective treatment for adolescents with severe obesity if assessed over a time horizon of 5 years. Our study underscores the need for long-term clinical trials in adolescents with at least 5 years of follow-up data that capture financial and quality-of-life end points.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Aggarwal2017,

title = {Cost-effectiveness of hepatitis C treatment using generic direct-acting antivirals available in India},

author = {Rakesh Aggarwal and Qiushi Chen and Amit Goel and Nicole Seguy and Razia Pendse and Turgay Ayer and Jagpreet Chhatwal},

url = {http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0176503},

doi = {10.1371/journal.pone.0176503},

issn = {1932-6203},

year  = {2017},

date = {2017-01-01},

journal = {PloS one},

volume = {12},

pages = {e0176503},

abstract = {Availability of directly-acting antivirals (DAAs) has changed the treatment landscape of hepatitis C virus (HCV) infection. The high price of DAAs has restricted their use in several countries. However, in some countries such as India, generic DAAs are available at much cheaper price. This study examined whether generic DAAs could be cost-saving and how long it would take for the treatment to become cost-saving/effective. A previously-validated, mathematical model was adapted to the HCV-infected population in India to compare the outcomes of no treatment versus treatment with DAAs. Model parameters were estimated from published studies. Cost-effectiveness of HCV treatment using available DAAs was calculated, using a payer's perspective. We estimated quality-adjusted life years (QALYs), disability-adjusted life years (DALYs), total costs, and incremental cost-effectiveness ratio of DAAs versus no treatment. One-way and probabilistic sensitivity analyses were conducted. Compared with no treatment, the use of generic DAAs in Indian HCV patients would increase the life expectancy by 8.02 years, increase QALYs by 3.89, avert 19.07 DALYs, and reduce the lifetime healthcare costs by $1,309 per-person treated. Treatment became cost-effective within 2 years, and cost-saving within 10 years of its initiation overall and within 5 years in persons with cirrhosis. Treating 10,000 HCV-infected persons could prevent 3400-3850 decompensated cirrhosis, 1800-2500 HCC, and 4000-4550 liver-related deaths. The results were sensitive to the costs of DAAs, pre- and post-treatment diagnostic tests and management of cirrhosis, and quality of life after sustained virologic response. Treatment with generic DAAs available in India will improve patient outcomes, provide a good value for money within 2 years, and be ultimately cost-saving. Therefore, in this and similar settings, HCV treatment should be a priority from a public health as well an economic perspective.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Besa2017,

title = {Erratum to: Hepatocellular carcinoma detection: diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid},

author = {Cecilia Besa and Sara Lewis and Pari Pandharipande and Jagpreet Chhatwal and Amita Kamath and Nancy Cooper and Ashley Knight-Greenfield and James S Babb and Paolo Boffetta and Norma Padron and Claude B Sirlin and Bachir Taouli},

url = {http://www.ncbi.nlm.nih.gov/pubmed/28755071},

doi = {10.1007/s00261-017-1256-7},

issn = {2366-0058},

year  = {2017},

date = {2017-01-01},

urldate = {2017-01-01},

journal = {Abdominal radiology (New York)},

volume = {42},

number = {1},

pages = {179-190},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Kabiri2016,

title = {Long-term disease and economic outcomes of prior authorization criteria for Hepatitis C treatment in Pennsylvania Medicaid},

author = {Mina Kabiri and Jagpreet Chhatwal and Julie M Donohue and Mark S Roberts and A Everette James and Michael A Dunn and Walid F Gellad},

url = {http://www.ncbi.nlm.nih.gov/pubmed/27932263},

doi = {10.1016/j.hjdsi.2016.11.001},

issn = {2213-0772},

year  = {2016},

date = {2016-12-01},

urldate = {2016-12-01},

journal = {Healthcare (Amsterdam, Netherlands)},

abstract = {Several highly effective but costly therapies for hepatitis C virus (HCV) are available. As a consequence of their high price, 36 state Medicaid programs limited treatment coverage to patients with more advanced HCV stages. States have only limited information available to predict the long-term impact of these decisions. We adapted a validated hepatitis C microsimulation model to the Pennsylvania Medicaid population to estimate the existing HCV prevalence in Pennsylvania Medicaid and estimate the impact of various HCV drug coverage policies on disease outcomes and costs. Outcome measures included rates of advanced-stage HCV outcomes and treatment and disease costs in both Medicaid and Medicare. We estimated that 46,700 individuals in Pennsylvania Medicaid were infected with HCV in 2015, 33% of whom were still undiagnosed. By expanding treatment to include mild fibrosis stage (Metavir F2), Pennsylvania Medicaid will spend an additional $273 million on medications in the next decade with no substantial reduction in the incidence of liver cancer or liver-related death. Medicaid patients who are not eligible for treatment under restricted policies would get treatment once they transition to the Medicare program, which would incur 10% reduction in HCV-related costs due to early treatment in Medicaid. Further expanding treatment to patients with early fibrosis stages (F0 or F1) would cost Medicaid an additional $693 million during the next decade but would reduce the number of individuals in need of treatment in Medicare by 46% and decrease Medicare treatment costs by 23%. In some scenarios, outcomes could worsen with eligibility expansion if there is inadequate capacity to treat all patients. Expansion of HCV treatment coverage to less severe stages of liver disease may not substantially improve liver related outcomes for patients in Pennsylvania Medicaid in scenarios in which coverage through Medicare is widely available.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Klebanoff2016a,

title = {Bariatric Surgery for Nonalcoholic Steatohepatitis: A Clinical and Cost-Effectiveness Analysis},

author = {Matthew Klebanoff and Kathleen E Corey and Jagpreet Chhatwal and Lee M Kaplan and Raymond T Chung and Chin Hur},

url = {http://www.ncbi.nlm.nih.gov/pubmed/27880977},

doi = {10.1002/hep.28958},

issn = {1527-3350},

year  = {2016},

date = {2016-11-01},

journal = {Hepatology (Baltimore, Md.)},

abstract = {Nonalcoholic steatohepatitis (NASH) affects 2-3% of the U.S. population and is expected to become the leading indication for liver transplantation in the next decade. Bariatric surgery may be an effective but expensive treatment for NASH. Using a state-transition model, our analysis aimed to assess the effectiveness and cost-effectiveness of surgery to manage NASH. We simulated the benefits and harms of laparoscopic Roux-en-Y gastric bypass surgery in patients defined by weight class (overweight, mild obesity, moderate obesity, and severe obesity) and fibrosis stage (F0-F3). Comparators included intensive lifestyle intervention (ILI) and no treatment. Quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs) were calculated. Our results showed that surgery and ILI in obese patients (with F0-F3) increased QALYs by 0.678-2.152 and 0.452-0.618, respectively, compared with no treatment. ICERs for surgery in all F0-F3 patients with mild, moderate, or severe obesity were $48,836/QALY, $24,949/QALY, and $19,222/QALY, respectively. In overweight patients (with F0-F3), surgery increased QALYs by 0.050-0.824, and ILI increased QALYs by 0.031-0.164. In overweight patients, it was cost-effective to reserve treatment only for F3 patients; the ICERs for providing surgery or ILI only to F3 patients were $30,484/QALY and $25,367/QALY, respectively. Surgery was both effective and cost-effective for obese patients with NASH, regardless of fibrosis stage. In overweight patients, surgery increased QALYs for all patients regardless of fibrosis stage, but it was cost-effective only for patients with F3 fibrosis. Our results highlight the promise of bariatric surgery for treating NASH and underscore the need for clinical trials in this area. This article is protected by copyright. All rights reserved.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2016b,

title = {Changing Cycle Lengths in State-Transition Models: Challenges and Solutions},

author = {Jagpreet Chhatwal and Suren Jayasuriya and Elamin H. Elbasha},

url = {http://www.ncbi.nlm.nih.gov/pubmed/27369084},

doi = {10.1177/0272989X16656165},

year  = {2016},

date = {2016-11-01},

urldate = {2016-11-01},

journal = {Med Decis Making},

volume = {36},

number = {8},

pages = {952-64},

institution = {Co., North Wales, PA, USA (EHE).},

abstract = {The choice of a cycle length in state-transition models should be determined by the frequency of clinical events and interventions. Sometimes there is need to decrease the cycle length of an existing state-transition model to reduce error in outcomes resulting from discretization of the underlying continuous-time phenomena or to increase the cycle length to gain computational efficiency. Cycle length conversion is also frequently required if a new state-transition model is built using observational data that have a different measurement interval than the model's cycle length. We show that a commonly used method of converting transition probabilities to different cycle lengths is incorrect and can provide imprecise estimates of model outcomes. We present an accurate approach that is based on finding the root of a transition probability matrix using eigendecomposition. We present underlying mathematical challenges of converting cycle length in state-transition models and provide numerical approximation methods when the eigendecomposition method fails. Several examples and analytical proofs show that our approach is more general and leads to more accurate estimates of model outcomes than the commonly used approach. MATLAB codes and a user-friendly online toolkit are made available for the implementation of the proposed methods.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chen2016a,

title = {Economic Burden of Chronic Lymphocytic Leukemia in the Era of Oral Targeted Therapies in the United States},

