W. Alton Russell, PhD
Assistant Professor, McGill University
Alton is a decision scientist who develops models that inform clinical practice and health policy. He joined the ITA in February 2021 as a Postdoctoral Fellow. As a member of the Jalali lab, Alton is primarily focused on developing simulation-based health economic analyses of policies to combat the United States opioid epidemic. In 2022, Alton joined the McGill School of Population and Global Health as an Assistant Professor
Prior to joining the ITA, Alton received undergraduate degrees from North Carolina State University in Industrial Engineering and Interdisciplinary Studies with a Global Health concentration. He then worked as a management consultant for U.S. hospitals for two years before pursuing an MS and a PhD in Management Science and Engineering from Stanford University. As a researcher, Alton uses simulation, optimization, and methods from data science, epidemiology, and health economics to inform decisions in healthcare. He is interested in augmenting existing methods in healthcare decision modeling and informing decisions in multiple clinical and policy-related areas, including the safety of the donated blood supply, pediatric kidney disease management, and gastrointestinal procedures, and measures to combat the opioid epidemic.
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Selected Publications
2021
Russell, W. Alton; Owusu-Ofori, Shirley; Owusu-Ofori, Alex; Micah, Eileen; Norman, Betty; Custer, Brian
Cost-effectiveness and budget impact of whole blood pathogen reduction in Ghana. Journal Article
In: Transfusion, vol. 61, iss. 12, pp. 3402-3412, 2021, ISSN: 1537-2995.
@article{Russell2021,
title = {Cost-effectiveness and budget impact of whole blood pathogen reduction in Ghana.},
author = {W. Alton Russell and Shirley Owusu-Ofori and Alex Owusu-Ofori and Eileen Micah and Betty Norman and Brian Custer},
url = {https://pubmed.ncbi.nlm.nih.gov/34651313/},
doi = {10.1111/trf.16704},
issn = {1537-2995},
year = {2021},
date = {2021-10-01},
urldate = {2021-10-01},
journal = {Transfusion},
volume = {61},
issue = {12},
pages = {3402-3412},
abstract = {Despite the promise of pathogen reduction for reducing transfusion-associated adverse events in sub-Saharan Africa, no health-economic assessment is publicly available. We developed a mathematical risk reduction model to estimate the impact of nationwide whole blood pathogen reduction in Ghana on the incidence of six infectious and one non-infectious transfusion-associated adverse events. We estimated the lifetime direct healthcare costs and disability-adjusted life years lost for each adverse event. For HIV, HCV, and HBV, we simulated disease progression using Markov models, accounting for the likelihood and timing of clinical detection and treatment. We performed probabilistic and univariate sensitivity analysis. Adding whole blood pathogen reduction to Ghana's blood safety portfolio would avert an estimated 19,898 (11,948-27,353) adverse events and 38,491 (16,444-67,118) disability-adjusted life years annually, primarily by averting sepsis (49%) and malaria (31%) infections. One year of pathogen reduction would cost an estimated $8,037,191 ($6,381,946-$9,880,760) and eliminate $8,656,389 ($4,462,614-$13,469,448) in direct healthcare spending on transfusion-associated adverse events. We estimate a 58% probability that the addition of pathogen reduction would reduce overall direct healthcare spending. Findings were most sensitive to uncertainty in the probability that a bacterially contaminated blood donation causes sepsis. Whole blood pathogen reduction would substantially reduce the burden of known transfusion-associated adverse events in Ghana and may reduce overall healthcare spending. Additional benefits not captured by this analysis may include averting secondary transmission of infectious diseases, reducing non-medical costs, and averting new or re-emerging transfusion-transmitted infections.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Despite the promise of pathogen reduction for reducing transfusion-associated adverse events in sub-Saharan Africa, no health-economic assessment is publicly available. We developed a mathematical risk reduction model to estimate the impact of nationwide whole blood pathogen reduction in Ghana on the incidence of six infectious and one non-infectious transfusion-associated adverse events. We estimated the lifetime direct healthcare costs and disability-adjusted life years lost for each adverse event. For HIV, HCV, and HBV, we simulated disease progression using Markov models, accounting for the likelihood and timing of clinical detection and treatment. We performed probabilistic and univariate sensitivity analysis. Adding whole blood pathogen reduction to Ghana's blood safety portfolio would avert an estimated 19,898 (11,948-27,353) adverse events and 38,491 (16,444-67,118) disability-adjusted life years annually, primarily by averting sepsis (49%) and malaria (31%) infections. One year of pathogen reduction would cost an estimated $8,037,191 ($6,381,946-$9,880,760) and eliminate $8,656,389 ($4,462,614-$13,469,448) in direct healthcare spending on transfusion-associated adverse events. We estimate a 58% probability that the addition of pathogen reduction would reduce overall direct healthcare spending. Findings were most sensitive to uncertainty in the probability that a bacterially contaminated blood donation causes sepsis. Whole blood pathogen reduction would substantially reduce the burden of known transfusion-associated adverse events in Ghana and may reduce overall healthcare spending. Additional benefits not captured by this analysis may include averting secondary transmission of infectious diseases, reducing non-medical costs, and averting new or re-emerging transfusion-transmitted infections.
