Dr. Gazelle is Professor of Radiology at Harvard Medical School and Professor in the Department of Health Policy and Management at the Harvard School of Public Health. He is the Founding Director of the MGH Institute for Technology Assessment and stepped down as Director in Spring of 2015. Dr. Gazelle directed the Dana-Farber/Harvard Cancer Center Program in Cancer Outcomes Research Training. He is also Vice Chair for Faculty Development and Associate Vice-Chair for Research in the MGH Department of Radiology.
Dr. Gazelle received his BA from Dartmouth College, and his MD from Case Western Reserve University School of Medicine. He completed a Radiology residency at University Hospitals of Cleveland, where he also served as Chief Resident. Following residency, he completed a fellowship in Abdominal Imaging and Interventional Radiology at the Massachusetts General Hospital, and then joined the faculty at the MGH in the Division of Abdominal Imaging and Interventional Radiology. In 1996, he received an MPH from the Harvard School of Public Health, where he majored in Health Care Management. In 1999, he received a PhD in Health Policy from Harvard University.
Dr. Gazelle has been President of the Association of University Radiologists, the Radiology Research Alliance and the New England Roentgen Ray Society. He has also been Chair of the American College of Radiology Commission on Research and Technology Assessment, the RSNA Research Development Committee, Director of Partners Radiology and a member of the RSNA R&E Foundation Board of Trustees. Dr. Gazelle is nationally and internationally known for his research evaluating the benefits, costs, and appropriate use of new medical technologies. Locally, he has led efforts at Partners HealthCare System to improve quality and safety in radiology and to develop approaches that can be used to measure and document performance improvement. Dr. Gazelle has authored more than 250 scientific articles, published 3 textbooks and presented numerous papers, lectures, and workshops nationally and internationally.
Selected Publications
Toumazis, Iakovos; Nijs, Koen; Cao, Pianpian; Bastani, Mehrad; Munshi, Vidit; Haaf, Kevin Ten; Jeon, Jihyoun; Gazelle, G. Scott; Feuer, Eric J.; Koning, Harry J.; Meza, Rafael; Kong, Chung Yin; Han, Summer S.; Plevritis, Sylvia K.
Cost-effectiveness Evaluation of the 2021 US Preventive Services Task Force Recommendation for Lung Cancer Screening. Journal Article
In: JAMA oncology, 2021, ISSN: 2374-2445, ().
@article{Toumazis2021,
title = {Cost-effectiveness Evaluation of the 2021 US Preventive Services Task Force Recommendation for Lung Cancer Screening.},
author = {Iakovos Toumazis and Koen Nijs and Pianpian Cao and Mehrad Bastani and Vidit Munshi and Kevin Ten Haaf and Jihyoun Jeon and G. Scott Gazelle and Eric J. Feuer and Harry J. Koning and Rafael Meza and Chung Yin Kong and Summer S. Han and Sylvia K. Plevritis},
url = {https://pubmed.ncbi.nlm.nih.gov/34673885/},
doi = {10.1001/jamaoncol.2021.4942},
issn = {2374-2445},
year = {2021},
date = {2021-10-01},
journal = {JAMA oncology},
abstract = {The US Preventive Services Task Force (USPSTF) issued its 2021 recommendation on lung cancer screening, which lowered the starting age for screening from 55 to 50 years and the minimum cumulative smoking exposure from 30 to 20 pack-years relative to its 2013 recommendation. Although costs are expected to increase because of the expanded screening eligibility criteria, it is unknown whether the new guidelines for lung cancer screening are cost-effective. To evaluate the cost-effectiveness of the 2021 USPSTF recommendation for lung cancer screening compared with the 2013 recommendation and to explore the cost-effectiveness of 6 alternative screening strategies that maintained a minimum cumulative smoking exposure of 20 pack-years and an ending age for screening of 80 years but varied the starting ages for screening (50 or 55 years) and the number of years since smoking cessation (≤15, ≤20, or ≤25). A comparative cost-effectiveness analysis using 4 independently developed microsimulation models that shared common inputs to assess the population-level health benefits and costs of the 2021 recommended screening strategy and 6 alternative screening strategies compared with the 2013 recommended screening strategy. The models simulated a 1960 US birth cohort. Simulated individuals entered the study at age 45 years and were followed up until death or age 90 years, corresponding to a study period from January 1, 2005, to December 31, 2050. Low-dose computed tomography in lung cancer screening programs with a minimum cumulative smoking exposure of 20 pack-years. Incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) of the 2021 vs 2013 USPSTF lung cancer screening recommendations as well as 6 alternative screening strategies vs the 2013 USPSTF screening strategy. Strategies with a mean ICER lower than $100 000 per QALY were deemed cost-effective. The 2021 USPSTF recommendation was estimated to be cost-effective compared with the 2013 recommendation, with a mean ICER of $72 564 (range across 4 models, $59 493-$85 837) per QALY gained. The 2021 recommendation was not cost-effective compared