2021
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}
}
2020
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}
}
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}
}
2019
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}
}
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}
}
2018
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}
}
2017
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}
}
Lubitz, Carrie C.; Ali, Ayman; Zhan, Tiannan; Heberle, Curtis; White, Craig; Ito, Yasuhiro; Miyauchi, Akira; Gazelle, G. Scott; Kong, Chung Yin; Hur, Chin
The thyroid cancer policy model: A mathematical simulation model of papillary thyroid carcinoma in The U.S. population Journal Article
In: PloS one, vol. 12, no. 5, pp. e0177068, 2017, ISSN: 1932-6203.
@article{Lubitz2017,
title = {The thyroid cancer policy model: A mathematical simulation model of papillary thyroid carcinoma in The U.S. population},
author = {Carrie C. Lubitz and Ayman Ali and Tiannan Zhan and Curtis Heberle and Craig White and Yasuhiro Ito and Akira Miyauchi and G. Scott Gazelle and Chung Yin Kong and Chin Hur},
url = {http://www.ncbi.nlm.nih.gov/pubmed/28481909},
doi = {10.1371/journal.pone.0177068},
issn = {1932-6203},
year = {2017},
date = {2017-05-01},
urldate = {2017-05-01},
journal = {PloS one},
volume = {12},
number = {5},
pages = {e0177068},
abstract = {Thyroid cancer affects over ½ million people in the U.S. and the incidence of thyroid cancer has increased worldwide at a rate higher than any other cancer, while survival has remained largely unchanged. The aim of this research was to develop, calibrate and verify a mathematical disease model to simulate the natural history of papillary thyroid cancer, which will serve as a platform to assess the effectiveness of clinical and cancer control interventions. Herein, we modeled the natural pre-clinical course of both benign and malignant thyroid nodules with biologically relevant health states from normal to detected nodule. Using established calibration techniques, optimal parameter sets for tumor growth characteristics, development rate, and detection rate were used to fit Surveillance Epidemiology and End Results (SEER) incidence data and other calibration targets. Model outputs compared to calibration targets demonstrating sufficient calibration fit and model validation are presented including primary targets of SEER incidence data and size distribution at detection of malignancy. Additionally, we show the predicted underlying benign and malignant prevalence of nodules in the population, the probability of detection based on size of nodule, and estimates of growth over time in both benign and malignant nodules. This comprehensive model provides a dynamic platform employable for future comparative effectiveness research. Future model analyses will test and assess various clinical management strategies to improve patient outcomes related to thyroid cancer and optimize resource utilization for patients with thyroid nodules.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Sheehan, Deirdre; Criss, Steven; Gazelle, G. Scott; Pandharipande, Pari; Kong, Chung Yin
Ëvaluating lung cancer screening in China: Implications for eligibility criteria design from a microsimulation modeling approach" Journal Article
In: PloS one, vol. 12, no. 3, pp. e0173119, 2017, ISSN: 1932-6203, ().
@article{Sheehan2017,
title = {\"{E}valuating lung cancer screening in China: Implications for eligibility criteria design from a microsimulation modeling approach"},
author = {Deirdre Sheehan and Steven Criss and G. Scott Gazelle and Pari Pandharipande and Chung Yin Kong},
url = {http://www.ncbi.nlm.nih.gov/pubmed/28273181},
doi = {10.1371/journal.pone.0173119},
issn = {1932-6203},
year = {2017},
date = {2017-03-01},
journal = {PloS one},
volume = {12},
number = {3},
pages = {e0173119},
abstract = {More than half of males in China are current smokers and evidence from western countries tells us that an unprecedented number of smoking-attributable deaths will occur as the Chinese population ages. We used the China Lung Cancer Policy Model (LCPM) to simulate effects of computed tomography (CT)-based lung cancer screening in China, comparing the impact of a screening guideline published in 2015 by a Chinese expert group to a version developed for the United States by the U.S. Centers for Medicare \& Medicaid Services (CMS). The China LCPM, built using an existing lung cancer microsimulation model, can project population outcomes associated with interventions for smoking-related