author = {Qiushi Chen and Nitin Jain and Turgay Ayer and William G Wierda and Christopher R Flowers and Susan M O'Brien and Michael J Keating and Hagop M Kantarjian and Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/27870563},

issn = {1527-7755},

year  = {2016},

date = {2016-11-01},

urldate = {2016-11-01},

journal = {Journal of clinical oncology : official journal of the American Society of Clinical Oncology},

pages = {JCO2016682856},

abstract = {Purpose Oral targeted therapies represent a significant advance for the treatment of patients with chronic lymphocytic leukemia (CLL); however, their high cost has raised concerns about affordability and the economic impact on society. Our objective was to project the future prevalence and cost burden of CLL in the era of oral targeted therapies in the United States. Methods We developed a simulation model that evaluated the evolving management of CLL from 2011 to 2025: chemoimmunotherapy (CIT) as the standard of care before 2014, oral targeted therapies for patients with del(17p) and relapsed CLL from 2014, and for first-line treatment from 2016 onward. A comparator scenario also was simulated where CIT remained the standard of care throughout. Disease progression and survival parameters for each therapy were based on published clinical trials. Results The number of people living with CLL in the United States is projected to increase from 128,000 in 2011 to 199,000 by 2025 (55% increase) due to improved survival; meanwhile, the annual cost of CLL management will increase from $0.74 billion to $5.13 billion (590% increase). The per-patient lifetime cost of CLL treatment will increase from $147,000 to $604,000 (310% increase) as oral targeted therapies become the first-line treatment. For patients enrolled in Medicare, the corresponding total out-of-pocket cost will increase from $9,200 to $57,000 (520% increase). Compared with the CIT scenario, oral targeted therapies resulted in an incremental cost-effectiveness ratio of $189,000 per quality-adjusted life-year. Conclusion The increased benefit and cost of oral targeted therapies is projected to enhance CLL survivorship but can impose a substantial financial burden on both patients and payers. More sustainable pricing strategies for targeted therapies are needed to avoid financial toxicity to patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2016a,

title = {Hepatitis C Disease Burden in the United States in the Era of Oral Direct-Acting Antivirals},

author = {Jagpreet Chhatwal and Xiaojie Wang and Turgay Ayer and Mina Kabiri and Raymond T. Chung and Chin Hur and Julie M. Donohue and Mark S. Roberts and Fasiha Kanwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/27015107},

doi = {10.1002/hep.28571},

year  = {2016},

date = {2016-11-01},

urldate = {2016-11-01},

journal = {Hepatology},

volume = {64},

number = {5},

pages = {1442-1450},

institution = {Department of Medicine, Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA.},

abstract = {Oral direct-acting antivirals (DAAs) represent a major advance in hepatitis C virus (HCV) treatment. Along with recent updates in HCV screening policy and expansions in insurance coverage, the treatment demand in the United States is changing rapidly. Our objective was to project the characteristics and number of people needing antiviral treatment, and HCV-associated disease burden in the era of oral DAAs. We used a previously developed and validated Hepatitis C Disease Burden Simulation model (HEP-SIM). HEP-SIM simulated the actual clinical management of HCV from 2001 onwards, which included antiviral treatment with peginterferon-based therapies as well as the recent oral DAAs, risk-based and birth-cohort HCV screening, and the impact of the Affordable Care Act. We also simulated two hypothetical scenarios-no treatment and treatment with peginterferon-based therapies only. We estimated that in 2010, 2.5 (95% CI: 1.9-3.1) million non-institutionalized people were viremic, which dropped to 1.9 (95% CI: 1.4-2.6) million in 2015, and projected to drop below 1 million by 2020. A total of 1.8 million HCV patients will receive HCV treatment from the launch of oral DAAs in 2014 until 2030. Based on current HCV management practices, it will take 4-6 years to treat the majority of patients aware of their disease. However, 560,000 patients would still remain unaware by 2020. Even in the oral DAA era, 320,000 patients will die, 157,000 will develop hepatocellular carcinoma, and 203,000 will develop decompensated cirrhosis in the next 35 years.HCV-associated disease burden will still remain substantial in the era of oral DAAs. Increasing HCV screening and treatment capacity is essential to further decreasing HCV burden in the United States. This article is protected by copyright. All rights reserved.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2016d,

title = {Optimal Timing of Hepatitis C Treatment for Patients on the Liver Transplant Waiting List},

author = {Jagpreet Chhatwal and Sumeyye K. Samur and Brian Kues and Turgay Ayer and Mark S Roberts and Fasiha Kanwal and Chin Hur and Drew Michael S Donnell and Raymond T Chung},

url = {http://www.ncbi.nlm.nih.gov/pubmed/27906468},

doi = {10.1002/hep.28926},

issn = {1527-3350},

year  = {2016},

date = {2016-11-01},

urldate = {2016-11-01},

journal = {Hepatology (Baltimore, Md.)},

abstract = {The availability of oral direct-acting antiviral (DAAs) has altered the hepatitis C virus (HCV) treatment paradigm for both pre- and post-liver transplant (LT) patients. There is a perceived trade-off between pre- versus post-LT treatment of HCV-treatment may improve liver function but potentially decrease the likelihood of a necessary LT. Our objective was to identify LT-eligible patients with decompensated cirrhosis who would benefit (and not benefit) from pre-LT treatment based on their MELD scores. We simulated a virtual trial comparing long-term outcomes of pre- versus post-LT HCV treatment with oral DAAs for patients having MELD scores between 10 and 40. We developed a Markov-based microsimulation model, SIM-LT (simulation of liver transplant candidates), which simulated the life course of patients on the transplant waiting list and after LT. SIM-LT integrated data from recent trials of oral DAAs (SOLAR 1 and 2), United Network for Organ Sharing (UNOS), and other studies. The outcomes of the model included life expectancy, 1-year and 5-year patient survival, and mortality. Model-predicted patient-survival was validated with UNOS data. We found that, at the national level, treating HCV before LT increased life expectancy if MELD ≤ 27, but could decrease life expectancy at higher MELD scores. Depending on the UNOS region, the threshold MELD score to treat HCV pre-LT varied between 23 and 27, and was lower for UNOS regions 3, 10 and 11, and higher for regions 1, 2, 4, 5, 8 and 9. Sensitivity analysis showed that the thresholds were stable. Our findings suggest that the optimal MELD threshold below which decompensated cirrhotic patients should receive HCV treatment while awaiting LT is between 23-27, depending on the UNOS region. This article is protected by copyright. All rights reserved.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Samur2016,

title = {Long-term Clinical Impact and Cost-Effectiveness of Obeticholic Acid for the Treatment of Primary Biliary Cholangitis},

author = {Sumeyye K. Samur and Matthew Klebanoff and Reiner Banken and Daniel S Pratt and Rick Chapman and Daniel A. Ollendorf and Anne M Loos and Kathleen Corey and Chin Hur and Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/27906472},

doi = {10.1002/hep.28932},

issn = {1527-3350},

year  = {2016},

date = {2016-11-01},

urldate = {2016-11-01},

journal = {Hepatology (Baltimore, Md.)},

abstract = {Primary biliary cholangitis (PBC) is a chronic, progressive autoimmune liver disease that mainly affects middle-aged women. Obeticholic acid (OCA), which was recently approved by the Food and Drug Administration for PBC treatment, has demonstrated positive effects on biochemical markers of liver function. Our objective was to evaluate the long-term clinical impact and cost-effectiveness of OCA as a second-line treatment for PBC in combination with ursodeoxycholic acid (UDCA) in adults with an inadequate response to UDCA. We developed a mathematical model to simulate the lifetime course of PBC patients treated with OCA+UDCA versus UDCA alone. Efficacy data were derived from the Phase III POISE trial, and the natural history of PBC was informed by published clinical studies. Model outcomes were validated using the PBC Global Study. We found that in comparison with UDCA; OCA+UDCA could decrease the 15-year cumulative incidences of decompensated cirrhosis from 12.2% to 4.5%, hepatocellular carcinoma from 9.1% to 4.0%, liver transplants from 4.5% to 1.2%, and liver-related deaths from 16.2% to 5.7%, and increase 15-year transplant-free survival from 61.1% to 72.9%. The lifetime cost of PBC treatment would increase from $63,000 to $902,000 (1,330% increment). The discounted quality-adjusted life years (QALYs) with UDCA and OCA+UDCA were 10.74 and 11.78 respectively, and the corresponding costs were $142,300 and $633,900, resulting in an incremental cost-effectiveness ratio of $473,400/QALY gained. The results were most sensitive to the cost of OCA. OCA is a promising new therapy to substantially improve the long-term outcomes of PBC patients. However, at its current annual price of $69,350, OCA is not cost-effective using a willingness-to-pay threshold of $100,000-per-QALY. Pricing below $18,450 per year, is needed to make OCA cost-effective. This article is protected by copyright. All rights reserved.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Besa2016,

title = {Hepatocellular carcinoma detection: diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid},

author = {Cecilia Besa and Sara Lewis and Pari Pandharipande and Jagpreet Chhatwal and Amita Kamath and Nancy Cooper and Ashley Knight-Greenfield and James S. Babb and Paolo Boffetta and Norma Padron and Claude B. Sirlin and Bachir Taouli},