with 6 alternative strategies that used the 20 pack-year criterion. Strategies associated with the most cost-effectiveness included those that expanded screening eligibility to include a greater number of former smokers who had not smoked for a longer duration (ie, ≤20 years and ≤25 years since smoking cessation vs ≤15 years since smoking cessation). In particular, the strategy that screened former smokers who quit within the past 25 years and began screening at age 55 years was associated with screening coverage closest to that of the 2021 USPSTF recommendation yet yielded greater cost-effectiveness, with a mean ICER of $66 533 (range across 4 models, $55 693-$80 539). This economic evaluation found that the 2021 USPSTF recommendation for lung cancer screening was cost-effective; however, alternative screening strategies that maintained a minimum cumulative smoking exposure of 20 pack-years but included individuals who quit smoking within the past 25 years may be more cost-effective and warrant further evaluation.},
keywords = {},
pubstate = {aheadofprint},
tppubtype = {article}
}
The US Preventive Services Task Force (USPSTF) issued its 2021 recommendation on lung cancer screening, which lowered the starting age for screening from 55 to 50 years and the minimum cumulative smoking exposure from 30 to 20 pack-years relative to its 2013 recommendation. Although costs are expected to increase because of the expanded screening eligibility criteria, it is unknown whether the new guidelines for lung cancer screening are cost-effective. To evaluate the cost-effectiveness of the 2021 USPSTF recommendation for lung cancer screening compared with the 2013 recommendation and to explore the cost-effectiveness of 6 alternative screening strategies that maintained a minimum cumulative smoking exposure of 20 pack-years and an ending age for screening of 80 years but varied the starting ages for screening (50 or 55 years) and the number of years since smoking cessation (≤15, ≤20, or ≤25). A comparative cost-effectiveness analysis using 4 independently developed microsimulation models that shared common inputs to assess the population-level health benefits and costs of the 2021 recommended screening strategy and 6 alternative screening strategies compared with the 2013 recommended screening strategy. The models simulated a 1960 US birth cohort. Simulated individuals entered the study at age 45 years and were followed up until death or age 90 years, corresponding to a study period from January 1, 2005, to December 31, 2050. Low-dose computed tomography in lung cancer screening programs with a minimum cumulative smoking exposure of 20 pack-years. Incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) of the 2021 vs 2013 USPSTF lung cancer screening recommendations as well as 6 alternative screening strategies vs the 2013 USPSTF screening strategy. Strategies with a mean ICER lower than $100 000 per QALY were deemed cost-effective. The 2021 USPSTF recommendation was estimated to be cost-effective compared with the 2013 recommendation, with a mean ICER of $72 564 (range across 4 models, $59 493-$85 837) per QALY gained. The 2021 recommendation was not cost-effective compared with 6 alternative strategies that used the 20 pack-year criterion. Strategies associated with the most cost-effectiveness included those that expanded screening eligibility to include a greater number of former smokers who had not smoked for a longer duration (ie, ≤20 years and ≤25 years since smoking cessation vs ≤15 years since smoking cessation). In particular, the strategy that screened former smokers who quit within the past 25 years and began screening at age 55 years was associated with screening coverage closest to that of the 2021 USPSTF recommendation yet yielded greater cost-effectiveness, with a mean ICER of $66 533 (range across 4 models, $55 693-$80 539). This economic evaluation found that the 2021 USPSTF recommendation for lung cancer screening was cost-effective; however, alternative screening strategies that maintained a minimum cumulative smoking exposure of 20 pack-years but included individuals who quit smoking within the past 25 years may be more cost-effective and warrant further evaluation.
Toumi, Asmae; DiGennaro, Catherine; Vahdat, Vahab; Jalali, Mohammad S.; Gazelle, G. Scott; Chhatwal, Jagpreet; Kelz, Rachel R; Lubitz, Carrie C.
Trends in Thyroid Surgery and Guideline-Concordant Care in the United States, 2007-2018. Journal Article
In: Thyroid : official journal of the American Thyroid Association, vol. 31, no. 6, pp. 941-949, 2021, ISSN: 1557-9077, ().
@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}
}
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. 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. 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. Conclusions: There was a significant changepoint occurring in November 2015 in the operative and management trends for benign and malignant thyroid disease.
Bennett, Debbie L.; Swan, J. Shannon; Gazelle, G. Scott; Saksena, Mansi
Music during image-guided breast biopsy reduces patient anxiety levels. Journal Article
In: Clinical imaging, vol. 65, pp. 18–23, 2020, ISSN: 1873-4499, ().