Russell, W. Alton; Custer, Brian Scott; Brandeau, Margaret L
Optimal portfolios of blood safety interventions: test, defer or modify? Journal Article
In: Health Care Management Science, vol. 24, no. 3, pp. 551-568, 2021, ().
@article{Russell2021a,
title = {Optimal portfolios of blood safety interventions: test, defer or modify?},
author = {W. Alton Russell and Brian Scott Custer and Margaret L Brandeau},
url = {https://pubmed.ncbi.nlm.nih.gov/33666808/},
doi = { 10.1007/s10729-021-09557-1},
year = {2021},
date = {2021-03-05},
urldate = {2021-01-01},
journal = {Health Care Management Science},
volume = {24},
number = {3},
pages = {551-568},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Russell, W. Alton
Estimating the effect of discontinuing universal screening of donated blood for Zika virus in the 50 UṠ. states Journal Article
In: Annals of Internal Medicine, 2021, ().
@article{Russell2021b,
title = {Estimating the effect of discontinuing universal screening of donated blood for Zika virus in the 50 U\.{S}. states},
author = {W. Alton Russell},
url = {https://www.acpjournals.org/doi/10.7326/M20-6879},
doi = {10.7326/M20-6879},
year = {2021},
date = {2021-01-01},
urldate = {2021-01-01},
journal = {Annals of Internal Medicine},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2019
Yu, Jessica X.; Russell, W. Alton; Ching, Jack H.; Kim, Nathan; Bendavid, Eran; Owens, Douglas K.; Kaltenbach, Tonya
Cost effectiveness of endoscopic resection vs transanal resection of complex benign rectal polyps Journal Article
In: Clinical Gastroenterology and Hepatology, vol. 17, no. 13, pp. 2740–2748.e6, 2019, ISSN: 15427714, ().