diseases. After calibrating the model to published Chinese smoking prevalence and lung cancer mortality rates, we simulated screening from 2016 to 2050 based on eligibility criteria from the CMS and Chinese guidelines, which differ by age to begin and end screening, pack-years smoked, and years since quitting. Outcomes included number of screens, mortality reduction, and life-years saved for each strategy. We projected that in the absence of screening, 14.98 million lung cancer deaths would occur between 2016 and 2050. Screening with the CMS guideline would prevent 0.72 million deaths and 5.8 million life-years lost, resulting in 6.58% and 1.97% mortality reduction in males and females, respectively. Screening with the Chinese guideline would prevent 0.74 million deaths and 6.6 million life-years lost, resulting in 6.30% and 2.79% mortality reduction in males and females, respectively. Through 2050, 1.43 billion screens would be required using the Chinese screening strategy, compared to 988 million screens using the CMS guideline. In conclusion, CT-based lung cancer screening implemented in 2016 and based on the Chinese screening guideline would prevent about 20,000 (2.9%) more lung cancer deaths through 2050, but would require about 445 million (44.7%) more screens than the CMS guideline.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Eisenberg, Jonathan; Reisner, Andrew T; Binder, William D; Zaheer, Atif; Gunn, Martin L; Linnau, Ken F; Miller, Chad M; Tramontano, Angela; Herring, Maurice; Dowling, Emily; Halpern, Elkan F.; Donelan, Karen; Gazelle, G. Scott; Pandharipande, Pari
Role of CT in the Diagnosis of Nonspecific Abdominal Pain: A Multicenter Analysis Journal Article
In: AJR. American journal of roentgenology, vol. 208, no. 3, pp. 570-576, 2017, ISSN: 1546-3141, ().
@article{Eisenberg2017,
title = {Role of CT in the Diagnosis of Nonspecific Abdominal Pain: A Multicenter Analysis},
author = {Jonathan Eisenberg and Andrew T Reisner and William D Binder and Atif Zaheer and Martin L Gunn and Ken F Linnau and Chad M Miller and Angela Tramontano and Maurice Herring and Emily Dowling and Elkan F. Halpern and Karen Donelan and G. Scott Gazelle and Pari Pandharipande},
url = {http://www.ncbi.nlm.nih.gov/pubmed/28075619},
doi = {10.2214/AJR.16.16669},
issn = {1546-3141},
year = {2017},
date = {2017-03-01},
journal = {AJR. American journal of roentgenology},
volume = {208},
number = {3},
pages = {570-576},
abstract = {The objective of our study was to determine whether specific patient and physician factors-known before CT-are associated with a diagnosis of nonspecific abdominal pain (NSAP) after CT in the emergency department (ED). We analyzed data originally collected in a prospective multicenter study. In the parent study, we identified ED patients referred to CT for evaluation of abdominal pain. We surveyed their physicians before and after CT to identify changes in leading diagnoses, diagnostic confidence, and admission decisions. In the current study, we conducted a multiple regression analysis to identify whether the following were associated with a post-CT diagnosis of NSAP: patient age; patient sex; physicians' years of experience; physicians' pre-CT diagnostic confidence; and physicians' pre-CT admission decision if CT had not been available. We analyzed patients with and those without a pre-CT diagnosis of NSAP separately. For the sensitivity analysis, we excluded patients with different physicians before and after CT. In total, 544 patients were included: 10% (52/544) with a pre-CT diagnosis of NSAP and 90% (492/544) with a pre-CT diagnosis other than NSAP. The leading diagnoses changed after CT in a large proportion of patients with a pre-CT diagnosis of NSAP (38%, 20/52). In regression analysis, we found that physicians' pre-CT diagnostic confidence was inversely associated with a post-CT diagnosis of NSAP in patients with a pre-CT diagnosis other than NSAP (p = 0.0001). No other associations were significant in both primary and sensitivity analyses. With the exception of physicians' pre-CT diagnostic confidence, the factors evaluated were not associated with a post-CT diagnosis of NSAP.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Jena, Anupam B; Huang, Jie; Fireman, Bruce; Fung, Vicki; Gazelle, G. Scott; Landrum, Mary Beth; Chernew, Michael; Newhouse, Joseph P; Hsu, John
Screening Mammography for Free: Impact of Eliminating Cost Sharing on Cancer Screening Rates Journal Article
In: Health services research, vol. 52, pp. 191–206, 2017, ISSN: 1475-6773, ().
