Qiushi Chen, PhD
Assistant Professor, College of Engineering, The Pennsylvania State University
Qiushi Chen joined the faculty of The Pennsylvania State University in January 2018 as an assistant professor in the Harold and Inge Marcus Department of Industrial and Manufacturing Engineering.
Dr Chen completed a post-doctoral research fellow at MGH-ITA, and continues to work with Dr. Jagpreet Chhatwal. He received his PhD in Operations Research from Georgia Institute of Technology in 2016 December, and a BS in Industrial Engineering from Tsinghua University, China, in 2010. Qiushi’s research interests focus on the mathematical modeling and optimization in the area of health care, including stochastic and dynamic modeling of health interventions, disease prevention and treatment strategies, and health economic evaluation with disease simulation models. He has been closely collaborating with health practitioners from various health institutes such as Winship Cancer Institute of Emory University, the University of Texas MD Anderson Cancer Center, and Massachusetts General Hospital. He has won the first prize in 2016 INFORMS Decision Analysis Society Student Paper Competition, and received the honorable mention of 2016 Public Sector Operations Research Best Paper Competition. He also received the George Fellowship from the George Family Foundation in 2012.
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Selected Publications
Chen, Qiushi; Griffin, Paul M; Kawasaki, Sarah S
Disability-Adjusted Life Years for Drug Overdose Crisis and COVID-19 Are Comparable During the Two Years of Pandemic in the United States Journal Article
In: Value Health, 2022, ISSN: 1524-4733.
@article{pmid36436793,
title = {Disability-Adjusted Life Years for Drug Overdose Crisis and COVID-19 Are Comparable During the Two Years of Pandemic in the United States},
author = {Qiushi Chen and Paul M Griffin and Sarah S Kawasaki},
doi = {10.1016/j.jval.2022.11.010},
issn = {1524-4733},
year = {2022},
date = {2022-11-01},
journal = {Value Health},
abstract = {OBJECTIVES: The drug overdose crisis with shifting patterns from primarily opioid to polysubstance uses and COVID-19 infections are two concurrent public health crises in the United States, affecting the population of sizes in different magnitudes (approximately <10 million for substance use disorder (SUD) and drug overdoses vs. 80 million for COVID-19 within two years of the pandemic). Our objective is to compare the relative scale of disease burden for the two crises within a common framework, which could help inform policymakers with resource allocation and prioritization strategies.
METHODS: We calculated disability-adjusted life years (DALYs) for SUD (including opioids and stimulants) and COVID-19 infections, respectively. We collected estimates for SUD prevalence, overdose deaths, COVID-19 cases and deaths, disability weights, and life expectancy from multiple publicly available sources. We then compared age distributions of estimated DALYs.
RESULTS: We estimated a total burden of 13.83 million DALYs for SUD and drug overdoses and 15.03 million DALYs for COVID-19 in two years since March 2020. COVID-19 burden was dominated by the fatal burden (>95% of total DALYs), whereas SUD burden was attributed to both fatal (53%) and non-fatal burdens (47%). The highest disease burden was among individuals aged 30-39 for SUD (27%) and 50-64 for COVID-19 (31%).
CONCLUSIONS: Despite the smaller size of the affected population, SUD and drug overdoses resulted in comparable disease burden to the COVID-19 pandemic. Additional resources supporting evidence-based interventions in prevention and treatment may be warranted to ameliorate SUD and drug overdoses during both the pandemic and post-pandemic recovery.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: The drug overdose crisis with shifting patterns from primarily opioid to polysubstance uses and COVID-19 infections are two concurrent public health crises in the United States, affecting the population of sizes in different magnitudes (approximately <10 million for substance use disorder (SUD) and drug overdoses vs. 80 million for COVID-19 within two years of the pandemic). Our objective is to compare the relative scale of disease burden for the two crises within a common framework, which could help inform policymakers with resource allocation and prioritization strategies.
METHODS: We calculated disability-adjusted life years (DALYs) for SUD (including opioids and stimulants) and COVID-19 infections, respectively. We collected estimates for SUD prevalence, overdose deaths, COVID-19 cases and deaths, disability weights, and life expectancy from multiple publicly available sources. We then compared age distributions of estimated DALYs.
RESULTS: We estimated a total burden of 13.83 million DALYs for SUD and drug overdoses and 15.03 million DALYs for COVID-19 in two years since March 2020. COVID-19 burden was dominated by the fatal burden (>95% of total DALYs), whereas SUD burden was attributed to both fatal (53%) and non-fatal burdens (47%). The highest disease burden was among individuals aged 30-39 for SUD (27%) and 50-64 for COVID-19 (31%).
CONCLUSIONS: Despite the smaller size of the affected population, SUD and drug overdoses resulted in comparable disease burden to the COVID-19 pandemic. Additional resources supporting evidence-based interventions in prevention and treatment may be warranted to ameliorate SUD and drug overdoses during both the pandemic and post-pandemic recovery.