url = {http://www.ncbi.nlm.nih.gov/pubmed/27448609},

doi = {10.1007/s00261-016-0841-5},

year  = {2016},

date = {2016-07-01},

urldate = {2016-07-01},

journal = {Abdom Radiol (NY)},

institution = {Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA. .},

abstract = {The purpose of this study was to evaluate the diagnostic performance of a "simulated" abbreviated MRI (AMRI) protocol using diffusion-weighted imaging (DWI) and T1-weighted (T1w) imaging obtained at the hepatobiliary phase (HBP) post gadoxetic acid injection alone and in combination, compared to dynamic contrast-enhanced (CE)-T1w imaging for the detection of hepatocellular carcinoma (HCC).This was an IRB approved HIPAA compliant retrospective single institution study including patients with liver disease who underwent gadoxetic acid-enhanced MRI for HCC diagnosis. Three independent observers assessed 2 sets of images (full CE-set and AMRI including DWI+T1w-HBP). Diagnostic performance of T1w-HBP and DWI alone and in combination was compared to that of CE-set. All imaging sets included unenhanced T1w and T2w sequences. A preliminary analysis was performed to assess cost savings of AMRI protocol compared to a full MRI study.174 patients including 62 with 80 HCCs were assessed. Equivalent per-patient sensitivity and negative predictive value (NPV) were observed for DWI (85.5% and 92.2%, pooled data) and T1w-HBP (89.8% and 94.2%) (P = 0.1-0.7), while these were significantly lower for the full AMRI protocol (DWI+T1w-HBP, 80.6% and 80},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chen2016d,

title = {Population-specific prognostic models are needed to stratify outcomes for African-Americans with diffuse large B-cell lymphoma},

author = {Qiushi Chen and Turgay Ayer and Loretta J Nastoupil and Jean L Koff and Ashley D Staton and Jagpreet Chhatwal and Christopher R Flowers},

url = {https://www.ncbi.nlm.nih.gov/pubmed/26415108},

doi = {10.3109/10428194.2015.1083098},

issn = {1029-2403},

year  = {2016},

date = {2016-01-01},

journal = {Leukemia \& lymphoma},

volume = {57},

pages = {842--851},

abstract = {Diffuse large B-cell lymphoma (DLBCL) demonstrates significant racial differences in age of onset, stage, and survival. To examine whether population-specific models improve prediction of outcomes for African-American (AA) patients with DLBCL, we utilized Surveillance, Epidemiology, and End Results data and compared stratification by the international prognostic index (IPI) in general and AA populations. We also constructed and compared prognostic models for general and AA populations using multivariable logistic regression (LR) and artificial neural network approaches. While the IPI adequately stratified outcomes for the general population, it failed to separate AA DLBCL patients into distinct risk groups. Our AA LR model identified age ≥ 55 (odds ratio 0.45, [95% CI: 0.36, 0.56], male sex (0.75, [0.60, 0.93]), and stage III/IV disease (0.43, [0.34, 0.54]) as adverse predictors of 5-year survival for AA patients. In addition, general-population prognostic models were poorly calibrated for AAs with DLBCL, indicating a need for validated AA-specific prognostic models.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Elbasha2015b,

title = {Myths and Misconceptions of Within-Cycle Correction: A Guide for Modelers and {D}ecision Makers},

author = {Elamin H. Elbasha and Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/26643402},

doi = {10.1007/s40273-015-0337-0},

year  = {2016},

date = {2016-01-01},

journal = {Pharmacoeconomics},

volume = {34},

number = {1},

pages = {13-22},

institution = {Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.},

abstract = {Commonly used decision-analytic models for cost-effectiveness analysis simulate time in discrete steps. Use of discrete-time steps can introduce errors when calculating cumulative outcomes such as costs and quality-adjusted life-years. There are a number of myths or misconceptions concerning how to correct these errors and the need to do so. This tutorial shows that, by neglecting to apply within-cycle (sometimes referred to as half-cycle or continuity) correction methods to the results of discrete-time models, the analyst may arrive at the wrong recommendation regarding the use of a technology. We show that the standard half-cycle correction method results in the same cumulative outcome as the trapezoidal rule and life-table method. However, the trapezoidal rule has the added advantage of applying the correction at each cycle, not just the initial and final cycle. We further show that the Simpson's 1/3 rule is more accurate than the trapezoidal rule. We recommend using the Simpson's 1/3 rule in the base-case analysis and, if needed, showing the results with other methods in the sensitivity analysis. We also demonstrate that both the trapezoidal and Simpson's rules can easily be implemented in commonly used software.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2016,

title = {Systematic Review of Modelling Approaches for the Cost Effectiveness of Hepatitis C Treatment with Direct-Acting Antivirals},

author = {Jagpreet Chhatwal and Tianhua He and Maria A. Lopez-Olivo},

url = {http://www.ncbi.nlm.nih.gov/pubmed/26748919},

doi = {10.1007/s40273-015-0373-9},

year  = {2016},

date = {2016-01-01},

urldate = {2016-01-01},

journal = {Pharmacoeconomics},

institution = {Department of General Internal Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.},

abstract = {New direct-acting antivirals (DAAs) are highly effective for hepatitis C virus (HCV) treatment. However, their prices have been widely debated. Decision-analytic models can project the long-term value of HCV treatment. Therefore, understanding of the methods used in these models and how they could influence results is important.Our objective was to describe and systematically review the methodological approaches in published cost-effectiveness models of chronic HCV treatment with DAAs.We searched several electronic databases, including Medline, Embase and EconLit, from 2011 to 2015.Study selection was performed by two reviewers independently. We included any cost-effectiveness analysis comparing DAAs with the old standard of care for HCV treatment. We excluded non-English-language studies and studies not reporting quality-adjusted life-years.One reviewer collected data and assessed the quality of reporting, using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Another reviewer crosschecked the abstracted information. The development methods of the included studies were synthetized on the basis of good modelling practice recommendations.Review of 304 citations revealed 36 cost-effectiveness analyses. The reporting quality scores of most articles were rated as acceptable, between 67 and 100 %. The majority of the studies were conducted in Europe (50 %), followed by the USA (44 %). Fifty-six percent of the 36 studies evaluated the cost effectiveness of HCV treatment in both treatment-naive and treatment-experienced patients, 97 % included genotype 1 patients and 53 % evaluated the cost effectiveness of second-generation or oral DAAs in comparison with the previous standard of care or other DAAs. Twenty-one models defined health states in terms of METAVIR fibrosis scores. Only one study used a discrete-event simulation approach, and the remainder used state-transition models. The time horizons varied; however, 89 % of studies used a lifetime horizon. One study was conducted from a societal perspective. Thirty-three percent of studies did not conduct any model validation. We also noted that none of the studies modelled HCV treatment as a prevention strategy, 86 % of models did not consider the possibility of re-infection with HCV after successful treatment, 97 % of studies did not consider indirect economic benefits resulting from HCV treatment and none of the studies evaluating oral DAAs used real-world data.The search was limited by date (from 1 January 2011 to 8 September 2015) and was also limited to English-language and published reports.Most modelling studies used a similar modelling structure and could have underestimated the value of HCV treatment. Future modelling efforts should consider the benefits of HCV treatment in preventing transmission, extra-hepatic and indirect economic benefits of HCV treatment, real-world cost-effectiveness analysis and cost effectiveness of HCV treatment in low- and middle-income countries.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{He2015,

title = {Prevention of Hepatitis C by Screening and Treatment in U.S. Prisons},

author = {Tianhua He and Kan Li and Mark S. Roberts and Anne C. Spaulding and Turgay Ayer and John J. Grefenstette and Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/26595252},

doi = {10.7326/M15-0617},

year  = {2015},

date = {2015-11-01},

urldate = {2015-11-01},

journal = {Ann Intern Med},

abstract = {The prevalence of hepatitis C virus (HCV) in U.S. prisoners is high; however, HCV testing and treatment are rare. Infected inmates released back into society contribute to the spread of HCV in the general population. Routine hepatitis screening of inmates followed by new therapies may reduce ongoing HCV transmission.To evaluate the health and economic effect of HCV screening and treatment in prisons on the HCV epidemic in society.Agent-based microsimulation model of HCV transmission and progression of HCV disease.Published literature.Population in U.S. prisons and general community.30 years.Societal.Risk-based and universal opt-out hepatitis C screening in prisons, followed by treatment in a portion of patients.Prevention of HCV transmission and associated disease in prisons and society, costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), and total prison budget.Implementing risk-based and opt-out screening could diagnose 41 900 to 122 700 new HCV cases in prisons in the next 30 years. Compared with no screening, these scenarios could prevent 5500 to 12 700 new HCV infections caused by releasees, wherein about 90% of averted infections would have occurred outside of prisons. HCV screening could also prevent 4200 to 11 700 liver-related deaths. The ICERs of screening scenarios were $19 600 to $29 200/QALY, and the respective first-year prison budget was $900 to $1150 million. Prisons would require an additional 12.4% of their current health care budget to implement such interventions.Results were sensitive to the time horizon, and ICERs otherwise remained less than $50 000 per QALY.Data on transmission network, reinfection rate, and opt-out HCV screening rate are lacking.Universal opt-out HCV screening in prisons is highly cost-effective and would reduce HCV transmission and HCV-associated diseases primarily in the outside community. Investing in U.S. prisons to manage hepatitis C is a strategic approach to address the current epidemic.National Institutes of Health.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Guirguis2015,