@article{Jena2017,
title = {Screening Mammography for Free: Impact of Eliminating Cost Sharing on Cancer Screening Rates},
author = {Anupam B Jena and Jie Huang and Bruce Fireman and Vicki Fung and G. Scott Gazelle and Mary Beth Landrum and Michael Chernew and Joseph P Newhouse and John Hsu},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26990550},
doi = {10.1111/1475-6773.12486},
issn = {1475-6773},
year = {2017},
date = {2017-02-01},
journal = {Health services research},
volume = {52},
pages = {191--206},
abstract = {To study the impact of eliminating cost sharing for screening mammography on mammography rates in a large Medicare Advantage (MA) health plan which in 2010 eliminated cost sharing in anticipation of the Affordable Care Act mandate. Large MA health maintenance organization offering individual-subscriber MA insurance and employer-supplemented group MA insurance. We investigated the impact on breast cancer screening of a policy that eliminated a $20 copayment for screening mammography in 2010 among 53,188 women continuously enrolled from 2007 to 2012 in an individual-subscriber MA plan, compared with 42,473 women with employer-supplemented group MA insurance in the same health maintenance organization who had full screening coverage during this period. We used differences-in-differences analysis to study the impact of cost-sharing elimination on mammography rates. Annual screening rates declined over time for both groups, with similar trends pre-2010 and a slower decline after 2010 among women whose copayments were eliminated. Among women aged 65-74 years in the individual-subscriber MA plan, 44.9 percent received screening in 2009 compared with 40.9 percent in 2012, while 49.5 percent of women in the employer-supplemented MA plan received screening in 2009 compared with 44.1 percent in 2012, that is, a difference-in-difference effect of 1.4 percentage points less decline in screening among women experiencing the cost-sharing elimination. Effects were concentrated among women without recent screening. There were no differences by neighborhood socioeconomic status or race/ethnicity. Eliminating cost sharing for screening mammography was associated with modesty lower decline in screening rates among women with previously low screening adherence.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
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
Impact of Radiofrequency Ablation Treatment of Barrett's Esophagus on Esophageal Adenocarcinoma: A Comparative Modeling Analysis Journal Article
In: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2017, ISSN: 1542-7714, ().
@article{Kroep2017,
title = {Impact of Radiofrequency Ablation Treatment of Barrett's Esophagus on Esophageal Adenocarcinoma: 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 = {http://www.ncbi.nlm.nih.gov/pubmed/28089850},
doi = {10.1016/j.cgh.2016.12.034},
issn = {1542-7714},
year = {2017},
date = {2017-01-01},
urldate = {2017-01-01},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2016
Pandharipande, Pari; Alabre, Claude I.; Coy, David L.; Zaheer, Atif; Miller, Chad M.; Herring, Maurice; Tramontano, Angela; Dowling, Emily; Eisenberg, Jonathan; Ashar, Bimal H.; Halpern, Elkan F.; Donelan, Karen; Gazelle, G. Scott
Changes in Physician Decision Making after CT: A Prospective Multicenter Study in Primary Care Settings Journal Article
In: Radiology, vol. 281, no. 3, pp. 835-846, 2016, ().