METHODS: We calculated disability-adjusted life years (DALYs) for SUD (including opioids and stimulants) and COVID-19 infections, respectively. We collected estimates for SUD prevalence, overdose deaths, COVID-19 cases and deaths, disability weights, and life expectancy from multiple publicly available sources. We then compared age distributions of estimated DALYs.
RESULTS: We estimated a total burden of 13.83 million DALYs for SUD and drug overdoses and 15.03 million DALYs for COVID-19 in two years since March 2020. COVID-19 burden was dominated by the fatal burden (>95% of total DALYs), whereas SUD burden was attributed to both fatal (53%) and non-fatal burdens (47%). The highest disease burden was among individuals aged 30-39 for SUD (27%) and 50-64 for COVID-19 (31%).
CONCLUSIONS: Despite the smaller size of the affected population, SUD and drug overdoses resulted in comparable disease burden to the COVID-19 pandemic. Additional resources supporting evidence-based interventions in prevention and treatment may be warranted to ameliorate SUD and drug overdoses during both the pandemic and post-pandemic recovery.
Mueller, Peter P.; Chen, Qiushi; Ayer, Turgay; Nemutlu, Gizem; Hajjar, Ali; Bethea, Emily D.; Peters, Mary Linton B.; Lee, Brian P.; Janjua, Naveed Z.; Kanwal, Fasiha; Chhatwal, Jagpreet
Duration and cost-effectiveness of hepatocellular carcinoma surveillance in hepatitis C patients after viral eradication. Journal Article
In: Journal of hepatology, vol. 77, iss. 1, pp. 55-62, 2022, ISSN: 1600-0641.
@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.},
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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.
Adee, Madeline; Zhuo, Yueran; Zhan, Tiannan; Chen, Qiushi; Toumi, Asmae; Ayer, Turgay; Nwankwo, Chizoba; Zhong, Huaiyang; Puenpatom, Amy; Chhatwal, Jagpreet
A Tool to Inform Hepatitis C Elimination: A Case for Hepatitis C Elimination in China. Journal Article
In: Clinical liver disease, vol. 17, pp. 99–106, 2021, ISSN: 2046-2484, ().
@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}
}
Chen, Qiushi; Ayer, Turgay; Adee, Madeline; Wang, Xiaojie; Kanwal, Fasiha; Chhatwal, Jagpreet
In: JAMA network open, vol. 3, pp. e2021173, 2020, ISSN: 2574-3805, ().
@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}
}
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.
Zhuo, Yueran; Hayashi, Tomoyuki; Chen, Qiushi; Aggarwal, Rakesh; Hutin, Yvan; Chhatwal, Jagpreet
Estimating the price at which hepatitis C treatment with direct-acting antivirals would be cost-saving in Japan. Journal Article
In: Scientific reports, vol. 10, no. 1, pp. 4089, 2020, ISSN: 2045-2322, ().
@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.},
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pubstate = {published},
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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.
Chhatwal, Jagpreet; Chen, Qiushi; Bethea, Emily; Hur, Chin; Spaulding, Anne C; Kanwal, Fasiha
In: Alimentary pharmacology & therapeutics, vol. 50, no. 1, pp. 66-74, 2019, ISSN: 1365-2036, ().
@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}
}
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.
Chen, Qiushi; Ayer, Turgay; Bethea, Emily; Kanwal, Fasiha; Wang, Xiaojie; Roberts, Mark; Zhuo, Yueran; Fagiuoli, Stefano; Petersen, Jorg; Chhatwal, Jagpreet
Changes in hepatitis C burden and treatment trends in Europe during the era of direct-acting antivirals: a modelling study. Journal Article
In: BMJ open, vol. 9, pp. e026726, 2019, ISSN: 2044-6055, ().
@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}
}
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.
Çağlayan, Çağlar; Terawaki, Hiromi; Ayer, Turgay; Goldstein, Jordan S; Rai, Ashish; Chen, Qiushi; Flowers, Christopher
Assessing the Effectiveness of Treatment Sequences for Older Patients With High-risk Follicular Lymphoma With a Multistate Model. Journal Article
In: Clinical lymphoma, myeloma & leukemia, vol. 19, no. 5, pp. 300-309, 2019, ISSN: 2152-2669, ().
