
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
Haaf, Kevin Ten; de Nijs, Koen; Simoni, Giulia; Alban, Andres; Cao, Pianpian; Sun, Zhuolu; Yong, Jean; Jeon, Jihyoun; Toumazis, Iakovos; Han, Summer S; Gazelle, G Scott; Kong, Chung Ying; Plevritis, Sylvia K; Meza, Rafael; de Koning, Harry J
The Impact of Model Assumptions on Personalized Lung Cancer Screening Recommendations Journal Article
In: Med Decis Making, vol. 44, no. 5, pp. 497-511, 2024, ISSN: 1552-681X.
@article{pmid38738534,
title = {The Impact of Model Assumptions on Personalized Lung Cancer Screening Recommendations},
author = {Kevin Ten Haaf and Koen de Nijs and Giulia Simoni and Andres Alban and Pianpian Cao and Zhuolu Sun and Jean Yong and Jihyoun Jeon and Iakovos Toumazis and Summer S Han and G Scott Gazelle and Chung Ying Kong and Sylvia K Plevritis and Rafael Meza and Harry J de Koning},
doi = {10.1177/0272989X241249182},
issn = {1552-681X},
year = {2024},
date = {2024-07-01},
urldate = {2024-05-01},
journal = {Med Decis Making},
volume = {44},
number = {5},
pages = {497-511},
abstract = {BACKGROUND: Recommendations regarding personalized lung cancer screening are being informed by natural-history modeling. Therefore, understanding how differences in model assumptions affect model-based personalized screening recommendations is essential.nnDESIGN: Five Cancer Intervention and Surveillance Modeling Network (CISNET) models were evaluated. Lung cancer incidence, mortality, and stage distributions were compared across 4 theoretical scenarios to assess model assumptions regarding 1) sojourn times, 2) stage-specific sensitivities, and 3) screening-induced lung cancer mortality reductions. Analyses were stratified by sex and smoking behavior.nnRESULTS: Most cancers had sojourn times \<5 y (model range [MR]; lowest to highest value across models: 83.5%-98.7% of cancers). However, cancer aggressiveness still varied across models, as demonstrated by differences in proportions of cancers with sojourn times \<2 y (MR: 42.5%-64.6%) and 2 to 4 y (MR: 28.8%-43.6%). Stage-specific sensitivity varied, particularly for stage I (MR: 31.3%-91.5%). Screening reduced stage IV incidence in most models for 1 y postscreening; increased sensitivity prolonged this period to 2 to 5 y. Screening-induced lung cancer mortality reductions among lung cancers detected at screening ranged widely (MR: 14.6%-48.9%), demonstrating variations in modeled treatment effectiveness of screen-detected cases. All models assumed longer sojourn times and greater screening-induced lung cancer mortality reductions for women. Models assuming differences in cancer epidemiology by smoking behaviors assumed shorter sojourn times and lower screening-induced lung cancer mortality reductions for heavy smokers.nnCONCLUSIONS: Model-based personalized screening recommendations are primarily driven by assumptions regarding sojourn times (favoring longer intervals for groups more likely to develop less aggressive cancers), sensitivity (higher sensitivities favoring longer intervals), and screening-induced mortality reductions (greater reductions favoring shorter intervals).nnIMPLICATIONS: Models suggest longer screening intervals may be feasible and benefits may be greater for women and light smokers.nnHIGHLIGHTS: Natural-history models are increasingly used to inform lung cancer screening, but causes for variations between models are difficult to assess.This is the first evaluation of these causes and their impact on personalized screening recommendations through easily interpretable metrics.Models vary regarding sojourn times, stage-specific sensitivities, and screening-induced lung cancer mortality reductions.Model outcomes were similar in predicting greater screening benefits for women and potentially light smokers. Longer screening intervals may be feasible for women and light smokers.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Collins, Reagan A; Herman, Tianna; Snyder, Rebecca A; Haines, Krista L; Stey, Anne; Arora, Tania K; Geevarghese, Sunil K; Phillips, Joseph D; Vicente, Diego; Griggs, Cornelia L; McElroy, Imani E; Wall, Anji E; Hughes, Tasha M; Sen, Srijan; Valinejad, Jaber; Alban, Andres; Swan, J Shannon; Mercaldo, Nathaniel; Jalali, Mohammad S; Chhatwal, Jagpreet; Gazelle, G Scott; Rangel, Erika; Yang, Chi-Fu Jeffrey; Donelan, Karen; Gold, Jessica A; West, Colin P; Cunningham, Carrie
Unspoken Truths: Mental Health Among Academic Surgeons Journal Article
In: Ann Surg, vol. 279, iss. 3, pp. 429-436, 2024, ISSN: 1528-1140.