@article{Pandharipande2016c,
title = {Changes in Physician Decision Making after CT: A Prospective Multicenter Study in Primary Care Settings},
author = {Pari Pandharipande and Claude I. Alabre and David L. Coy and Atif Zaheer and Chad M. Miller and Maurice Herring and Angela Tramontano and Emily Dowling and Jonathan Eisenberg and Bimal H. Ashar and Elkan F. Halpern and Karen Donelan and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/27479641},
doi = {10.1148/radiol.2016152887},
year = {2016},
date = {2016-12-01},
urldate = {2016-12-01},
journal = {Radiology},
volume = {281},
number = {3},
pages = {835-846},
institution = {4; Department of Radiology, Virginia Mason Medical Center, Seattle, Wash (D.L.C.); Departments of Radiology (A.Z.) and Medicine (B.H.A.), Johns Hopkins Medical Institutions, Baltimore, Md; Department of Radiology, Duke University Medical Center, Durham, NC},
abstract = {Purpose To determine the effect of computed tomography (CT) results on physician decision making in three common clinical scenarios in primary care. Materials and Methods This research was approved by the institutional review board (IRB) and was HIPAA compliant. All physicians consented to participate with an opt-in or opt-out mechanism; patient consent was waived with IRB approval. In this prospective multicenter observational study, outpatients referred by primary care providers (PCPs) for CT evaluation of abdominal pain, hematuria, or weight loss were identified. Prior to CT, PCPs were surveyed to elicit their leading diagnosis, confidence in that diagnosis (confidence range, 0%-100%), a rule-out diagnosis, and a management plan if CT were not available. Surveys were repeated after CT. Study measures were the proportion of patients in whom leading diagnoses and management changed (PCP management vs specialist referral vs emergency department transfer), median changes in diagnostic confidence, and the proportion of patients in whom CT addressed rule-out diagnoses. Regression analyses were used to identify associations between study measures and site and participant characteristics. Specifically, logistic regression analysis was used for binary study measures (change in leading diagnosis, change in management), and linear regression analysis was used for the continuous study measure (change in diagnostic confidence). Accrual began on September 5, 2012, and ended on June 28, 2014. Results In total, 91 PCPs completed pre- and post-CT surveys in 373 patients. In patients with abdominal pain, hematuria, or weight loss, leading diagnoses changed after CT in 53% (131 of 246), 49% (36 of 73), and 57% (27 of 47) of patients, respectively. Management changed in 35% (86 of 248), 27% (20 of 74), and 54% (26 of 48) of patients, respectively. Median absolute changes in diagnostic confidence were substantial and significant (+20%, +20%, and +19%, respectively; P ≤ .001 for all); median confidence after CT was high (90%, 88%, and 80%, respectively). PCPs reported CT was helpful in confirming or excluding rule-out diagnoses in 98% (184 of 187), 97% (59 of 61), and 97% (33 of 34) of patients, respectively. Significant associations between primary measures and site and participant characteristics were not identified. Conclusion Changes in PCP leading diagnoses and management after CT were common, and diagnostic confidence increased substantially. (©) RSNA, 2016 Online supplemental material is available for this article.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Hur, Chin; Tramontano, Angela; Dowling, Emily; Brooks, Gabriel A.; Jeon, Alvin; Brugge, William R; Gazelle, G. Scott; Kong, Chung Yin; Pandharipande, Pari
Early Pancreatic Ductal Adenocarcinoma Survival Is Dependent on Size: Positive Implications for Future Targeted Screening Journal Article
In: Pancreas, vol. 45, pp. 1062–1066, 2016, ISSN: 1536-4828, ().
@article{Hur2016,
title = {Early Pancreatic Ductal Adenocarcinoma Survival Is Dependent on Size: Positive Implications for Future Targeted Screening},
author = {Chin Hur and Angela Tramontano and Emily Dowling and Gabriel A. Brooks and Alvin Jeon and William R Brugge and G. Scott Gazelle and Chung Yin Kong and Pari Pandharipande},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26692444},
doi = {10.1097/MPA.0000000000000587},
issn = {1536-4828},
year = {2016},
date = {2016-08-01},
urldate = {2016-08-01},
journal = {Pancreas},
volume = {45},
pages = {1062--1066},
abstract = {Pancreatic ductal adenocarcinoma (PDAC) has not experienced a meaningful mortality improvement for the past few decades. Successful screening is difficult to accomplish because most PDACs present late in their natural history, and current interventions have not provided significant benefit. Our goal was to identify determinants of survival for early PDAC to help inform future screening strategies. Early PDACs from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program database (2000-2010) were analyzed. We stratified by size and included carcinomas in situ (Tis). Overall cancer-specific survival was calculated. A Cox proportional hazards model was developed and the significance of key covariates for survival prediction was evaluated. A Kaplan-Meier plot demonstrated significant differences in survival by size at diagnosis; these survival benefits persisted after adjustment for key covariates in the Cox proportional hazards analysis. In addition, relatively weaker predictors of worse survival included older age, male sex, black race, nodal involvement, tumor location within the head of the pancreas, and no surgery or radiotherapy. For early PDAC, we found tumor size to be the strongest predictor of survival, even after adjustment for other patient characteristics. Our findings suggest that early PDAC detection can have clinical benefit, which has positive implications for future screening strategies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Harvey, H. Benjamin; Alkasab, Tarik K.; Prabhakar, Anand M.; Halpern, Elkan F.; Rosenthal, Daniel I.; Pandharipande, Pari; Gazelle, G. Scott
Radiologist Peer Review by Group Consensus Journal Article
In: J Am Coll Radiol, vol. 13, no. 6, pp. 656-62, 2016, ().