@article{Bennett2020,
title = {Music during image-guided breast biopsy reduces patient anxiety levels.},
author = {Debbie L. Bennett and J. Shannon Swan and G. Scott Gazelle and Mansi Saksena},
url = {https://www.ncbi.nlm.nih.gov/pubmed/32353714},
doi = {10.1016/j.clinimag.2020.03.018},
issn = {1873-4499},
year = {2020},
date = {2020-09-01},
journal = {Clinical imaging},
volume = {65},
pages = {18--23},
abstract = {Interventions to decrease anxiety associated with image-guided breast biopsy are needed. Music intervention has been shown to be helpful in other outpatient procedural settings but data are limited regarding its effectiveness in the setting of breast biopsy. The purpose of this study was to determine whether listening to self-selected music during image-guided breast biopsy lowers anxiety. This randomized controlled trial was approved by the institutional review board and was HIPAA-compliant. 157 women between 18 and 75 (mean, 49.7 years) years of age, undergoing stereotactic or ultrasound-guided core biopsy, were enrolled in the study and were prospectively randomized to music or usual care. Patients in the music group listened to music of their choice during the biopsy. All patients completed the State Trait Anxiety Inventory (STAI) before and after the biopsy. Differences in pre-biopsy and post-biopsy anxiety levels were compared between the two groups using the Mann-Whitney U test. Baseline trait anxiety scores in the two groups were similar (34.0 music, 31.5 contro},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Interventions to decrease anxiety associated with image-guided breast biopsy are needed. Music intervention has been shown to be helpful in other outpatient procedural settings but data are limited regarding its effectiveness in the setting of breast biopsy. The purpose of this study was to determine whether listening to self-selected music during image-guided breast biopsy lowers anxiety. This randomized controlled trial was approved by the institutional review board and was HIPAA-compliant. 157 women between 18 and 75 (mean, 49.7 years) years of age, undergoing stereotactic or ultrasound-guided core biopsy, were enrolled in the study and were prospectively randomized to music or usual care. Patients in the music group listened to music of their choice during the biopsy. All patients completed the State Trait Anxiety Inventory (STAI) before and after the biopsy. Differences in pre-biopsy and post-biopsy anxiety levels were compared between the two groups using the Mann-Whitney U test. Baseline trait anxiety scores in the two groups were similar (34.0 music, 31.5 contro
Lee, Janie; Lowry, Kathryn; Chubiz, Jessica Cott; Swan, J. Shannon; Motazedi, Tina; Halpern, Elkan F.; Tosteson, Anna N A; Gazelle, G. Scott; Donelan, Karen
Breast cancer risk, worry, and anxiety: Effect on patient perceptions of false-positive screening results. Journal Article
In: Breast (Edinburgh, Scotland), vol. 50, pp. 104–112, 2020, ISSN: 1532-3080, ().
@article{JLee2020,
title = {Breast cancer risk, worry, and anxiety: Effect on patient perceptions of false-positive screening results.},
author = {Janie Lee and Kathryn Lowry and Jessica Cott Chubiz and J. Shannon Swan and Tina Motazedi and Elkan F. Halpern and Anna N A Tosteson and G. Scott Gazelle and Karen Donelan},
url = {https://www.ncbi.nlm.nih.gov/pubmed/32135458},
doi = {10.1016/j.breast.2020.02.004},
issn = {1532-3080},
year = {2020},
date = {2020-04-01},
journal = {Breast (Edinburgh, Scotland)},
volume = {50},
pages = {104--112},
abstract = {The impact of mammography screening recall on quality-of-life (QOL) has been studied in women at average risk for breast cancer, but it is unknown whether these effects differ by breast cancer risk level. We used a vignette-based survey to evaluate how women across the spectrum of breast cancer risk perceive the experience of screening recall. Women participating in mammography or breast MRI screening were recruited to complete a vignette-based survey. Using a numerical rating scale (0-100), women rated QOL for hypothetical scenarios of screening recall, both before and after benign results were known. Lifetime breast cancer risk was calculated using Gail and BRCAPRO risk models. Risk perception, trait anxiety, and breast cancer worry were assessed using validated instruments. The final study cohort included 162 women at low (n = 43, 26%), intermediate (n = 66, 41%), and high-risk (n = 53, 33%). Actual breast cancer risk was not a predictor of QOL for any of the presented scenarios. Across all risk levels, QOL ratings were significantly lower for the period during diagnostic uncertainty compared to after benign results were known (p 0.05). In multivariable regression analyses, breast cancer worry was a significant predictor of decreased QoL for all screening scenarios while awaiting results, including scenarios with non-invasive imaging alone or with biopsy. High trait anxiety and family history predicted lower QOL scores after receipt of benign test results (p 0.05). Women with high trait anxiety and family history may particularly benefit from discussions about the risk of recall when choosing a screening regimen.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The impact of mammography screening recall on quality-of-life (QOL) has been studied in women at average risk for breast cancer, but it is unknown whether these effects differ by breast cancer risk level. We used a vignette-based survey to evaluate how women across the spectrum of breast cancer risk perceive the experience of screening recall. Women participating in mammography or breast MRI screening were recruited to complete a vignette-based survey. Using a numerical rating scale (0-100), women rated QOL for hypothetical scenarios of screening recall, both before and after benign results were known. Lifetime breast cancer risk was calculated using Gail and BRCAPRO risk models. Risk perception, trait anxiety, and breast cancer worry were assessed using validated instruments. The final study cohort included 162 women at low (n = 43, 26%), intermediate (n = 66, 41%), and high-risk (n = 53, 33%). Actual breast cancer risk was not a predictor of QOL for any of the presented scenarios. Across all risk levels, QOL ratings were significantly lower for the period during diagnostic uncertainty compared to after benign results were known (p 0.05). In multivariable regression analyses, breast cancer worry was a significant predictor of decreased QoL for all screening scenarios while awaiting results, including scenarios with non-invasive imaging alone or with biopsy. High trait anxiety and family history predicted lower QOL scores after receipt of benign test results (p 0.05). Women with high trait anxiety and family history may particularly benefit from discussions about the risk of recall when choosing a screening regimen.