title = {Clinical Impact of Alcohol-Related Cirrhosis in the Next Decade: Estimates Based on Current Epidemiological Trends in the United States},

author = {John Guirguis and Jagpreet Chhatwal and Jaividhya Dasarathy and John Rivas and David McMichael and Laura E. Nagy and Arthur J. McCullough and Srinivasan Dasarathy},

url = {http://www.ncbi.nlm.nih.gov/pubmed/26500036},

doi = {10.1111/acer.12887},

year  = {2015},

date = {2015-10-01},

urldate = {2015-10-01},

journal = {Alcohol Clin Exp Res},

institution = {Departments of Gastroenterology, Hepatology and Transplant Surgery, Cleveland Clinic, Cleveland, Ohio.},

abstract = {Identifying changes in the epidemiology of liver disease is critical for establishing healthcare priorities and allocating resources to develop therapies. The projected contribution of different etiologies toward development of cirrhosis in the United States was estimated based on current publications on epidemiological data and advances in therapy. Given the heterogeneity of published reports and the different perceptions that are not always reconcilable, a critical overview rather than a formal meta-analysis of the existing data and projections for the next decade was performed.Data from the World Health Organization Global Status Report on Alcohol and Health of 2014, Scientific Registry of Transplant Recipients from 1999 to 2012, National Institute on Alcohol Abuse and Alcoholism, and the Centers for Disease Control and Prevention were inquired to determine future changes in the epidemiology of liver disease.Alcohol consumption has increased over the past 60 years. In 2010, transplant-related costs for liver recipients were the highest for hepatitis C (~$124 million) followed by alcohol-related cirrhosis (~$86 million). We anticipate a significant reduction in incidence cirrhosis due to causes other than alcohol because of the availability of high efficiency antiviral agents for hepatitis C, universal and effective vaccination for hepatitis B, relative stabilization of the obesity trends in the United States, and novel, potentially effective therapies for nonalcoholic steatohepatitis. The proportion of alcohol-related liver disease is therefore likely to increase in both the population as a whole and the liver transplant wait list.Alcohol-related cirrhosis and alcohol-related liver disorders will be the major cause of liver disease in the coming decades. There is an urgent need to allocate resources aimed toward understanding the pathogenesis of the disease and its complications so that effective therapies can be developed.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2015,

title = {Why We Should Be Willing to Pay for Hepatitis C Treatment},

author = {Jagpreet Chhatwal and Qiushi Chen and Fashiha Kanwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/26091736},

doi = {10.1016/j.cgh.2015.06.005},

year  = {2015},

date = {2015-10-01},

urldate = {2015-10-01},

journal = {Clin Gastroenterol Hepatol},

volume = {13},

number = {10},

pages = {1711-3},

institution = {Houston Veterans Affairs Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center; Department of Medicine, Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX USA.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{ChenQ2015,

title = {Population-specific prognostic models are needed to stratify outcomes for African-Americans with diffuse large B-cell lymphoma},

author = {Qiushi Chen and Turgay Ayer and Loretta J. Nastoupil and Jean L. Koff and Ashley D. Staton and Jagpreet Chhatwal and Christopher R. Flowers},

url = {http://www.ncbi.nlm.nih.gov/pubmed/26415108},

doi = {10.3109/10428194.2015.1083098},

year  = {2015},

date = {2015-09-01},

journal = {Leuk Lymphoma},

pages = {1--26},

institution = {c Department of Hematology/Oncology , Winship Cancer Institute, Emory University , Atlanta , GA , USA.},

abstract = {Diffuse large B-cell lymphoma (DLBCL) demonstrates significant racial differences in age of onset, stage, and survival. To examine whether population-specific models improve prediction of outcomes for African-American (AA) DLBCL patients, we utilized Surveillance, Epidemiology, and End Results data and compared stratification by the international prognostic index (IPI) in general and AA populations. We also constructed and compared prognostic models for general and AA populations using multivariable logistic regression (LR) and artificial neural network approaches. While the IPI adequately stratified outcomes for the general population, it failed to separate AA DLBCL patients into distinct risk groups. Our AA LR model identified age≥55 (odds ratio 0.45, [95% CI: 0.36, 0.56], male sex (0.75, [0.60, 0.93]), and stage III/IV disease (0.43, [0.34, 0.54]) as adverse predictors of 5-year survival for AA patients. In addition, general-population prognostic models were poorly calibrated for AAs with DLBCL, indicating a need for validated AA-specific prognostic models.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2015d,

title = {Reply to price and value in cancer care},

author = {Jagpreet Chhatwal and Michael S. Mathisen and Hagop M. Kantarjian},

url = {http://www.ncbi.nlm.nih.gov/pubmed/26249735},

doi = {10.1002/cncr.29624},

year  = {2015},

date = {2015-08-01},

journal = {Cancer},

institution = {Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Deshmukh2015,

title = {Long-Term Outcomes of Adding HPV Vaccine to the Anal Intraepithelial Neoplasia Treatment Regimen in HIV-Positive Men Who Have Sex with Men},

author = {Ashish A. Deshmukh and Jagpreet Chhatwal and Elizabeth Y. Chiao and Alan G. Nyitray and Prajnan Das and Scott B. Cantor},

url = {http://www.ncbi.nlm.nih.gov/pubmed/26223993},

doi = {10.1093/cid/civ628},

year  = {2015},

date = {2015-07-01},

urldate = {2015-07-01},

journal = {Clin Infect Dis},

institution = {Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.},

abstract = { Recent evidence shows that vaccinating men who have sex with men (MSM) who have a history of high-grade anal intraepithelial neoplasia (HGAIN) with quadrivalent human papillomavirus (qHPV) vaccine was associated with a 50% reduction in the risk of recurrent or persistent HGAIN. We evaluated the long-term clinical and economic outcomes of adding the qHPV vaccine to the treatment regimen for HGAIN in HIV-positive MSM age≥27 years. We constructed a Markov model of anal histology in HIV-positive MSM comparing qHPV vaccination with no vaccination after treatment for HGAIN, the current practice. The model parameters including baseline prevalence, disease transitions, costs, and utilities were either obtained from the literature or calibrated using a natural history model of anal carcinogenesis. The model outputs included lifetime costs, quality-adjusted life years (QALYs), and lifetime risk of developing anal cancer. We estimated the incremental cost-effectiveness ratio of qHPV vaccination and decrease in lifetime risk of anal cancer. We also conducted deterministic and probabilistic sensitivity analyses to evaluate the robustness of the results. qHPV vaccination after treatment for HGAIN decreased the lifetime risk of anal cancer by 63% compared to no vaccination. The qHPV vaccination strategy was cost saving (i.e., it decreased the lifetime costs by $419 and increased QALYs by 0.16). Results were robust to the sensitivity analysis. Vaccinating HIV-positive MSM age≥27 years with qHPV after treatment for HGAIN is a cost-saving strategy. Therefore, expansion of current vaccination guidelines to include this population should be a high priority.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Seymour2015,

title = {County-Level Effects of Prehospital Regionalization of Critically Ill Patients: A Simulation Study},

author = {Christopher W. Seymour and Osama Alotaik and David J. Wallace and Ahmed E. Elhabashy and Jagpreet Chhatwal and Thomas D. Rea and Derek C. Angus and Graham Nichol and Jeremy M. Kahn},

url = {http://www.ncbi.nlm.nih.gov/pubmed/26102251},

doi = {10.1097/CCM.0000000000001133},

year  = {2015},

date = {2015-06-01},

journal = {Crit Care Med},

institution = {1Department of Critical Care and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 2Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care, University of Pittsburgh, Pitts},

abstract = {Regionalization may improve critical care delivery, yet stakeholders cite concerns about its feasibility. We sought to determine the operational effects of prehospital regionalization of nontrauma, nonarrest critical illness.King County, Washington.Discrete event simulation study.All 2006 hospital discharge data, linked to all adult, eligible patients transported by county emergency medical services agencies.We simulated active triage of high-risk patients to designated referral centers using a validated prehospital risk score; we studied three regionalization scenarios: 1) up triage, 2) up and down triage, and 3) up and down triage after reducing ICU beds by 25%. We determined the effect on patient routing, ICU occupancy at referral and nonreferral hospitals, and emergency medical services transport times.A total of 119,117 patients were hospitalized at 11 nonreferral centers and 76,817 patients were hospitalized at three referral centers. Among 20,835 emergency medical services patients, 7,817 patients (43%) were eligible for up triage and 10,242 patients (57%) were eligible for down triage. At baseline, mean daily ICU bed occupancy was 61% referral and 47% at nonreferral hospitals. Up triage increased referral ICU occupancy to 68%, up and down triage to 64%, and up and down triage with bed reduction to 74%. Mean daily nonreferral ICU occupancy did not exceed 60%. Total emergency medical services transport time increased by less than 3% with up and down triage.Regionalization based on prehospital triage of the critically ill can allocate high-risk patients to referral hospitals without adversely affecting ICU occupancy or prehospital travel time.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2015c,