@article{Harvey2016,
title = {Radiologist Peer Review by Group Consensus},
author = {H. Benjamin Harvey and Tarik K. Alkasab and Anand M. Prabhakar and Elkan F. Halpern and Daniel I. Rosenthal and Pari Pandharipande and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26908200},
doi = {10.1016/j.jacr.2015.11.013},
year = {2016},
date = {2016-06-01},
journal = {J Am Coll Radiol},
volume = {13},
number = {6},
pages = {656-62},
institution = {Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts.},
abstract = {The objective of this study was to evaluate the feasibility of the consensus-oriented group review (COGR) method of radiologist peer review within a large subspecialty imaging department.This study was institutional review board approved and HIPAA compliant. Radiologist interpretations of CT, MRI, and ultrasound examinations at a large academic radiology department were subject to peer review using the COGR method from October 2011 through September 2013. Discordance rates and sources of discordance were evaluated on the basis of modality and division, with group differences compared using a χ(2) test. Potential associations between peer review outcomes and the time after the initiation of peer review or the number of radiologists participating in peer review were tested by linear regression analysis and the t test, respectively.A total of 11,222 studies reported by 83 radiologists were peer reviewed using COGR during the two-year study period. The average radiologist participated in 112 peer review conferences and had 3.3% of his or her available CT, MRI and ultrasound studies peer reviewed. The rate of discordance was 2.7% (95% confidence interval [CI], 2.4%-3.0%), with significant differences in discordance rates on the basis of division and modality. Discordance rates were highest for MR (3.4%; 95% CI, 2.8%-4.1%), followed by ultrasound (2.7%; 95% CI, 2.0%-3.4%) and CT (2.4%; 95% CI, 2.0%-2.8%). Missed findings were the most common overall cause for discordance (43.8%; 95% CI, 38.2%-49.4%), followed by interpretive errors (23.5%; 95% CI, 18.8%-28.3%), dictation errors (19.0%; 95% CI, 14.6%-23.4%), and recommendation (10.8%; 95% CI, 7.3%-14.3%). Discordant cases, compared with concordant cases, were associated with a significantly greater number of radiologists participating in the peer review process (5.9 vs 4.7 participating radiologists, P .001) and were significantly more likely to lead to an addendum (62.9% vs 2.7%, P .0001).COGR permits departments to collect highly contextualized peer review data to better elucidate sources of error in diagnostic imaging reports, while reviewing a sufficient case volume to comply with external standards for ongoing performance review.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Pandharipande, Pari; Reisner, Andrew T.; Binder, William D.; Zaheer, Atif; Gunn, Martin L.; Linnau, Ken F.; Miller, Chad M.; Avery, Laura L.; Herring, Maurice; Tramontano, Angela; Dowling, Emily; Abujudeh, Hani H.; Eisenberg, Jonathan; Halpern, Elkan F.; Donelan, Karen; Gazelle, G. Scott
CT in the Emergency Department: A Real-Time Study of Changes in Physician Decision Making Journal Article
In: Radiology, vol. 278, no. 3, pp. 812-21, 2016, ().