White, Craig; Weinstein, Milton C; Fingeret, Abbey L; Randolph, Gregory W; Miyauchi, Akira; Ito, Yasuhiro; Zhan, Tiannan; Ali, Ayman; Gazelle, G. Scott; Lubitz, Carrie C.
In: Annals of surgery, vol. 271, no. 4, pp. 765-773, 2020, ISSN: 1528-1140, ().
@article{White2018,
title = {Is Less More? A Microsimulation Model Comparing Cost-effectiveness of the Revised American Thyroid Association's 2015 to 2009 Guidelines for the Management of Patients With Thyroid Nodules and Differentiated Thyroid Cancer.},
author = {Craig White and Milton C Weinstein and Abbey L Fingeret and Gregory W Randolph and Akira Miyauchi and Yasuhiro Ito and Tiannan Zhan and Ayman Ali and G. Scott Gazelle and Carrie C. Lubitz},
url = {https://www.ncbi.nlm.nih.gov/pubmed/30339630},
doi = {10.1097/SLA.0000000000003074},
issn = {1528-1140},
year = {2020},
date = {2020-04-01},
urldate = {2020-04-01},
journal = {Annals of surgery},
volume = {271},
number = {4},
pages = {765-773},
abstract = {To assess relative clinical and economic performance of the revised American Thyroid Association (ATA) thyroid cancer guidelines compared to current standard of care. Diagnosis of thyroid cancer in the United States has tripled whereas mortality has only marginally increased. Most patients present with small papillary carcinomas and have historically received at least a total thyroidectomy as a treatment. In 2015, the ATA released the revised guidelines recommending an option for active surveillance (AS) of small papillary thyroid carcinoma and thyroid lobectomy for larger unifocal tumors. We created a Markov microsimulation model to evaluate the performance of the ATA's 2015 guidelines compared to the ATA's 2009 guidelines. We modeled a cohort of simulated patients with demographic and thyroid nodule characteristics representative of those presenting clinically in the United States. Outcome measures include life expectancy, quality-adjusted life years, costs, and frequency of surgical adverse events. In our base case analysis, the ATA 2015 strategy dominates the ATA 2009 strategy. The ATA 2015 strategy delivers greater discounted average quality-adjusted life years (13.09 vs 12.43) at a lower discounted average cost ($14,752 vs $20,126). Deaths due to thyroid cancer under the 2015 strategy are higher than the 2009 strategy but this is offset by a reduction in surgical deaths, leading to greater average life expectancy under the ATA 2015 strategy. The optimal strategy is sensitive to patients who experience a greater decrement in quality of life while undergoing AS. The ATA 2015 Guidelines represent a cost-effective strategy regarding AS and extent of surgery.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
To assess relative clinical and economic performance of the revised American Thyroid Association (ATA) thyroid cancer guidelines compared to current standard of care. Diagnosis of thyroid cancer in the United States has tripled whereas mortality has only marginally increased. Most patients present with small papillary carcinomas and have historically received at least a total thyroidectomy as a treatment. In 2015, the ATA released the revised guidelines recommending an option for active surveillance (AS) of small papillary thyroid carcinoma and thyroid lobectomy for larger unifocal tumors. We created a Markov microsimulation model to evaluate the performance of the ATA's 2015 guidelines compared to the ATA's 2009 guidelines. We modeled a cohort of simulated patients with demographic and thyroid nodule characteristics representative of those presenting clinically in the United States. Outcome measures include life expectancy, quality-adjusted life years, costs, and frequency of surgical adverse events. In our base case analysis, the ATA 2015 strategy dominates the ATA 2009 strategy. The ATA 2015 strategy delivers greater discounted average quality-adjusted life years (13.09 vs 12.43) at a lower discounted average cost ($14,752 vs $20,126). Deaths due to thyroid cancer under the 2015 strategy are higher than the 2009 strategy but this is offset by a reduction in surgical deaths, leading to greater average life expectancy under the ATA 2015 strategy. The optimal strategy is sensitive to patients who experience a greater decrement in quality of life while undergoing AS. The ATA 2015 Guidelines represent a cost-effective strategy regarding AS and extent of surgery.
Goehler, Alexander; Mayrhofer, Thomas; Pursnani, Amit; Ferencik, Maros; Lumish, Heidi S.; Barth, Cordula; Karády, J'ulia; Chow, Benjamin; Truong, Quynh A.; Udelson, James E.; Fleg, Jerome L.; Nagurney, John T.; Gazelle, G. Scott; Hoffmann, Udo
Long-term health outcomes and cost-effectiveness of coronary CT angiography in patients with suspicion for acute coronary syndrome. Journal Article
In: Journal of cardiovascular computed tomography, vol. 14, pp. 44–54, 2020, ISSN: 1876-861X, ().