@article{pmid37991182,
title = {Unspoken Truths: Mental Health Among Academic Surgeons},
author = {Reagan A Collins and Tianna Herman and Rebecca A Snyder and Krista L Haines and Anne Stey and Tania K Arora and Sunil K Geevarghese and Joseph D Phillips and Diego Vicente and Cornelia L Griggs and Imani E McElroy and Anji E Wall and Tasha M Hughes and Srijan Sen and Jaber Valinejad and Andres Alban and J Shannon Swan and Nathaniel Mercaldo and Mohammad S Jalali and Jagpreet Chhatwal and G Scott Gazelle and Erika Rangel and Chi-Fu Jeffrey Yang and Karen Donelan and Jessica A Gold and Colin P West and Carrie Cunningham},
doi = {10.1097/SLA.0000000000006159},
issn = {1528-1140},
year = {2024},
date = {2024-03-01},
urldate = {2024-03-01},
journal = {Ann Surg},
volume = {279},
issue = {3},
pages = {429-436},
abstract = {OBJECTIVE: To characterize the current state of mental health within the surgical workforce in the United States (US).nnSUMMARY BACKGROUND DATA: Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown.nnMETHODS: Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed.nnRESULTS: Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P\<0.001), anxiety (31.6% vs. 16.2%, P=0.001), PTSD (12.8% vs. 5.6%, P=0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P=0.022). 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past two weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P=0.033), and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P\<0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P=0.002) were associated with increased odds of suicidal ideation over the past 12 months.nnCONCLUSIONS: Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the US.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Potter, Alexandra L; Xu, Nuo N; Senthil, Priyanka; Srinivasan, Deepti; Lee, Hang; Gazelle, G Scott; Chelala, Lydia; Zheng, Wei; Fintelmann, Florian J; Sequist, Lecia V; Donington, Jessica; Palmer, Julie R; Yang, Chi-Fu Jeffrey
Pack-Year Smoking History: An Inadequate and Biased Measure to Determine Lung Cancer Screening Eligibility Journal Article
In: J Clin Oncol, pp. JCO2301780, 2024, ISSN: 1527-7755.
@article{pmid38537159,
title = {Pack-Year Smoking History: An Inadequate and Biased Measure to Determine Lung Cancer Screening Eligibility},
author = {Alexandra L Potter and Nuo N Xu and Priyanka Senthil and Deepti Srinivasan and Hang Lee and G Scott Gazelle and Lydia Chelala and Wei Zheng and Florian J Fintelmann and Lecia V Sequist and Jessica Donington and Julie R Palmer and Chi-Fu Jeffrey Yang},
doi = {10.1200/JCO.23.01780},
issn = {1527-7755},
year = {2024},
date = {2024-03-01},
journal = {J Clin Oncol},
pages = {JCO2301780},
abstract = {PURPOSE: Pack-year smoking history is an imperfect and biased measure of cumulative tobacco exposure. The use of pack-year smoking history to determine lung cancer screening eligibility in the current US Preventive Services Task Force (USPSTF) guideline may unintentionally exclude many high-risk individuals, especially those from racial and ethnic minority groups. It is unclear whether using a smoking duration cutoff instead of a smoking pack-year cutoff would improve the selection of individuals for screening.nnMETHODS: We analyzed 49,703 individuals with a smoking history from the Southern Community Cohort Study (SCCS) and 22,126 individuals with a smoking history from the Black Women's Health Study (BWHS) to assess eligibility for screening under the USPSTF guideline versus a proposed guideline that replaces the ≥20-pack-year criterion with a ≥20-year smoking duration criterion.nnRESULTS: Under the USPSTF guideline, only 57.6% of Black patients with lung cancer in the SCCS would have qualified for screening, whereas a significantly higher percentage of White patients with lung