@article{Yu2019,
title = {Cost effectiveness of endoscopic resection vs transanal resection of complex benign rectal polyps},
author = {Jessica X. Yu and W. Alton Russell and Jack H. Ching and Nathan Kim and Eran Bendavid and Douglas K. Owens and Tonya Kaltenbach},
url = {https://www.sciencedirect.com/science/article/pii/S1542356519302472},
doi = {10.1016/j.cgh.2019.02.041},
issn = {15427714},
year = {2019},
date = {2019-03-01},
journal = {Clinical Gastroenterology and Hepatology},
volume = {17},
number = {13},
pages = {2740--2748.e6},
publisher = {W.B. Saunders},
abstract = {Background \& Aims: Complex benign rectal polyps can be managed with transanal surgery or with endoscopic resection (ER). Though the complication rate after ER is lower than transanal surgery, recurrence is higher. Patients lost to follow up after ER might therefore be at increased risk for rectal cancer. We evaluated the costs, benefits, and cost effectiveness of ER compared to 2 surgical techniques for removing complex rectal polyps, using a 50-year time horizon\textemdashthis allowed us to capture rates of cancer development among patients lost from follow-up surveillance. Methods: We created a Markov model to simulate the lifetime outcomes and costs of ER, transanal endoscopic microsurgery (TEM), and transanal minimally invasive surgery (TAMIS) for the management of a complex benign rectal polyp. We assessed the effect of surveillance by allowing a portion of the patients to be lost to follow up. We calculated the cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio or each intervention over a 50-year time horizon. Results: We found that TEM was slightly more effective than TAMIS and ER (TEM, 19.54 QALYs; TAMIS, 19.53 QALYs; and ER, 19.53 QALYs), but ER had a lower lifetime discounted cost (ER cost $7161, TEM cost $10,459, and TAMIS cost $11,253). TEM was not cost effective compared to ER, with an incremental cost-effectiveness ratio of $485,333/QALY. TAMIS was dominated by TEM. TEM became cost effective when the mortality from ER exceeded 0.63%, or if the loss to follow up rate exceeded 25.5%. Conclusions: Using a Markov model, we found that ER, TEM, and TAMIS have similar effectiveness, but ER is less expensive, in management of benign rectal polyps. As the rate of loss to follow up increases, transanal surgery becomes more effective relative to ER.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background & Aims: Complex benign rectal polyps can be managed with transanal surgery or with endoscopic resection (ER). Though the complication rate after ER is lower than transanal surgery, recurrence is higher. Patients lost to follow up after ER might therefore be at increased risk for rectal cancer. We evaluated the costs, benefits, and cost effectiveness of ER compared to 2 surgical techniques for removing complex rectal polyps, using a 50-year time horizon—this allowed us to capture rates of cancer development among patients lost from follow-up surveillance. Methods: We created a Markov model to simulate the lifetime outcomes and costs of ER, transanal endoscopic microsurgery (TEM), and transanal minimally invasive surgery (TAMIS) for the management of a complex benign rectal polyp. We assessed the effect of surveillance by allowing a portion of the patients to be lost to follow up. We calculated the cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio or each intervention over a 50-year time horizon. Results: We found that TEM was slightly more effective than TAMIS and ER (TEM, 19.54 QALYs; TAMIS, 19.53 QALYs; and ER, 19.53 QALYs), but ER had a lower lifetime discounted cost (ER cost $7161, TEM cost $10,459, and TAMIS cost $11,253). TEM was not cost effective compared to ER, with an incremental cost-effectiveness ratio of $485,333/QALY. TAMIS was dominated by TEM. TEM became cost effective when the mortality from ER exceeded 0.63%, or if the loss to follow up rate exceeded 25.5%. Conclusions: Using a Markov model, we found that ER, TEM, and TAMIS have similar effectiveness, but ER is less expensive, in management of benign rectal polyps. As the rate of loss to follow up increases, transanal surgery becomes more effective relative to ER.
Russell, W. Alton; Stramer, Susan L.; Busch, Michael P.; Custer, Brian
Screening the blood supply for Zika virus in the 50 U.S. States and Puerto Rico: A cost-effectiveness analysis Journal Article
In: Annals of Internal Medicine, vol. 170, no. 3, pp. 164–174, 2019, ISSN: 15393704, ().