@article{Goehler2020,
title = {Long-term health outcomes and cost-effectiveness of coronary CT angiography in patients with suspicion for acute coronary syndrome.},
author = {Alexander Goehler and Thomas Mayrhofer and Amit Pursnani and Maros Ferencik and Heidi S. Lumish and Cordula Barth and J'ulia Kar\'{a}dy and Benjamin Chow and Quynh A. Truong and James E. Udelson and Jerome L. Fleg and John T. Nagurney and G. Scott Gazelle and Udo Hoffmann},
url = {https://www.ncbi.nlm.nih.gov/pubmed/31303580},
doi = {10.1016/j.jcct.2019.06.008},
issn = {1876-861X},
year = {2020},
date = {2020-01-01},
journal = {Journal of cardiovascular computed tomography},
volume = {14},
pages = {44--54},
abstract = {Randomized trials have shown favorable clinical outcomes for coronary CT angiography (CTA) in patients with suspected acute coronary syndrome (ACS). Our goal was to estimate the cost-effectiveness of coronary CTA as compared to alternative management strategies for ACP patients over lifetime. Markov microsimulation model was developed to compare cost-effectiveness of competitive strategies for ACP patients: 1) coronary CTA, 2) standard of care (SOC), 3) AHA/ACC Guidelines, and 4) expedited emergency department (ED) discharge protocol with outpatient testing. ROMICAT-II trial was used to populate the model with low to intermediate risk of ACS patient data, whereas diagnostic test-, treatment effect-, morbidity/mortality-, quality of life- and cost data were obtained from the literature. We predicted test utilization, costs, 1-, 3-, 10-year and over lifetime cardiovascular morbidity/mortality for each strategy. We determined quality adjusted life years (QALY) and incremental cost-effectiveness ratio. Observed outcomes in ROMICAT-II were used to validate the short-term model. Estimated short-term outcomes accurately reflected observed outcomes in ROMICAT-II as coronary CTA was associated with higher costs ($4,490 vs. $2,513-$4,144) and revascularization rates (5.2% vs. 2.6%-3.7%) compared to alternative strategies. Over lifetime, coronary CTA dominated SOC and ACC/AHA Guidelines and was cost-effective compared to expedited ED protocol ($49,428/QALY). This was driven by lower cardiovascular mortality (coronary CTA vs. expedited discharge: 3-year: 1.04% vs. 1.10-1.17; 10-year: 5.06% vs. 5.21-5.36%; respectively). Coronary CTA in patients with suspected ACS renders affordable long-term health benefits as compared to alternative strategies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Randomized trials have shown favorable clinical outcomes for coronary CT angiography (CTA) in patients with suspected acute coronary syndrome (ACS). Our goal was to estimate the cost-effectiveness of coronary CTA as compared to alternative management strategies for ACP patients over lifetime. Markov microsimulation model was developed to compare cost-effectiveness of competitive strategies for ACP patients: 1) coronary CTA, 2) standard of care (SOC), 3) AHA/ACC Guidelines, and 4) expedited emergency department (ED) discharge protocol with outpatient testing. ROMICAT-II trial was used to populate the model with low to intermediate risk of ACS patient data, whereas diagnostic test-, treatment effect-, morbidity/mortality-, quality of life- and cost data were obtained from the literature. We predicted test utilization, costs, 1-, 3-, 10-year and over lifetime cardiovascular morbidity/mortality for each strategy. We determined quality adjusted life years (QALY) and incremental cost-effectiveness ratio. Observed outcomes in ROMICAT-II were used to validate the short-term model. Estimated short-term outcomes accurately reflected observed outcomes in ROMICAT-II as coronary CTA was associated with higher costs ($4,490 vs. $2,513-$4,144) and revascularization rates (5.2% vs. 2.6%-3.7%) compared to alternative strategies. Over lifetime, coronary CTA dominated SOC and ACC/AHA Guidelines and was cost-effective compared to expedited ED protocol ($49,428/QALY). This was driven by lower cardiovascular mortality (coronary CTA vs. expedited discharge: 3-year: 1.04% vs. 1.10-1.17; 10-year: 5.06% vs. 5.21-5.36%; respectively). Coronary CTA in patients with suspected ACS renders affordable long-term health benefits as compared to alternative strategies.
Goehler, Alexander; Mayrhofer, Thomas; Pursnani, Amit; Ferencik, Maros; Lumish, Heidi S; Barth, Cordula; Karády, J'ulia; Chow, Benjamin; Truong, Quynh A; Udelson, James E; Fleg, Jerome L; Nagurney, John T; Gazelle, G. Scott; Hoffmann, Udo
Long-term health outcomes and cost-effectiveness of coronary CT angiography in patients with suspicion for acute coronary syndrome. Journal Article
In: Journal of cardiovascular computed tomography, 2019, ISSN: 1876-861X, ().