cancer (74.0%) would have qualified ( < .001). Under the proposed guideline, the percentage of Black and White patients with lung cancer who would have qualified for screening increased to 85.3% and 82.0%, respectively, eradicating the disparity in screening eligibility between the groups. In the BWHS, using a 20-year smoking duration cutoff instead of a 20-pack-year cutoff increased the percentage of Black women with lung cancer who would have qualified for screening from 42.5% to 63.8%.nnCONCLUSION: Use of a 20-year smoking duration cutoff instead of a 20-pack-year cutoff greatly increases the proportion of patients with lung cancer who would qualify for screening and eliminates the racial disparity in screening eligibility between Black versus White individuals; smoking duration has the added benefit of being easier to calculate and being a more precise assessment of smoking exposure compared with pack-year smoking history.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Toumazis, Iakovos; Cao, Pianpian; de Nijs, Koen; Bastani, Mehrad; Munshi, Vidit; Hemmati, Mehdi; Haaf, Kevin Ten; Jeon, Jihyoun; Tammemägi, Martin; Gazelle, G Scott; Feuer, Eric J; Kong, Chung Yin; Meza, Rafael; de Koning, Harry J; Plevritis, Sylvia K; Han, Summer S
Risk Model-Based Lung Cancer Screening : A Cost-Effectiveness Analysis Journal Article
In: Ann Intern Med, 2023, ISSN: 1539-3704.
@article{pmid36745885,
title = {Risk Model-Based Lung Cancer Screening : A Cost-Effectiveness Analysis},
author = {Iakovos Toumazis and Pianpian Cao and Koen de Nijs and Mehrad Bastani and Vidit Munshi and Mehdi Hemmati and Kevin Ten Haaf and Jihyoun Jeon and Martin Tammem\"{a}gi and G Scott Gazelle and Eric J Feuer and Chung Yin Kong and Rafael Meza and Harry J de Koning and Sylvia K Plevritis and Summer S Han},
doi = {10.7326/M22-2216},
issn = {1539-3704},
year = {2023},
date = {2023-02-01},
journal = {Ann Intern Med},
abstract = {BACKGROUND: In their 2021 lung cancer screening recommendation update, the U.S. Preventive Services Task Force (USPSTF) evaluated strategies that select people based on their personal lung cancer risk (risk model-based strategies), highlighting the need for further research on the benefits and harms of risk model-based screening.
OBJECTIVE: To evaluate and compare the cost-effectiveness of risk model-based lung cancer screening strategies versus the USPSTF recommendation and to explore optimal risk thresholds.
DESIGN: Comparative modeling analysis.
DATA SOURCES: National Lung Screening Trial; Surveillance, Epidemiology, and End Results program; U.S. Smoking History Generator.
TARGET POPULATION: 1960 U.S. birth cohort.
TIME HORIZON: 45 years.
PERSPECTIVE: U.S. health care sector.
INTERVENTION: Annual low-dose computed tomography in risk model-based strategies that start screening at age 50 or 55 years, stop screening at age 80 years, with 6-year risk thresholds between 0.5% and 2.2% using the PLCOm2012 model.
OUTCOME MEASURES: Incremental cost-effectiveness ratio (ICER) and cost-effectiveness efficiency frontier connecting strategies with the highest health benefit at a given cost.
RESULTS OF BASE-CASE ANALYSIS: Risk model-based screening strategies were more cost-effective than the USPSTF recommendation and exclusively comprised the cost-effectiveness efficiency frontier. Among the strategies on the efficiency frontier, those with a 6-year risk threshold of 1.2% or greater were cost-effective with an ICER less than $100 000 per quality-adjusted life-year (QALY). Specifically, the strategy with a 1.2% risk threshold had an ICER of $94 659 (model range, $72 639 to $156 774), yielding more QALYs for less cost than the USPSTF recommendation, while having a similar level of screening coverage (person ever-screened 21.7% vs. USPSTF's 22.6%).