title = {Are high drug prices for hematologic malignancies justified? A critical analysis},

author = {Jagpreet Chhatwal and Michael Mathisen and Hagop Kantarjian},

url = {http://www.ncbi.nlm.nih.gov/pubmed/26102457},

doi = {10.1002/cncr.29512},

year  = {2015},

date = {2015-06-01},

urldate = {2015-06-01},

journal = {Cancer},

institution = {Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.},

abstract = {In the past 15 years, treatment outcomes for hematologic malignancies have improved substantially. However, drug prices have also increased drastically. This commentary examines the value of the treatment of hematologic malignancies at current prices in the United States through a reanalysis of a systematic review evaluating 29 studies of 9 treatments for 4 hematologic malignancies. Incremental cost-effectiveness ratios (ICERs) were calculated on the basis of drug prices in the United States in 2014. Sixty-three percent of the studies (15 of 24) had ICERs higher than $50,000 per quality-adjusted life-year (QALY), the benchmark widely used by health economists to define cost-effectiveness. In studies evaluating the current standard-of-care treatments for chronic myeloid leukemia, the ICERs for tyrosine kinase inhibitors versus hydroxyurea or interferon ranged from $210,000 to $426,000/QALY. The lower ICER values were mostly obtained from 11 studies evaluating rituximab, which was approved by the Food and Drug Administration in 1997 (ICER range, $37,000-$69,000/QALY). In conclusion, the costs of the majority of new treatments for hematologic cancers are too high to be deemed cost-effective in the United States. Cancer 2015 © 2015 American Cancer Society.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Elbasha2015,

title = {Theoretical Foundations and Practical Applications of Within-Cycle Correction Methods},

author = {Elamin H. Elbasha and Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/26092831},

doi = {10.1177/0272989X15585121},

year  = {2015},

date = {2015-06-01},

urldate = {2015-06-01},

journal = {Med Decis Making},

institution = {Co., Inc., Kenilworth, NJ (EHE); and Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston TX (JC).},

abstract = {. Modeling guidelines recommend applying a half-cycle correction (HCC) to outcomes from discrete-time state-transition models (DTSTMs). However, there is still no consensus on why and how to perform the correction. The objective was to provide theoretical foundations for HCC and to compare (both mathematically and numerically) the performance of different correction methods in reducing errors in outcomes from DTSTMs.. We defined 7 methods from the field of numerical integration: Riemann sum of rectangles (left, midpoint, right), trapezoids, life-table, and Simpson's 1/3rd and 3/8th rules. We applied these methods to a standard 3-state disease progression Markov chain to evaluate the cost-effectiveness of a hypothetical intervention. We solved the discrete- and continuous-time (our gold standard) versions of the model analytically and derived expressions for various outcomes including discounted quality-adjusted life-years, discounted costs, and incremental cost-effectiveness ratios.. The standard HCC method gave the same results as the trapezoidal rule and life-table method. We found situations where applying the standard HCC can do more harm than good. Compared with the gold standard, all correction methods resulted in approximation errors. Contrary to conventional wisdom, the errors need not cancel each other out or become insignificant when incremental outcomes are calculated. We found that a wrong decision can be made with a less accurate method. The performance of each correction method vastly improved when a shorter cycle length was selected; Simpson's 1/3rd rule was the fastest method to converge to the gold standard.. Cumulative outcomes in DTSTMs are prone to errors that can be reduced with more accurate methods like Simpson's rules. We clarified several misconceptions and provided recommendations and algorithms for practical implementation of these methods.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2015a,

title = {Economic evaluations with agent-based modelling: an introduction},

author = {Jagpreet Chhatwal and Tianhua He},

url = {http://www.ncbi.nlm.nih.gov/pubmed/25609398},

doi = {10.1007/s40273-015-0254-2},

year  = {2015},

date = {2015-05-01},

urldate = {2015-05-01},

journal = {Pharmacoeconomics},

volume = {33},

number = {5},

pages = {423--433},

institution = {Department of Health Services Research, Unit 1444, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA, .},

abstract = {Agent-based modelling (ABM) is a relatively new technique, which overcomes some of the limitations of other methods commonly used for economic evaluations. These limitations include linearity, homogeneity and stationarity. Agents in ABMs are autonomous entities, who interact with each other and with the environment. ABMs provide an inductive or 'bottom-up' approach, i.e. individual-level behaviours define system-level components. ABMs have a unique property to capture emergence phenomena that otherwise cannot be predicted by the combination of individual-level interactions. In this tutorial, we discuss the basic concepts and important features of ABMs. We present a case study of an application of a simple ABM to evaluate the cost effectiveness of screening of an infectious disease. We also provide our model, which was developed using an open-source software program, NetLogo. We discuss software, resources, challenges and future research opportunities of ABMs for economic evaluations.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Elbasha2015a,

title = {Characterizing Heterogeneity Bias in Cohort-Based Models},

author = {Elamin H. Elbasha and Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/25851486},

doi = {10.1007/s40273-015-0273-z},

year  = {2015},

date = {2015-04-01},

urldate = {2015-04-01},

journal = {Pharmacoeconomics},

institution = {Co. Inc., UG1C-60, PO Box 1000, North Wales, PA, 19454-1099, USA, .},

abstract = {Previous research using numerical methods suggested that use of a cohort-based model instead of an individual-based model can result in significant heterogeneity bias. However, the direction of the bias is not known a priori. We characterized mathematically the conditions that lead to upward or downward bias.We used a standard three-state disease progression model to evaluate the cost effectiveness of a hypothetical intervention. We solved the model analytically and derived expressions for life expectancy, discounted quality-adjusted life years (QALYs), discounted lifetime costs and incremental net monetary benefits (INMB). An outcome was calculated using the mean of the input under the cohort-based approach and the whole input distribution for all persons under the individual-based approach. We investigated the impact of heterogeneity on outcomes by varying one parameter at a time while keeping all others constant. We evaluated the curvature of outcome functions and used Jensen's inequality to determine the direction of the bias.Both life expectancy and QALYs were underestimated by the cohort-based approach. If there was heterogeneity only in disease progression, total costs were overestimated, whereas QALYs gained, incremental costs and INMB were under- or overestimated, depending on the progression rate. INMB was underestimated when only efficacy was heterogeneous. Both approaches yielded the same outcome when the heterogeneity was only in cost or utilities.A cohort-based approach that does not adjust for heterogeneity underestimates life expectancy and may underestimate or overestimate other outcomes. Characterizing the bias is useful for comparative assessment of models and informing decision making.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2015b,

title = {Cost-effectiveness and budget impact of hepatitis C virus treatment with sofosbuvir and ledipasvir in the United States},

author = {Jagpreet Chhatwal and Fasiha Kanwal and Mark S. Roberts and Michael A. Dunn},

url = {http://www.ncbi.nlm.nih.gov/pubmed/25775312},

doi = {10.7326/M14-1336},

year  = {2015},

date = {2015-03-01},

journal = {Ann Intern Med},

volume = {162},

number = {6},

pages = {397--406},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Xenakis2014,

title = {A decision-analytic model of idelalisib in relapsed or refractory patients with follicular lymphoma in the United States},

author = {Alexander Xenakis and Rachel Beckerman and Jagpreet Chhatwal and Stephanie A Gregory and Andrew Briggs},

url = {http://www.ncbi.nlm.nih.gov/pubmed/28141450},

doi = {10.1200/jco.2014.32.30_suppl.30},

issn = {1527-7755},

year  = {2014},

date = {2014-10-01},

urldate = {2014-10-01},

journal = {Journal of clinical oncology : official journal of the American Society of Clinical Oncology},

volume = {32},

pages = {30},

abstract = {30 Background: There are currently few treatment options for relapsed/refractory (RR) indolent non-Hodgkin's lymphoma (iNHL) patients. Idelalisib (IDELA) is a first-in class PI3Kδ inhibitor with substantial clinical efficacy in iNHL patients refractory to rituximab and an alkylating agent. A single-arm clinical trial (Study 101-09) showed RR iNHL patients treated with IDELA have a median of 11 and 20.3 months of progression-free and overall survival (PFS and OS), respectively. Efficacy was also demonstrated in patients with iNHL subtypes such as follicular lymphoma (FL). The objective of this study was to project the health outcomes of IDELA versus the current standard of care for US FL patients. A partitioned survival model simulated a cohort of RR FL patients over 10 year time horizon. Patients first received IDELA or an aggregate comparator of current RR iNHL chemotherapy regimens in a progression-free state before transitioning to a progressive-disease state where they received palliative care until death. Survival data was fit and extrapolated from Study 101-09 (IDELA) for FL patients. A real-world database claims analysis provided survival, disease- and treatment-related adverse event (AEs) profiles, and medical resource utilization data for RR iNHL patients for the comparator. All outcomes were discounted at 3%. Claims data predicted a median of 6.16 and 13.04 months of PFS and OS, respectively, for the comparator. Our model suggests that IDELA treatment improved health outcomes over 10 years versus the comparator, increasing life-months (LMs) and progression-free life-months (PFLMs) by 9.94 and 4.63 mos, respectively. Over 1 year, IDELA reduced both AEs and hospitalisations in FL patients by 40.3% and 49.8%, respectively. Deterministic and probabilistic sensitivity analyses demonstrated the model results are robust across different methods of survival extrapolation. IDELA was projected to improve health outcomes in RR FL patients compared to current treatments, largely driven by improved PFS and OS; short-term reductions in AEs and hospitalisation were specifically related to a delayed disease progression.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Kabiri2014,