@article{Goehler2019,
title = {Long-term health outcomes and cost-effectiveness of coronary CT angiography in patients with suspicion for acute coronary syndrome.},
author = {Alexander Goehler and Thomas Mayrhofer and Amit Pursnani and Maros Ferencik and Heidi S Lumish and Cordula Barth and J'ulia Kar\'{a}dy and Benjamin Chow and Quynh A Truong and James E Udelson and Jerome L Fleg and John T Nagurney and G. Scott Gazelle and Udo Hoffmann},
url = {https://www.ncbi.nlm.nih.gov/pubmed/31303580},
doi = {10.1016/j.jcct.2019.06.008},
issn = {1876-861X},
year = {2019},
date = {2019-06-01},
journal = {Journal of cardiovascular computed tomography},
abstract = {Randomized trials have shown favorable clinical outcomes for coronary CT angiography (CTA) in patients with suspected acute coronary syndrome (ACS). Our goal was to estimate the cost-effectiveness of coronary CTA as compared to alternative management strategies for ACP patients over lifetime. Markov microsimulation model was developed to compare cost-effectiveness of competitive strategies for ACP patients: 1) coronary CTA, 2) standard of care (SOC), 3) AHA/ACC Guidelines, and 4) expedited emergency department (ED) discharge protocol with outpatient testing. ROMICAT-II trial was used to populate the model with low to intermediate risk of ACS patient data, whereas diagnostic test-, treatment effect-, morbidity/mortality-, quality of life- and cost data were obtained from the literature. We predicted test utilization, costs, 1-, 3-, 10-year and over lifetime cardiovascular morbidity/mortality for each strategy. We determined quality adjusted life years (QALY) and incremental cost-effectiveness ratio. Observed outcomes in ROMICAT-II were used to validate the short-term model. Estimated short-term outcomes accurately reflected observed outcomes in ROMICAT-II as coronary CTA was associated with higher costs ($4,490 vs. $2,513-$4,144) and revascularization rates (5.2% vs. 2.6%-3.7%) compared to alternative strategies. Over lifetime, coronary CTA dominated SOC and ACC/AHA Guidelines and was cost-effective compared to expedited ED protocol ($49,428/QALY). This was driven by lower cardiovascular mortality (coronary CTA vs. expedited discharge: 3-year: 1.04% vs. 1.10-1.17; 10-year: 5.06% vs. 5.21-5.36%; respectively). Coronary CTA in patients with suspected ACS renders affordable long-term health benefits as compared to alternative strategies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Randomized trials have shown favorable clinical outcomes for coronary CT angiography (CTA) in patients with suspected acute coronary syndrome (ACS). Our goal was to estimate the cost-effectiveness of coronary CTA as compared to alternative management strategies for ACP patients over lifetime. Markov microsimulation model was developed to compare cost-effectiveness of competitive strategies for ACP patients: 1) coronary CTA, 2) standard of care (SOC), 3) AHA/ACC Guidelines, and 4) expedited emergency department (ED) discharge protocol with outpatient testing. ROMICAT-II trial was used to populate the model with low to intermediate risk of ACS patient data, whereas diagnostic test-, treatment effect-, morbidity/mortality-, quality of life- and cost data were obtained from the literature. We predicted test utilization, costs, 1-, 3-, 10-year and over lifetime cardiovascular morbidity/mortality for each strategy. We determined quality adjusted life years (QALY) and incremental cost-effectiveness ratio. Observed outcomes in ROMICAT-II were used to validate the short-term model. Estimated short-term outcomes accurately reflected observed outcomes in ROMICAT-II as coronary CTA was associated with higher costs ($4,490 vs. $2,513-$4,144) and revascularization rates (5.2% vs. 2.6%-3.7%) compared to alternative strategies. Over lifetime, coronary CTA dominated SOC and ACC/AHA Guidelines and was cost-effective compared to expedited ED protocol ($49,428/QALY). This was driven by lower cardiovascular mortality (coronary CTA vs. expedited discharge: 3-year: 1.04% vs. 1.10-1.17; 10-year: 5.06% vs. 5.21-5.36%; respectively). Coronary CTA in patients with suspected ACS renders affordable long-term health benefits as compared to alternative strategies.
Lee, Leslie K; Reisner, Andrew T; Binder, William D; Zaheer, Atif; Gunn, Martin L; Linnau, Ken F; Miller, Chad M; Herring, Maurice; Tramontano, Angela; Kambadakone, Avinash; Catalano, Onofrio A; Harisinghani, Mukesh; Halpern, Elkan F.; Donelan, Karen; Gazelle, G. Scott; Pandharipande, Pari
In: AJR. American journal of roentgenology, vol. 212, no. 2, pp. 382-385, 2019, ISSN: 1546-3141, ().