RESULTS OF SENSITIVITY ANALYSES: Risk model-based strategies were robustly more cost-effective than the 2021 USPSTF recommendation under varying modeling assumptions.
LIMITATION: Risk models were restricted to age, sex, and smoking-related risk predictors.
CONCLUSION: Risk model-based screening is more cost-effective than the USPSTF recommendation, thus warranting further consideration.
PRIMARY FUNDING SOURCE: National Cancer Institute (NCI).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: To evaluate and compare the cost-effectiveness of risk model-based lung cancer screening strategies versus the USPSTF recommendation and to explore optimal risk thresholds.
DESIGN: Comparative modeling analysis.
DATA SOURCES: National Lung Screening Trial; Surveillance, Epidemiology, and End Results program; U.S. Smoking History Generator.
TARGET POPULATION: 1960 U.S. birth cohort.
TIME HORIZON: 45 years.
PERSPECTIVE: U.S. health care sector.
INTERVENTION: Annual low-dose computed tomography in risk model-based strategies that start screening at age 50 or 55 years, stop screening at age 80 years, with 6-year risk thresholds between 0.5% and 2.2% using the PLCOm2012 model.
OUTCOME MEASURES: Incremental cost-effectiveness ratio (ICER) and cost-effectiveness efficiency frontier connecting strategies with the highest health benefit at a given cost.
RESULTS OF BASE-CASE ANALYSIS: Risk model-based screening strategies were more cost-effective than the USPSTF recommendation and exclusively comprised the cost-effectiveness efficiency frontier. Among the strategies on the efficiency frontier, those with a 6-year risk threshold of 1.2% or greater were cost-effective with an ICER less than $100 000 per quality-adjusted life-year (QALY). Specifically, the strategy with a 1.2% risk threshold had an ICER of $94 659 (model range, $72 639 to $156 774), yielding more QALYs for less cost than the USPSTF recommendation, while having a similar level of screening coverage (person ever-screened 21.7% vs. USPSTF's 22.6%).
RESULTS OF SENSITIVITY ANALYSES: Risk model-based strategies were robustly more cost-effective than the 2021 USPSTF recommendation under varying modeling assumptions.
LIMITATION: Risk models were restricted to age, sex, and smoking-related risk predictors.
CONCLUSION: Risk model-based screening is more cost-effective than the USPSTF recommendation, thus warranting further consideration.
PRIMARY FUNDING SOURCE: National Cancer Institute (NCI).
DiGennaro, Catherine; Vahdat, Vahab; Jalali, Mohammad; Toumi, Asmae; Watson, Tina; Gazelle, G Scott; Mercaldo, Nathaniel; Lubitz, Carrie C
In: Thyroid, vol. 32, iss. 10, pp. 1144-1157, 2022, ISSN: 1557-9077.
@article{pmid35999710,
title = {Assessing Bias and Limitations of Clinical Validation Studies of Molecular Diagnostic Tests for Indeterminate Thyroid Nodules: Systematic Review and Meta-Analysis},
author = {Catherine DiGennaro and Vahab Vahdat and Mohammad Jalali and Asmae Toumi and Tina Watson and G Scott Gazelle and Nathaniel Mercaldo and Carrie C Lubitz},
doi = {10.1089/thy.2022.0269},
issn = {1557-9077},
year = {2022},
date = {2022-10-01},
urldate = {2022-09-26},
journal = {Thyroid},
volume = {32},
issue = {10},
pages = {1144-1157},
abstract = {BACKGROUND: Molecular tests for thyroid nodules with indeterminate fine needle aspiration results are increasingly used in clinical practice; however, true diagnostic summaries of these tests are unknown. A systematic review and meta-analysis were completed to (1) evaluate the accuracy of commercially available molecular tests for malignancy in indeterminate thyroid nodules and (2) quantify biases and limitations in studies which validate those tests.