@article{Pandharipande2015,
title = {CT in the Emergency Department: A Real-Time Study of Changes in Physician Decision Making},
author = {Pari Pandharipande and Andrew T. Reisner and William D. Binder and Atif Zaheer and Martin L. Gunn and Ken F. Linnau and Chad M. Miller and Laura L. Avery and Maurice Herring and Angela Tramontano and Emily Dowling and Hani H. Abujudeh and Jonathan Eisenberg and Elkan F. Halpern and Karen Donelan and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26402399},
doi = {10.1148/radiol.2015150473},
year = {2016},
date = {2016-03-01},
urldate = {2016-03-01},
journal = {Radiology},
volume = {278},
number = {3},
pages = {812-21},
institution = {From the Department of Radiology (P.V.P., L.L.A., H.H.A., E.F.H., G.S.G.), Institute for Technology Assessment (P.V.P., M.S.H., A.C.T., E.C.D., J.D.E., E.F.H., G.S.G.), Department of Emergency Medicine (A.T.R., W.D.B.), and Department of Medicine, Mongan},
abstract = {Purpose To determine how physicians' diagnoses, diagnostic uncertainty, and management decisions are affected by the results of computed tomography (CT) in emergency department settings. Materials and Methods This study was approved by the institutional review board and compliant with HIPAA. Data were collected between July 12, 2012, and January 13, 2014. The requirement to obtain patient consent was waived. In this prospective, four-center study, patients presenting to the emergency department who were referred for CT with abdominal pain, chest pain and/or dyspnea, or headache were identified. Physicians were surveyed before and after CT to determine the leading diagnosis, diagnostic confidence (on a scale of 0% to 100%), alternative ruleout diagnosis, and management decisions. Primary measures were the proportion of patients for whom the leading diagnosis or admission decision changed and median changes in diagnostic confidence. Secondary measures addressed alternative diagnoses and return-to-care visits (eg, to emergency department) at 1-month follow-up. Regression analysis was used to identify associations between primary measures and site and participant characteristics. Results Both surveys were completed for 1280 patients by 245 physicians. The leading diagnosis changed in 235 of 460 patients with abdominal pain (51%), 163 of 387 with chest pain and/or dyspnea (42%), and 103 of 433 with headache (24%). Pre-CT diagnostic confidence was inversely associated with the likelihood of a diagnostic change (P},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Kong, Chung Yin; Sheehan, Deirdre; McMahon, Pamela M.; Gazelle, G. Scott; Pandharipande, Pari
In: MDM policy & practice, vol. 1, 2016, ISSN: 2381-4683, ().
@article{Kong2016,
title = {Combined Biomarker and Computed {T}omography Screening Strategies for Lung Cancer: Projections of {H}ealth and Economic {T}radeoffs in the US Population.},
author = {Chung Yin Kong and Deirdre Sheehan and Pamela M. McMahon and G. Scott Gazelle and Pari Pandharipande},
url = {https://www.ncbi.nlm.nih.gov/pubmed/30148212},
doi = {10.1177/2381468316643968},
issn = {2381-4683},
year = {2016},
date = {2016-01-01},
journal = {MDM policy \& practice},
volume = {1},
abstract = {Lung cancer screening with computed tomography (CT) of individuals who meet certain age and smoking history criteria is the current standard-of-care. Using a published simulation model, we compared outcomes associated with seven biomarker+CT screening strategies to CT screening alone using CMS eligibility criteria. We assumed that the biomarker: had conditionally independent performance; was used for first-line screening in some, or all, individuals screened; and could be extended to CMS-ineligible smokers. Strategies differed by inclusion criteria (e.g. pack-years) and proportion of individuals for whom CT remained the first-line test. Each model run simulated a combined cohort of one million men and one million women born in 1950. Primary outcomes were cancer-specific mortality reduction and screening costs; biomarker costs were measured relative to CT. Efficiency frontiers identified optimal health and economic trade-offs. Sensitivity analysis evaluated the stability of results. Standard-of-care screening yielded an 8.3% cancer-specific mortality reduction in the simulated U.S. population (screened+unscreened individuals). For a biomarker test with 75% sensitivity and 95% specificity, mortality reductions across biomarker+CT strategies ranged from 7.0% to 23.9%. If the biomarker's cost was \>0.86× that of CT, standard-of-care screening remained on the efficiency frontier, indicating that health and economic trade-offs were equally (or more) efficient relative to all biomarker+CT strategies. Biomarker+CT strategy costs were principally driven by biomarker specificity; mortality reduction was driven by sensitivity. Combined biomarker+CT strategies have the potential to improve future lung cancer screening effectiveness in the U.S. and achieve economic efficiency that is greater than the current standard-of-care.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2015
Hur, Chin; Tramontano, Angela; Dowling, Emily; Brooks, Gabriel A.; Jeon, Alvin; Brugge, William R.; Gazelle, G. Scott; Kong, Chung Yin; Pandharipande, Pari
Early Pancreatic Ductal Adenocarcinoma Survival Is Dependent on Size: Positive Implications for Future Targeted Screening Journal Article
In: Pancreas, 2015, ().