@article{LeeLK2018,
title = {Repeat CT Performed Within One Month of CT Conducted in the Emergency Department for Abdominal Pain: A Secondary Analysis of Data From a Prospective Multicenter Study.},
author = {Leslie K Lee and Andrew T Reisner and William D Binder and Atif Zaheer and Martin L Gunn and Ken F Linnau and Chad M Miller and Maurice Herring and Angela Tramontano and Avinash Kambadakone and Onofrio A Catalano and Mukesh Harisinghani and Elkan F. Halpern and Karen Donelan and G. Scott Gazelle and Pari Pandharipande},
url = {https://www.ncbi.nlm.nih.gov/pubmed/30512995},
doi = {10.2214/AJR.18.20060},
issn = {1546-3141},
year = {2019},
date = {2019-02-01},
journal = {AJR. American journal of roentgenology},
volume = {212},
number = {2},
pages = {382-385},
abstract = {The purpose of this study is to determine both the frequency of repeat CT performed within 1 month after a patient visits the emergency department (ED) and undergoes CT evaluation for abdominal pain and the frequency of worsened or new CT-based diagnoses. Secondary analysis was performed on data collected during a prospective multicenter study. The parent study included patients who underwent CT in the ED for abdominal pain between 2012 and 2014, and these patients constituted the study group of the present analysis. The proportion of patients who underwent (in any setting) repeat abdominal CT within 1 month of the index CT examination was calculated. For each of these patients, results of the index and repeat CT scans were compared by an independent panel and categorized as follows: no change (group 1); same process, improved (group 2); same process, worse (group 3); or different process (group 4). The proportion of patients in groups 1 and 2 versus groups 3 and 4 was calculated, and patient and ED physician characteristics were compared. The parent study included 544 patients (246 of whom were men [45%]; mean patient age, 49.4 years). Of those 544 patients, 53 (10%; 95% CI, 7.5-13%) underwent repeat abdominal CT. Patients' CT comparisons were categorized as follows: group 1 for 43% of patients (23/53), group 2 for 26% (14/53), group 3 for 15% (8/53), and group 4 for 15% (8/53). New or worse findings were present in 30% of patients (16/53) (95% CI, 19-44%). When patients with findings in groups 1 and 2 were compared to patients with findings in groups 3 and 4, no significant difference was noted in patient age (p = 0.25) or sex (p = 0.76), the number of days between scans (p = 0.98), and the diagnostic confidence of the ED physician after the index CT scan was obtained (p = 0.33). Short-term, repeat abdominal CT was performed for 10% of patients who underwent CT in the ED for abdominal pain, and it yielded new or worse findings for 30% of those patients.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The purpose of this study is to determine both the frequency of repeat CT performed within 1 month after a patient visits the emergency department (ED) and undergoes CT evaluation for abdominal pain and the frequency of worsened or new CT-based diagnoses. Secondary analysis was performed on data collected during a prospective multicenter study. The parent study included patients who underwent CT in the ED for abdominal pain between 2012 and 2014, and these patients constituted the study group of the present analysis. The proportion of patients who underwent (in any setting) repeat abdominal CT within 1 month of the index CT examination was calculated. For each of these patients, results of the index and repeat CT scans were compared by an independent panel and categorized as follows: no change (group 1); same process, improved (group 2); same process, worse (group 3); or different process (group 4). The proportion of patients in groups 1 and 2 versus groups 3 and 4 was calculated, and patient and ED physician characteristics were compared. The parent study included 544 patients (246 of whom were men [45%]; mean patient age, 49.4 years). Of those 544 patients, 53 (10%; 95% CI, 7.5-13%) underwent repeat abdominal CT. Patients' CT comparisons were categorized as follows: group 1 for 43% of patients (23/53), group 2 for 26% (14/53), group 3 for 15% (8/53), and group 4 for 15% (8/53). New or worse findings were present in 30% of patients (16/53) (95% CI, 19-44%). When patients with findings in groups 1 and 2 were compared to patients with findings in groups 3 and 4, no significant difference was noted in patient age (p = 0.25) or sex (p = 0.76), the number of days between scans (p = 0.98), and the diagnostic confidence of the ED physician after the index CT scan was obtained (p = 0.33). Short-term, repeat abdominal CT was performed for 10% of patients who underwent CT in the ED for abdominal pain, and it yielded new or worse findings for 30% of those patients.
Lowry, Kathryn; Braunstein, Lior Z; Economopoulos, Konstantinos; Salama, Laura; Lehman, Constance D; Gazelle, G. Scott; Halpern, Elkan F.; Giess, Catherine S; Taghian, Alphonse G; Lee, Janie
Predictors of surveillance mammography outcomes in women with a personal history of breast cancer. Journal Article
In: Breast cancer research and treatment, vol. 171, no. 1, pp. 209-215, 2018, ISSN: 1573-7217, ().