METHODS: PubMed, EMBASE, and Web of Science were systematically searched through July 2021. English language articles that reported original clinical validation attempts of molecular tests for indeterminate thyroid nodules were included if they reported counts of true negative, true positive, false negative, and false positive results. We performed screening and full text review, followed by assessment of eight common biases and limitations, extraction of diagnostic and histopathological information, and meta-analysis of clinical validity using a bivariate linear mixed-effects model.
RESULTS: 49 studies were included. Meta-analysis of Afirma GEC (n=38 studies) revealed a sensitivity of 0.92 (95% CI: 0.90-0.94), specificity of 0.26 (0.20-0.32), negative likelihood ratio (LR-) of 0.32 (0.23-0.44), positive likelihood ratio (LR+) of 1.24 (1.15-1.35), and AUC of 0.83 (0.74-0.89). Afirma GSC (n=10) had a sensitivity of 0.94 (0.89-0.96), specificity of 0.38 (0.27-0.50), LR- of 0.18 (0.10-0.30), LR+ of 1.52 (1.28-1.87), and AUC of 0.91 (0.62-0.92). ThyroSeq v1 and v2 (n=10) had a sensitivity of 0.86 (0.82-0.90), specificity of 0.74 (0.59-0.85), LR- of 0.19 (0.13-0.26), LR+ of 3.52 (2.08-5.92), and AUC of 0.86 (0.81-0.90). ThyroSeq v3 (n=6) had a sensitivity of 0.92 (0.86-0.95), specificity of 0.41 (0.18-0.69), LR- of 0.24 (0.09-0.62), LR+ of 1.67 (1.09-2.98), and AUC of 0.90 (0.63-0.92). 14% of studies conducted blinded histopathologic review of excised thyroid nodules, and 8% made the decision to go to surgery blind to molecular test results.
CONCLUSIONS: Meta-analyses reveal high diagnostic accuracy of molecular tests for thyroid nodule assessment of malignancy risk; however, these studies are subject to several limitations. Limitations and their potential clinical impacts must be addressed and, when feasible, adjusted for using valid statistical methodologies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
METHODS: PubMed, EMBASE, and Web of Science were systematically searched through July 2021. English language articles that reported original clinical validation attempts of molecular tests for indeterminate thyroid nodules were included if they reported counts of true negative, true positive, false negative, and false positive results. We performed screening and full text review, followed by assessment of eight common biases and limitations, extraction of diagnostic and histopathological information, and meta-analysis of clinical validity using a bivariate linear mixed-effects model.
RESULTS: 49 studies were included. Meta-analysis of Afirma GEC (n=38 studies) revealed a sensitivity of 0.92 (95% CI: 0.90-0.94), specificity of 0.26 (0.20-0.32), negative likelihood ratio (LR-) of 0.32 (0.23-0.44), positive likelihood ratio (LR+) of 1.24 (1.15-1.35), and AUC of 0.83 (0.74-0.89). Afirma GSC (n=10) had a sensitivity of 0.94 (0.89-0.96), specificity of 0.38 (0.27-0.50), LR- of 0.18 (0.10-0.30), LR+ of 1.52 (1.28-1.87), and AUC of 0.91 (0.62-0.92). ThyroSeq v1 and v2 (n=10) had a sensitivity of 0.86 (0.82-0.90), specificity of 0.74 (0.59-0.85), LR- of 0.19 (0.13-0.26), LR+ of 3.52 (2.08-5.92), and AUC of 0.86 (0.81-0.90). ThyroSeq v3 (n=6) had a sensitivity of 0.92 (0.86-0.95), specificity of 0.41 (0.18-0.69), LR- of 0.24 (0.09-0.62), LR+ of 1.67 (1.09-2.98), and AUC of 0.90 (0.63-0.92). 14% of studies conducted blinded histopathologic review of excised thyroid nodules, and 8% made the decision to go to surgery blind to molecular test results.
CONCLUSIONS: Meta-analyses reveal high diagnostic accuracy of molecular tests for thyroid nodule assessment of malignancy risk; however, these studies are subject to several limitations. Limitations and their potential clinical impacts must be addressed and, when feasible, adjusted for using valid statistical methodologies.
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}
}
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}
}
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}
}
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}
}
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}
}