@article{Russell2019,
title = {Screening the blood supply for Zika virus in the 50 U.S. States and Puerto Rico: A cost-effectiveness analysis},
author = {W. Alton Russell and Susan L. Stramer and Michael P. Busch and Brian Custer},
url = {http://annals.org/aim/fullarticle/2720163/screening-blood-supply-zika-virus-50-u-s-states-puerto},
doi = {10.7326/M18-2238},
issn = {15393704},
year = {2019},
date = {2019-01-01},
urldate = {2019-01-01},
journal = {Annals of Internal Medicine},
volume = {170},
number = {3},
pages = {164--174},
abstract = {Background: In 2016, universal individual donation nucleic acid testing (ID-NAT) of donated blood for Zika virus began in U.S. states and territories. Objective: To assess the cost-effectiveness of universal ID-NAT in the first year of screening compared with alternatives for the 50 states and separately for Puerto Rico. Design: Microsimulation that captured Zika-related harms to transfusion recipients, sexual partners, and their infants. Data Sources: National testing results compiled by AABB and costs, utilities, and outcome probabilities estimated from the literature. Target Population: Transfusion recipients. Time Horizon: Lifetime. Perspective: Societal. Intervention: Universal ID-NAT, universal mini-pool NAT (MP-NAT), and ID-NAT exclusively for components transfused to women of childbearing age. Seasonally targeted strategies in Puerto Rico and geographically targeted strategies in the 50 states were also considered. Outcome Measures: Costs, quality-adjusted life-years (QALYs), and outcomes. Results of Base-Case Analysis: In Puerto Rico, MP-NAT exclusively during high mosquito season was cost-effective at $81 123 per QALY (95% CI, $49 138 to $978 242 per QALY). No screening policy was cost-effective in the 50 states. Universal ID-NAT cost $341 million per QALY (CI, $125 million to $2.90 billion per QALY) compared with no screening in the 50 states. Results of Sensitivity Analysis: In Puerto Rico, MP-NAT only during the season of high mosquito activity was most cost-effective in 64% of probabilistic sensitivity analysis iterations. In the 50 states, no intervention was cost-effective in 99.99% of iterations. Cost-effectiveness was highly dependent on the rate of assumed infectious donations. Limitation: Data were limited on the component-specific trans-missibility of Zika and long-term sequelae of infection. Conclusion: Screening was cost-effective only in the high mosquito season in Puerto Rico, and no evaluated screening policy was cost-effective in the 50 states. During periods with lower rates of Zika-infectious donations, the cost-effectiveness of screening will be even less favorable. Primary Funding Source: None.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: In 2016, universal individual donation nucleic acid testing (ID-NAT) of donated blood for Zika virus began in U.S. states and territories. Objective: To assess the cost-effectiveness of universal ID-NAT in the first year of screening compared with alternatives for the 50 states and separately for Puerto Rico. Design: Microsimulation that captured Zika-related harms to transfusion recipients, sexual partners, and their infants. Data Sources: National testing results compiled by AABB and costs, utilities, and outcome probabilities estimated from the literature. Target Population: Transfusion recipients. Time Horizon: Lifetime. Perspective: Societal. Intervention: Universal ID-NAT, universal mini-pool NAT (MP-NAT), and ID-NAT exclusively for components transfused to women of childbearing age. Seasonally targeted strategies in Puerto Rico and geographically targeted strategies in the 50 states were also considered. Outcome Measures: Costs, quality-adjusted life-years (QALYs), and outcomes. Results of Base-Case Analysis: In Puerto Rico, MP-NAT exclusively during high mosquito season was cost-effective at $81 123 per QALY (95% CI, $49 138 to $978 242 per QALY). No screening policy was cost-effective in the 50 states. Universal ID-NAT cost $341 million per QALY (CI, $125 million to $2.90 billion per QALY) compared with no screening in the 50 states. Results of Sensitivity Analysis: In Puerto Rico, MP-NAT only during the season of high mosquito activity was most cost-effective in 64% of probabilistic sensitivity analysis iterations. In the 50 states, no intervention was cost-effective in 99.99% of iterations. Cost-effectiveness was highly dependent on the rate of assumed infectious donations. Limitation: Data were limited on the component-specific trans-missibility of Zika and long-term sequelae of infection. Conclusion: Screening was cost-effective only in the high mosquito season in Puerto Rico, and no evaluated screening policy was cost-effective in the 50 states. During periods with lower rates of Zika-infectious donations, the cost-effectiveness of screening will be even less favorable. Primary Funding Source: None.
Russell, W. Alton; Scheinker, David; Sutherland, Scott
Epidemiologic impact of alternative acute kidney injury definitions in a pediatric inpatient setting Journal Article
In: Working Paper, 2019, ().
@article{Russell2019b,
title = {Epidemiologic impact of alternative acute kidney injury definitions in a pediatric inpatient setting},
author = {W. Alton Russell and David Scheinker and Scott Sutherland},
year = {2019},
date = {2019-01-01},
urldate = {2019-01-01},
journal = {Working Paper},
keywords = {},
pubstate = {published},
tppubtype = {article}
}