title = {The changing burden of hepatitis C virus infection in the United States: model-based predictions},

author = {Mina Kabiri and Alison B. Jazwinski and Mark S. Roberts and Andrew J. Schaefer and Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/25089861},

doi = {10.7326/M14-0095},

year  = {2014},

date = {2014-08-01},

urldate = {2014-08-01},

journal = {Ann Intern Med},

volume = {161},

number = {3},

pages = {170--180},

abstract = {Chronic hepatitis C virus (HCV) infection causes a substantial health and economic burden in the United States. With the availability of direct-acting antiviral agents, recently approved therapies and those under development, and 1-time birth-cohort screening, the burden of this disease is expected to decrease.To predict the effect of new therapies and screening on chronic HCV infection and associated disease outcomes.Individual-level state-transition model.Existing and anticipated therapies and screening for HCV infection in the United States.Total HCV-infected population in the United States.The number of cases of chronic HCV infection and outcomes of advanced-stage HCV infection.The number of cases of chronic HCV infection decreased from 3.2 million in 2001 to 2.3 million in 2013. One-time birth-cohort screening beginning in 2013 is expected to identify 487,000 cases of HCV infection in the next 10 years. In contrast, 1-time universal screening could identify 933,700 cases. With the availability of highly effective therapies, HCV infection could become a rare disease in the next 22 years. Recently approved therapies for HCV infection and 1-time birth-cohort screening could prevent approximately 124,200 cases of decompensated cirrhosis, 78,800 cases of hepatocellular carcinoma, 126,500 liver-related deaths, and 9900 liver transplantations by 2050. Increasing the treatment capacity would further reduce the burden of HCV disease.Institutionalized patients with HCV infection were excluded, and empirical data on the effectiveness of future therapies and on the future annual incidence and treatment capacity of HCV infection are lacking.New therapies for HCV infection and widespread implementation of screening and treatment will play an important role in reducing the burden of HCV disease. More aggressive screening recommendations are needed to identify a large pool of infected patients.National Institutes of Health.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Ayvaci2014,

title = {Predicting invasive breast cancer versus DCIS in different age groups},

author = {Mehmet U S. Ayvaci and Oguzhan Alagoz and Jagpreet Chhatwal and Alejandro Munoz del Rio and Edward A. Sickles and Houssam Nassif and Karla Kerlikowske and Elizabeth S. Burnside},

url = {http://www.ncbi.nlm.nih.gov/pubmed/25112586},

doi = {10.1186/1471-2407-14-584},

year  = {2014},

date = {2014-01-01},

journal = {BMC Cancer},

volume = {14},

pages = {584},

institution = {Systems Engineering, University of Wisconsin, 1513 University Avenue, Madison, WI 53706, USA. .},

abstract = {Increasing focus on potentially unnecessary diagnosis and treatment of certain breast cancers prompted our investigation of whether clinical and mammographic features predictive of invasive breast cancer versus ductal carcinoma in situ (DCIS) differ by age.We analyzed 1,475 malignant breast biopsies, 1,063 invasive and 412 DCIS, from 35,871 prospectively collected consecutive diagnostic mammograms interpreted at University of California, San Francisco between 1/6/1997 and 6/29/2007. We constructed three logistic regression models to predict the probability of invasive cancer versus DCIS for the following groups: women ≥ 65 (older group), women 50-64 (middle age group), and women \< 50 (younger group). We identified significant predictors and measured the performance in all models using area under the receiver operating characteristic curve (AUC).The models for older and the middle age groups performed significantly better than the model for younger group (AUC = 0.848 vs, 0.778; p = 0.049 and AUC = 0.851 vs, 0.778; p = 0.022, respectively). Palpability and principal mammographic finding were significant predictors in distinguishing invasive from DCIS in all age groups. Family history of breast cancer, mass shape and mass margins were significant positive predictors of invasive cancer in the older group whereas calcification distribution was a negative predictor of invasive cancer (i.e. predicted DCIS). In the middle age group--mass margins, and in the younger group--mass size were positive predictors of invasive cancer.Clinical and mammographic finding features predict invasive breast cancer versus DCIS better in older women than younger women. Specific predictive variables differ based on age.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Wallace2014,

title = {Accuracy of prehospital transport time estimation},

author = {David J. Wallace and Jeremy M. Kahn and Derek C. Angus and Christian Martin-Gill and Clifton W. Callaway and Thomas D. Rea and Jagpreet Chhatwal and Kristen Kurland and Christopher W. Seymour},

url = {http://www.ncbi.nlm.nih.gov/pubmed/24552519},

doi = {10.1111/acem.12289},

year  = {2014},

date = {2014-01-01},

urldate = {2014-01-01},

journal = {Acad Emerg Med},

volume = {21},

number = {1},

pages = {9--16},

institution = {Clinical Research, Investigation and Systems Modeling of Acute Illness (CRISMA) Center, the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; The Department of Emergency Medicine, University of Pittsburgh S},

abstract = {Estimates of prehospital transport times are an important part of emergency care system research and planning; however, the accuracy of these estimates is unknown. The authors examined the accuracy of three estimation methods against observed transport times in a large cohort of prehospital patient transports.This was a validation study using prehospital records in King County, Washington, and southwestern Pennsylvania from 2002 to 2006 and 2005 to 2011, respectively. Transport time estimates were generated using three methods: linear arc distance, Google Maps, and ArcGIS Network Analyst. Estimation error, defined as the absolute difference between observed and estimated transport time, was assessed, as well as the proportion of estimated times that were within specified error thresholds. Based on the primary results, a regression estimate was used that incorporated population density, time of day, and season to assess improved accuracy. Finally, hospital catchment areas were compared using each method with a fixed drive time.The authors analyzed 29,935 prehospital transports to 44 hospitals. The mean (± standard deviation [±SD]) absolute error was 4.8 (±7.3) minutes using linear arc, 3.5 (±5.4) minutes using Google Maps, and 4.4 (±5.7) minutes using ArcGIS. All pairwise comparisons were statistically significant (p \< 0.01). Estimation accuracy was lower for each method among transports more than 20 minutes (mean [±SD] absolute error was 12.7 [±11.7] minutes for linear arc, 9.8 [±10.5] minutes for Google Maps, and 11.6 [±10.9] minutes for ArcGIS). Estimates were within 5 minutes of observed transport time for 79% of linear arc estimates, 86.6% of Google Maps estimates, and 81.3% of ArcGIS estimates. The regression-based approach did not substantially improve estimation. There were large differences in hospital catchment areas estimated by each method.Route-based transport time estimates demonstrate moderate accuracy. These methods can be valuable for informing a host of decisions related to the system organization and patient access to emergency medical care; however, they should be employed with sensitivity to their limitations.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Alagoz2013,

title = {Optimal Policies for Reducing Unnecessary Follow-up Mammography Exams in Breast Cancer Diagnosis},

author = {Oguzhan Alagoz and Jagpreet Chhatwal and Elizabeth S. Burnside},

url = {http://www.ncbi.nlm.nih.gov/pubmed/24501588},

year  = {2013},

date = {2013-09-01},

urldate = {2013-09-01},

journal = {Decis Anal},

volume = {10},

number = {3},

pages = {200--224},

institution = {Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, .},

abstract = {Mammography is the most effective screening tool for early diagnosis of breast cancer. Based on the mammography findings, radiologists need to choose from one of the following three alternatives: 1) take immediate diagnostic actions including prompt biopsy to confirm breast cancer; 2) recommend a follow-up mammogram; 3) recommend routine annual mammography. There are no validated structured guidelines based on a decision-analytical framework to aid radiologists in making such patient management decisions. Surprisingly, only 15-45% of the breast biopsies and less than 1% of short-interval follow-up recommendations are found to be malignant, resulting in unnecessary tests and patient-anxiety. We develop a finite-horizon discrete-time Markov decision process (MDP) model that may help radiologists make patient-management decisions to maximize a patient's total expected quality-adjusted life years. We use clinical data to find the policies recommended by the MDP model and also compare them to decisions made by radiologists at a large mammography practice. We also derive the structural properties of the MDP model, including sufficiency conditions that ensure the existence of a double control-limit type policy.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Elbasha2013,

title = {Cost-effectiveness analysis of boceprevir for the treatment of chronic hepatitis C virus genotype 1 infection in Portugal},

author = {Elamin H. Elbasha and Jagpreet Chhatwal and Shannon A. Ferrante and Antoine C. El Khoury and Pedro A. Laires},