@article{Lowry2018,
title = {Predictors of surveillance mammography outcomes in women with a personal history of breast cancer.},
author = {Kathryn Lowry and Lior Z Braunstein and Konstantinos Economopoulos and Laura Salama and Constance D Lehman and G. Scott Gazelle and Elkan F. Halpern and Catherine S Giess and Alphonse G Taghian and Janie Lee},
url = {http://www.ncbi.nlm.nih.gov/pubmed/29748762},
doi = {10.1007/s10549-018-4808-9},
issn = {1573-7217},
year = {2018},
date = {2018-08-01},
journal = {Breast cancer research and treatment},
volume = {171},
number = {1},
pages = {209-215},
abstract = {To identify predictors of poor mammography surveillance outcomes based on clinico-pathologic features. This study was HIPAA compliant and IRB approved. We performed an electronic medical record review for a cohort of women with American Joint Committee on Cancer (AJCC) Stage I or II invasive breast cancer treated with breast conservation therapy who developed subsequent in-breast treatment recurrence (IBTR) or contralateral breast cancer (CBC). Poor surveillance outcome was defined as second breast cancer not detected by surveillance mammography, including interval cancers (diagnosed within 365 days of surveillance mammogram with negative results) and clinically detected cancers (diagnosed without a surveillance mammogram in the preceding 365 days). Univariate and multivariate logistic regression were performed to identify predictors of poor mammography surveillance outcome, including patient and primary tumor characteristics, breast density, mode of primary tumor detection, and time to second cancer diagnosis. 164 women met inclusion criteria (65 with IBTR, 99 with CBC); 124 had screen-detected second cancers. On univariate analysis, poor surveillance outcome (n = 40) was associated with age at primary cancer diagnosis 50 years (p 0.0001), AJCC stage II primary cancers (p = 0.007), and heterogeneously or extremely dense breasts (p = 0.04). On multivariate analysis, age 50 years at primary breast cancer diagnosis remained a significant predictor of poor surveillance outcome (p = 0.001). Women younger than age 50 at primary breast cancer diagnosis are at risk of poor surveillance mammography outcomes, and may be appropriate candidates for more intensive clinical and imaging surveillance.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
To identify predictors of poor mammography surveillance outcomes based on clinico-pathologic features. This study was HIPAA compliant and IRB approved. We performed an electronic medical record review for a cohort of women with American Joint Committee on Cancer (AJCC) Stage I or II invasive breast cancer treated with breast conservation therapy who developed subsequent in-breast treatment recurrence (IBTR) or contralateral breast cancer (CBC). Poor surveillance outcome was defined as second breast cancer not detected by surveillance mammography, including interval cancers (diagnosed within 365 days of surveillance mammogram with negative results) and clinically detected cancers (diagnosed without a surveillance mammogram in the preceding 365 days). Univariate and multivariate logistic regression were performed to identify predictors of poor mammography surveillance outcome, including patient and primary tumor characteristics, breast density, mode of primary tumor detection, and time to second cancer diagnosis. 164 women met inclusion criteria (65 with IBTR, 99 with CBC); 124 had screen-detected second cancers. On univariate analysis, poor surveillance outcome (n = 40) was associated with age at primary cancer diagnosis 50 years (p 0.0001), AJCC stage II primary cancers (p = 0.007), and heterogeneously or extremely dense breasts (p = 0.04). On multivariate analysis, age 50 years at primary breast cancer diagnosis remained a significant predictor of poor surveillance outcome (p = 0.001). Women younger than age 50 at primary breast cancer diagnosis are at risk of poor surveillance mammography outcomes, and may be appropriate candidates for more intensive clinical and imaging surveillance.
Kroep, Sonja; Heberle, Curtis; Curtius, Kit; Kong, Chung Yin; Lansdorp-Vogelaar, Iris; Ali, Ayman; Wolf, W Asher; Shaheen, Nicholas J; Spechler, Stuart J; Rubenstein, Joel H; Nishioka, Norman S; Meltzer, Stephen J; Hazelton, William D; Ballegooijen, Marjolein; Tramontano, Angela; Gazelle, G. Scott; Luebeck, E Georg; Inadomi, John M; Hur, Chin
Radiofrequency Ablation of Barrett's Esophagus Reduces Esophageal Adenocarcinoma Incidence and Mortality in a Comparative Modeling Analysis. Journal Article
In: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, vol. 15, pp. 1471–1474, 2017, ISSN: 1542-7714, ().
@article{Kroep2017a,
title = {Radiofrequency Ablation of Barrett's Esophagus Reduces Esophageal Adenocarcinoma Incidence and Mortality in a Comparative Modeling Analysis.},
author = {Sonja Kroep and Curtis Heberle and Kit Curtius and Chung Yin Kong and Iris Lansdorp-Vogelaar and Ayman Ali and W Asher Wolf and Nicholas J Shaheen and Stuart J Spechler and Joel H Rubenstein and Norman S Nishioka and Stephen J Meltzer and William D Hazelton and Marjolein Ballegooijen and Angela Tramontano and G. Scott Gazelle and E Georg Luebeck and John M Inadomi and Chin Hur},
url = {https://www.ncbi.nlm.nih.gov/pubmed/28089850},
doi = {10.1016/j.cgh.2016.12.034},
issn = {1542-7714},
year = {2017},
date = {2017-09-01},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {15},
pages = {1471--1474},
keywords = {},
pubstate = {published},
tppubtype = {article}
}