@article{Caglayan2019,
title = {Assessing the Effectiveness of Treatment Sequences for Older Patients With High-risk Follicular Lymphoma With a Multistate Model.},
author = {\c{C}a\u{g}lar \c{C}a\u{g}layan and Hiromi Terawaki and Turgay Ayer and Jordan S Goldstein and Ashish Rai and Qiushi Chen and Christopher Flowers},
url = {https://www.ncbi.nlm.nih.gov/pubmed/30686772},
doi = {10.1016/j.clml.2018.12.019},
issn = {2152-2669},
year = {2019},
date = {2019-05-01},
urldate = {2019-05-01},
journal = {Clinical lymphoma, myeloma \& leukemia},
volume = {19},
number = {5},
pages = {300-309},
abstract = {Disease progression within 60 years have been associated with poor overall survival (OS) in follicular lymphoma (FL). No standard treatment exists for these high-risk patients, and the effectiveness of sequential therapies remains unclear. We studied the course of FL with first-, second-, and third-line treatment. Using large population-based data, we identified 5234 patients with FL diagnosed in 2000 to 2009. Of these patients, 71% had received second-line therapy 2 years, and 29% had received no therapy after first-line therapy, with a median OS of 3 years. Treatment included rituximab, R-CVP (rituximab, cyclophosphamide, vincristine), R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine), R-Other (other rituximab-containing), and other regimens. The Aalen-Johansen estimator and Cox proportional hazards models were used to quantify the outcomes and assess the effects of the clinical and sociodemographic factors. R-CHOP demonstrated the most favorable 5-year OS among first- (71%), second- (55%), and third-line (61%) therapies. First-line R-CHOP improved OS (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.50-0.64) and reduced the mortality risks after first-line (HR, 0.60; 95% CI, 0.47-0.77), second-line (HR, 0.40; 95% CI, 0.29-0.53), and third-line (HR, 0.63; 95% CI, 0.53-0.76) treatments. B-symptoms, being married, and histologic grade 1/2 were associated with the use of earlier second-line therapy. Early progression from second- to third-line therapy was associated with poor OS. The repeated use of R-CHOP or R-CVP as first- and second-line treatment yielded high 2-year mortality rates (R-CHOP + R-CHOP, 17.3%; R-CVP + R-CVP, 21.1%). Our multistate approach assessed the effect of sequential therapy on the immediate and subsequent treatment-line outcomes. We found that R-CHOP in any line improved OS for patients with high-risk FL.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Disease progression within 60 years have been associated with poor overall survival (OS) in follicular lymphoma (FL). No standard treatment exists for these high-risk patients, and the effectiveness of sequential therapies remains unclear. We studied the course of FL with first-, second-, and third-line treatment. Using large population-based data, we identified 5234 patients with FL diagnosed in 2000 to 2009. Of these patients, 71% had received second-line therapy 2 years, and 29% had received no therapy after first-line therapy, with a median OS of 3 years. Treatment included rituximab, R-CVP (rituximab, cyclophosphamide, vincristine), R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine), R-Other (other rituximab-containing), and other regimens. The Aalen-Johansen estimator and Cox proportional hazards models were used to quantify the outcomes and assess the effects of the clinical and sociodemographic factors. R-CHOP demonstrated the most favorable 5-year OS among first- (71%), second- (55%), and third-line (61%) therapies. First-line R-CHOP improved OS (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.50-0.64) and reduced the mortality risks after first-line (HR, 0.60; 95% CI, 0.47-0.77), second-line (HR, 0.40; 95% CI, 0.29-0.53), and third-line (HR, 0.63; 95% CI, 0.53-0.76) treatments. B-symptoms, being married, and histologic grade 1/2 were associated with the use of earlier second-line therapy. Early progression from second- to third-line therapy was associated with poor OS. The repeated use of R-CHOP or R-CVP as first- and second-line treatment yielded high 2-year mortality rates (R-CHOP + R-CHOP, 17.3%; R-CVP + R-CVP, 21.1%). Our multistate approach assessed the effect of sequential therapy on the immediate and subsequent treatment-line outcomes. We found that R-CHOP in any line improved OS for patients with high-risk FL.
Chhatwal, Jagpreet; Chen, Qiushi; Wang, Xiaojie; Ayer, Turgay; Zhuo, Yueran; Janjua, Naveed Z; Kanwal, Fasiha
Assessment of the Feasibility and Cost of Hepatitis C Elimination in Pakistan. Journal Article
In: JAMA network open, vol. 2, pp. e193613, 2019, ISSN: 2574-3805, ().
@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}
}
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.
Chen, Qiushi; Larochelle, Marc R.; Weaver, Davis; Lietz, Anna; Mueller, Peter P.; Mercaldo, Sarah Fletcher; Wakeman, Sarah E.; Freedberg, Kenneth A.; Raphel, Tiana; Knudsen, Amy; Pandharipande, Pari; Chhatwal, Jagpreet
Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States Journal Article
In: JAMA Network Open, vol. 2, no. 2, pp. e187621-e187621, 2019, ISSN: 2574-3805, ().
@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}
}
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%—from 0.93 million (95% UI, 0.83-1.03 million) in 2015 to 1.50 million (95% UI, 0.98-2.22 million) by 2025. Across all interventions tested, further lowering the incidence of prescription opioid misuse from 2015 levels is projected to decrease overdose deaths by only 3.0% to 5.3%.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.