doi = {10.1007/s40258-012-0007-8},

year  = {2013},

date = {2013-02-01},

journal = {Appl Health Econ Health Policy},

volume = {11},

number = {1},

pages = {65--78},

institution = {Dohme Corp., Whitehouse Station, NJ, USA. elamin_elbasha},

abstract = {The recent approval of two protease inhibitors, boceprevir and telaprevir, is likely to change the management of chronic hepatitis C virus (HCV) genotype 1 infection.We evaluated the long-term clinical outcomes and the cost effectiveness of therapeutic strategies using boceprevir with peginterferon plus ribavirin (PR) in comparison with PR alone for treating HCV genotype 1 infection in Portugal.A Markov model was developed to project the expected lifetime costs and quality-adjusted life-years (QALYs) associated with PR alone and the treatment strategies outlined by the European Medicines Agency in the boceprevir summary of product characteristics. The boceprevir-based therapeutic strategies differ according to whether or not the patient was previously treated and whether or not the patient had compensated cirrhosis. The model simulated the experience of a series of cohorts of chronically HCV-infected patients (each defined by age, sex, race and fibrosis score). All treatment-related inputs were obtained from boceprevir clinical trials - SPRINT-2, RESPOND-2 and PROVIDE. Estimates of the natural history parameters and health state utilities were based on published studies. Portugal-specific annual direct costs of HCV health states were estimated by convening a panel of experts to derive health state resource use and multiplying the results by national unit costs. The model was developed from a healthcare system perspective with a timeframe corresponding to the remaining duration of the patients' lifetimes. Both future costs and QALYs were discounted at 5 %. To test the robustness of the conclusions, we conducted deterministic and probabilistic sensitivity analyses.In comparison with the treatment with PR alone, boceprevir-based regimens were projected to reduce the lifetime incidence of advanced liver disease, liver transplantation, and liver-related death by 45-51 % and increase life expectancy by 2.3-4.3 years. Although the addition of BOC increased treatment costs by €13,300-€19,700, the reduction of disease burden resulted in a decrease of €5,400-€9,000 in discounted health state costs and an increase of 0.68-1.23 in discounted QALYs per patient. The incremental cost-effectiveness ratios of the boceprevir-based regimens compared with PR among previously untreated and previously treated patients were €11,600/QALY and €8,700/QALY, respectively. The results were most sensitive to variations in sustained virologic response rates, discount rates and age at treatment.Adding boceprevir to PR was projected to reduce the number of liver complications and liver-related deaths, and to be cost effective in treating both previously untreated and treated patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Ferrante2013,

title = {Boceprevir for previously untreated patients with chronic hepatitis C Genotype 1 infection: a US-based cost-effectiveness modeling study},

author = {Shannon Allen Ferrante and Jagpreet Chhatwal and Clifford A. Brass and Antoine C. El Khoury and Fred Poordad and Jean-Pierre Bronowicki and Elamin H. Elbasha},

url = {http://www.ncbi.nlm.nih.gov/pubmed/23621902},

doi = {10.1186/1471-2334-13-190},

year  = {2013},

date = {2013-01-01},

journal = {BMC Infect Dis},

volume = {13},

pages = {190},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2013,

title = {Cost-effectiveness of boceprevir in patients previously treated for chronic hepatitis C genotype 1 infection in the United States},

author = {Jagpreet Chhatwal and Shannon A. Ferrante and Cliff Brass and Antoine C. El Khoury and Margaret Burroughs and Bruce Bacon and Rafael Esteban-Mur and Elamin H. Elbasha},

doi = {10.1016/j.jval.2013.07.006},

year  = {2013},

date = {2013-01-01},

journal = {Value Health},

volume = {16},

number = {6},

pages = {973--986},

institution = {Dohme Corp., Whitehouse Station, NJ, USA. Electronic address: chhatwal},

abstract = {The phase 3 trial, Serine Protease Inhibitor Boceprevir and PegIntron/Rebetol-2 (RESPOND-2), demonstrated that the addition of boceprevir (BOC) to peginterferon-ribavirin (PR) resulted in significantly higher rates of sustained virologic response (SVR) in previously treated patients with chronic hepatitis C virus (HCV) genotype-1 infection as compared with PR alone. We evaluated the cost-effectiveness of treatment with BOC in previously treated patients with chronic hepatitis C in the United States using treatment-related data from RESPOND-2 and PROVIDE studies.We developed a Markov cohort model to project the burden of HCV disease, lifetime costs, and quality-adjusted life-years associated with PR and two BOC-based therapies-response-guided therapy (BOC/RGT) and fixed-duration therapy for 48 weeks (BOC/PR48). We estimated treatment-related inputs (efficacy, adverse events, and discontinuations) from clinical trials and obtained disease progression rates, costs, and quality-of-life data from published studies. We estimated the incremental cost-effectiveness ratio (ICER) for BOC-based regimens as studied in RESPOND-2, as well as by patient's prior response to treatment and the IL-28B genotype.BOC-based regimens were projected to reduce the lifetime incidence of liver-related complications by 43% to 53% in comparison with treatment with PR. The ICER of BOC/RGT in comparison with that of PR was $30,200, and the ICER of BOC/PR48 in comparison with that of BOC/RGT was $91,500. At a willingness-to-pay threshold of $50,000, the probabilities of BOC/RGT and BOC/PR48 being the preferred option were 0.74 and 0.25, respectively.In patients previously treated for chronic HCV genotype-1 infection, BOC was projected to increase quality-adjusted life-years and reduce the lifetime incidence of liver complications. In addition, BOC-based therapies were projected to be cost-effective in comparison with PR alone at commonly used willingness-to-pay thresholds.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Luangkesorn2013,

title = {A sequential experimental design method to evaluate a combination of school closure and vaccination policies to control an H1N1-like pandemic},

author = {Kiatikun Louis Luangkesorn and Farhad Ghiasabadi and Jagpreet Chhatwal},

url = {http://www.ncbi.nlm.nih.gov/pubmed/23903393},

doi = {10.1097/PHH.0b013e3182939a5c},

year  = {2013},

date = {2013-01-01},

urldate = {2013-01-01},

journal = {J Public Health Manag Pract},

volume = {19 Suppl 2},

pages = {S37--S41},

institution = {Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. },

abstract = {During the 2009 H1N1 pandemic, computational agent-based models (ABMs) were extensively used to evaluate interventions to control the spread of emerging pathogens. However, evaluating different possible combinations of interventions using ABMs can be computationally very expensive and time-consuming. Therefore, most policy studies have examined the impact of a single policy decision.To apply a sequential experimental design method with an ABM to analyze policy alternatives composed of a combination of school closure and vaccination policies to provide a set of promising "optimal" combinations of policies to control an H1N1-type epidemic to policy makers.We used an open-source agent-based modeling system, FRED (A Framework for Reconstructing Epidemiological Dynamic), to simulate the spread of an H1N1 epidemic in Alleghany County, Pennsylvania, with a census-based synthetic population. We used an approach called best subset selection method to evaluate 72 alternative policies consisting of a combination of options for school closure threshold, closure duration, Advisory Committee on Immunization Practices prioritization, and second-dose vaccination prioritization policies. Using the attack rate as a performance measure, best subset selection enabled us to eliminate inferior alternatives and identify a small group of alternative policies that could be further evaluated on the basis of other criteria.Our sequential design approach to evaluate a combination of alternative mitigation policies leads to a savings in computational effort by a factor of 2 when examining combinations of school closure and vaccination policies.Best subset selection demonstrates a substantial reduction in the computational burden of a large-scale ABM in evaluating several alternative policies. Our method also provides policy makers with a set of promising policy combinations for further evaluation based on implementation considerations or other criteria.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Burnside2012,

title = {What is the optimal threshold at which to recommend breast biopsy?},

author = {Elizabeth S. Burnside and Jagpreet Chhatwal and Oguzhan Alagoz},

url = {http://www.ncbi.nlm.nih.gov/pubmed/23144986},

doi = {10.1371/journal.pone.0048820},

year  = {2012},

date = {2012-01-01},

journal = {PLoS One},

volume = {7},

number = {11},

pages = {e48820},

institution = {Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA. },

abstract = {A 2% threshold, traditionally used as a level above which breast biopsy recommended, has been generalized to all patients from several specific situations analyzed in the literature. We use a sequential decision analytic model considering clinical and mammography features to determine the optimal general threshold for image guided breast biopsy and the sensitivity of this threshold to variation of these features.We built a decision analytical model called a Markov Decision Process (MDP) model, which determines the optimal threshold of breast cancer risk to perform breast biopsy in order to maximize a patient's total quality-adjusted life years (QALYs). The optimal biopsy threshold is determined based on a patient's probability of breast cancer estimated by a logistic regression model (LRM) which uses demographic risk factors (age, family history, and hormone use) and mammographic findings (described using the established lexicon-BI-RADS). We estimate the MDP model's parameters using SEER data (prevalence of invasive vs. in situ disease, stage at diagnosis, and survival), US life tables (all cause mortality), and the medical literature (biopsy disutility and treatment efficacy) to determine the optimal "base case" risk threshold for breast biopsy and perform sensitivity analysis. The base case MDP model reveals that 2% is the optimal threshold for breast biopsy for patients between 42 and 75 however the thresholds below age 42 is lower (1%) and above age 75 is higher (range of 3-5%). Our sensitivity analysis reveals that the optimal biopsy threshold varies most notably with changes in age and disutility of biopsy.Our MDP model validates the 2% threshold currently used for biopsy but shows this optimal threshold varies substantially with patient age and biopsy disutility.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2010,

title = {Optimal Breast Biopsy Decision-Making Based on Mammographic Features and Demographic Factors},

author = {Jagpreet Chhatwal and Oguzhan Alagoz and Elizabeth S. Burnside},

url = {http://www.ncbi.nlm.nih.gov/pubmed/21415931},

doi = {10.1287/opre.1100.0877},

year  = {2010},

date = {2010-11-01},

urldate = {2010-11-01},

journal = {Oper Res},

volume = {58},

number = {6},

pages = {1577--1591},

institution = {Health Economic Statistics, Merck Research Laboratories, North Wales, Pennsylvania 19454, .},

abstract = {Breast cancer is the most common non-skin cancer affecting women in the United States, where every year more than 20 million mammograms are performed. Breast biopsy is commonly performed on the suspicious findings on mammograms to confirm the presence of cancer. Currently, 700,000 biopsies are performed annually in the U.S.; 55%-85% of these biopsies ultimately are found to be benign breast lesions, resulting in unnecessary treatments, patient anxiety, and expenditures. This paper addresses the decision problem faced by radiologists: When should a woman be sent for biopsy based on her mammographic features and demographic factors? This problem is formulated as a finite-horizon discrete-time Markov decision process. The optimal policy of our model shows that the decision to biopsy should take the age of patient into account; particularly, an older patient's risk threshold for biopsy should be higher than that of a younger patient. When applied to the clinical data, our model outperforms radiologists in the biopsy decision-making problem. This study also derives structural properties of the model, including sufficiency conditions that ensure the existence of a control-limit type policy and nondecreasing control-limits with age.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Ayer2010,

title = {Breast cancer risk estimation with artificial neural networks revisited: discrimination and calibration},

author = {Turgay Ayer and Oguzhan Alagoz and Jagpreet Chhatwal and Jude W. Shavlik and Charles E Kahn and Elizabeth S. Burnside},

url = {http://www.ncbi.nlm.nih.gov/pubmed/20564067},

doi = {10.1002/cncr.25081},

year  = {2010},

date = {2010-07-01},

journal = {Cancer},

volume = {116},

number = {14},

pages = {3310--3321},

institution = {Industrial and Systems Engineering Department, University of Wisconsin, Madison, Wisconsin 53792-3252, USA.},

abstract = {Discriminating malignant breast lesions from benign ones and accurately predicting the risk of breast cancer for individual patients are crucial to successful clinical decisions. In the past, several artificial neural network (ANN) models have been developed for breast cancer-risk prediction. All studies have reported discrimination performance, but not one has assessed calibration, which is an equivalently important measure for accurate risk prediction. In this study, the authors have evaluated whether an artificial neural network (ANN) trained on a large prospectively collected dataset of consecutive mammography findings can discriminate between benign and malignant disease and accurately predict the probability of breast cancer for individual patients.Our dataset consisted of 62,219 consecutively collected mammography findings matched with the Wisconsin State Cancer Reporting System. The authors built a 3-layer feedforward ANN with 1000 hidden-layer nodes. The authors trained and tested their ANN by using 10-fold cross-validation to predict the risk of breast cancer. The authors used area the under the receiver-operating characteristic curve (AUC), sensitivity, and specificity to evaluate discriminative performance of the radiologists and their ANN. The authors assessed the accuracy of risk prediction (ie, calibration) of their ANN by using the Hosmer-Lemeshow (H-L) goodness-of-fit test.Their ANN demonstrated superior discrimination (AUC, 0.965) compared with the radiologists (AUC, 0.939; P\<.001). The authors' ANN was also well calibrated as shown by an H-L goodness of fit P-value of .13.The authors' ANN can effectively discriminate malignant abnormalities from benign ones and accurately predict the risk of breast cancer for individual abnormalities.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Ayer2010a,

title = {Informatics in radiology: comparison of logistic regression and artificial neural network models in breast cancer risk estimation},

author = {Turgay Ayer and Jagpreet Chhatwal and Oguzhan Alagoz and Charles E Kahn and Ryan W. Woods and Elizabeth S. Burnside},

url = {http://www.ncbi.nlm.nih.gov/pubmed/19901087},

doi = {10.1148/rg.301095057},

year  = {2010},

date = {2010-01-01},

journal = {Radiographics},

volume = {30},

number = {1},

pages = {13--22},

institution = {Departments of Industrial and Systems Engineering, Radiology, and Biostatistics and Medical Informatics, University of Wisconsin, 1513 University Ave., Madison, WI 53706-1572, USA.},

abstract = {Computer models in medical diagnosis are being developed to help physicians differentiate between healthy patients and patients with disease. These models can aid in successful decision making by allowing calculation of disease likelihood on the basis of known patient characteristics and clinical test results. Two of the most frequently used computer models in clinical risk estimation are logistic regression and an artificial neural network. A study was conducted to review and compare these two models, elucidate the advantages and disadvantages of each, and provide criteria for model selection. The two models were used for estimation of breast cancer risk on the basis of mammographic descriptors and demographic risk factors. Although they demonstrated similar performance, the two models have unique characteristics-strengths as well as limitations-that must be considered and may prove complementary in contributing to improved clinical decision making.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Burnside2009,

title = {Probabilistic computer model developed from clinical data in national mammography database format to classify mammographic findings},

author = {Elizabeth S. Burnside and Jesse Davis and Jagpreet Chhatwal and Oguzhan Alagoz and Mary J. Lindstrom and Berta M. Geller and Benjamin Littenberg and Katherine A. Shaffer and Charles E Kahn and C David Page},

url = {http://www.ncbi.nlm.nih.gov/pubmed/19366902},

doi = {10.1148/radiol.2513081346},

year  = {2009},

date = {2009-06-01},

journal = {Radiology},

volume = {251},

number = {3},

pages = {663--672},

institution = {Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252, USA. },

abstract = {To determine whether a Bayesian network trained on a large database of patient demographic risk factors and radiologist-observed findings from consecutive clinical mammography examinations can exceed radiologist performance in the classification of mammographic findings as benign or malignant.The institutional review board exempted this HIPAA-compliant retrospective study from requiring informed consent. Structured reports from 48 744 consecutive pooled screening and diagnostic mammography examinations in 18 269 patients from April 5, 1999 to February 9, 2004 were collected. Mammographic findings were matched with a state cancer registry, which served as the reference standard. By using 10-fold cross validation, the Bayesian network was tested and trained to estimate breast cancer risk by using demographic risk factors (age, family and personal history of breast cancer, and use of hormone replacement therapy) and mammographic findings recorded in the Breast Imaging Reporting and Data System lexicon. The performance of radiologists compared with the Bayesian network was evaluated by using area under the receiver operating characteristic curve (AUC), sensitivity, and specificity.The Bayesian network significantly exceeded the performance of interpreting radiologists in terms of AUC (0.960 vs 0.93},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chhatwal2009,

title = {A logistic regression model based on the national mammography database format to aid breast cancer diagnosis},

author = {Jagpreet Chhatwal and Oguzhan Alagoz and Mary J. Lindstrom and Charles E. Kahn and Katherine A. Shaffer and Elizabeth S. Burnside},

url = {http://www.ncbi.nlm.nih.gov/pubmed/19304723},

doi = {10.2214/AJR.07.3345},

year  = {2009},

date = {2009-04-01},

urldate = {2009-04-01},

journal = {AJR Am J Roentgenol},

volume = {192},

number = {4},

pages = {1117--1127},

institution = {Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI 53792-3252, USA.},

abstract = {The purpose of our study was to create a breast cancer risk estimation model based on the descriptors of the National Mammography Database using logistic regression that can aid in decision making for the early detection of breast cancer.We created two logistic regression models based on the mammography features and demographic data for 62,219 consecutive mammography records from 48,744 studies in 18,269 [corrected] patients reported using the Breast Imaging Reporting and Data System (BI-RADS) lexicon and the National Mammography Database format between April 5, 1999 and February 9, 2004. State cancer registry outcomes matched with our data served as the reference standard. The probability of cancer was the outcome in both models. Model 2 was built using all variables in Model 1 plus radiologists' BI-RADS assessment categories. We used 10-fold cross-validation to train and test the model and to calculate the area under the receiver operating characteristic curves (A(z)) to measure the performance. Both models were compared with the radiologists' BI-RADS assessments.Radiologists achieved an A(z) value of 0.939 +/- 0.011. The A(z) was 0.927 +/- 0.015 for Model 1 and 0.963 +/- 0.009 for Model 2. At 90% specificity, the sensitivity of Model 2 (90%) was significantly better (p \< 0.001) than that of radiologists (82%) and Model 1 (83%). At 85% sensitivity, the specificity of Model 2 (96%) was significantly better (p \< 0.001) than that of radiologists (88%) and Model 1 (87%).Our logistic regression model can effectively discriminate between benign and malignant breast disease and can identify the most important features associated with breast cancer.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}