@article{Hur2015a,
title = {Early Pancreatic Ductal Adenocarcinoma Survival Is Dependent on Size: Positive Implications for Future Targeted Screening},
author = {Chin Hur and Angela Tramontano and Emily Dowling and Gabriel A. Brooks and Alvin Jeon and William R. Brugge and G. Scott Gazelle and Chung Yin Kong and Pari Pandharipande},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26692444},
doi = {10.1097/MPA.0000000000000587},
year = {2015},
date = {2015-12-01},
urldate = {2015-12-01},
journal = {Pancreas},
institution = {From the *Institute for Technology Assessment and †Gastroenterology Division, Department of Medicine, Massachusetts General Hospital; ‡Harvard Medical School; §Department of Radiology, Massachusetts General Hospital; and ∥Dana Farber Cancer Institute, Bos},
abstract = {Pancreatic ductal adenocarcinoma (PDAC) has not experienced a meaningful mortality improvement for the past few decades. Successful screening is difficult to accomplish because most PDACs present late in their natural history, and current interventions have not provided significant benefit. Our goal was to identify determinants of survival for early PDAC to help inform future screening strategies.Early PDACs from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program database (2000-2010) were analyzed. We stratified by size and included carcinomas in situ (Tis). Overall cancer-specific survival was calculated. A Cox proportional hazards model was developed and the significance of key covariates for survival prediction was evaluated.A Kaplan-Meier plot demonstrated significant differences in survival by size at diagnosis; these survival benefits persisted after adjustment for key covariates in the Cox proportional hazards analysis. In addition, relatively weaker predictors of worse survival included older age, male sex, black race, nodal involvement, tumor location within the head of the pancreas, and no surgery or radiotherapy.For early PDAC, we found tumor size to be the strongest predictor of survival, even after adjustment for other patient characteristics. Our findings suggest that early PDAC detection can have clinical benefit, which has positive implications for future screening strategies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Harvey, H. Benjamin; Alkasab, Tarik K.; Pandharipande, Pari; Halpern, Elkan F.; Prabhakar, Anand M.; Oklu, Rahmi; Rosenthal, Daniel I.; Hirsch, Joshua A.; Gazelle, G. Scott; Brink, James A.
Non-Research-Related Physician-Industry Relationships of Radiologists in the United States Journal Article
In: J Am Coll Radiol, vol. 12, no. 11, pp. 1142-50, 2015, ().
@article{Harvey2015b,
title = {Non-Research-Related Physician-Industry Relationships of Radiologists in the United States},
author = {H. Benjamin Harvey and Tarik K. Alkasab and Pari Pandharipande and Elkan F. Halpern and Anand M. Prabhakar and Rahmi Oklu and Daniel I. Rosenthal and Joshua A. Hirsch and G. Scott Gazelle and James A. Brink},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26243797},
doi = {10.1016/j.jacr.2015.04.017},
year = {2015},
date = {2015-11-01},
journal = {J Am Coll Radiol},
volume = {12},
number = {11},
pages = {1142-50},
institution = {Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.},
abstract = {To evaluate non-research-related, physician-industry financial relationships in the United States, in 2013, as reported pursuant to the Physician Payments Sunshine Act (a provision of the Affordable Care Act).In September 2014, CMS released the first five months (August 2013 to December 2013) of data disclosing physician-industry financial relationships. The frequency and value of non-research-related transfers in radiology were calculated and compared with those for 19 other specialties. Subanalyses of the frequency and value of such transfers in radiology were performed, based on state of licensure, radiologic subspecialty, nature of payment, manufacturer identity, and drug or device involved.A total of 7.4% (2,654 of 35,768) of radiologists from the United States had reportable non-research-related financial relationship(s) with industry during the 5-month period, the second-lowest level among the medical specialties evaluated. The average value of non-research-related transfers of value to radiologists, excluding royalties and licenses, was low ($438.71; SD: $2,912.15; median: $43.85), with $10 per month. Of all categories, that of food and beverage had the most transfers of value (86.0%; 5,655 of 6,577); royalties and licensure were associated with the greatest average value ($27,072.34; SD: $67,524.92). Although high-value relationships were rare, 57.8% (26 of 45) of radiologists who received a value \>$1,000 per month held leadership positions in imaging enterprises.Less than 4% of radiologists have non-research-related financial relationships with industry that are valued at \>$10 per month, suggesting that meaningful, deleterious effects of such relationships on radiology practice, if present, are infrequent.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Lubitz, Carrie C.; Economopoulos, Konstantinos; Sy, Stephen; Johanson, Colden; Kunzel, Heike E.; Reincke, Martin; Gazelle, G. Scott; Weinstein, Milton C.; Gaziano, Thomas A.
Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients Journal Article
In: Circ Cardiovasc Qual Outcomes, vol. 8, no. 6, pp. 621-30, 2015, ().
@article{Lubitz2015a,
title = {Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients},
author = {Carrie C. Lubitz and Konstantinos Economopoulos and Stephen Sy and Colden Johanson and Heike E. Kunzel and Martin Reincke and G. Scott Gazelle and Milton C. Weinstein and Thomas A. Gaziano},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26555126},
doi = {10.1161/CIRCOUTCOMES.115.002002},
year = {2015},
date = {2015-11-01},
urldate = {2015-11-01},
journal = {Circ Cardiovasc Qual Outcomes},
volume = {8},
number = {6},
pages = {621-30},
institution = {From the Departments of Surgery (C.C.L., K.P.E.) and Radiology (G.S.G.), Massachusetts General Hospital, Boston; Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (C.C.L., K.P.E., C.J., G.S.G.); Depar},
abstract = {Primary aldosteronism (PA) is a common and underdiagnosed disease with significant morbidity potentially cured by surgery. We aim to assess if the long-term cardiovascular benefits of identifying and treating surgically correctable PA outweigh the upfront increased costs in patients at the time patients are diagnosed with resistant hypertension (RH).A decision-analytic model compares aggregate costs and systolic blood pressure changes of 6 recommended or implemented diagnostic strategies for PA in a simulated population of at-risk RH patients. We also evaluate a 7th "treat all" strategy wherein all patients with RH are treated with a mineralocorticoid-receptor antagonist without further testing at RH diagnosis. Changes in systolic blood pressure are subsequently converted into gains in quality-adjusted life years (QALYs) by applying National Health and Nutrition Examination Survey data on concomitant risk factors to an existing cardiovascular disease simulation model. QALYs and lifetime costs were then used to calculate incremental cost-effectiveness ratios for the competing strategies. The incremental cost-effectiveness ratio for the strategy of computerized tomography (CT) followed by adrenal venous sampling (AVS) was $82 000/QALY compared with treat all. Incremental cost-effectiveness ratios for CT alone and AVS alone were $200 000/QALY and $492 000/QALY; the other strategies were more costly and less effective. Integrating differential patient-reported health-related quality of life adjustments for patients with PA, and incremental cost-effectiveness ratios for screening patients with CT followed by AVS, CT alone, and AVS alone were $52 000/QALY, $114 000/QALY, and $269 000/QALY gained.CT scanning followed by AVS was a cost-effective strategy to screen for PA among patients with RH.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Glover, McKinley; Khalilzadeh, Omid; Choy, Garry; Prabhakar, Anand M.; Pandharipande, Pari; Gazelle, G. Scott
Hospital Evaluations by Social Media: A Comparative Analysis of Facebook Ratings among Performance Outliers Journal Article
In: J Gen Intern Med, vol. 30, no. 10, pp. 1440-6, 2015, ().
@article{Glover2015,
title = {Hospital Evaluations by Social Media: A Comparative Analysis of Facebook Ratings among Performance Outliers},
author = {McKinley Glover and Omid Khalilzadeh and Garry Choy and Anand M. Prabhakar and Pari Pandharipande and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/25749881},
doi = {10.1007/s11606-015-3236-3},
year = {2015},
date = {2015-10-01},
urldate = {2015-10-01},
journal = {J Gen Intern Med},
volume = {30},
number = {10},
pages = {1440-6},
institution = {Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, .},
abstract = {An increasing number of hospitals and health systems utilize social media to allow users to provide feedback and ratings. The correlation between ratings on social media and more conventional hospital quality metrics remains largely unclear, raising concern that healthcare consumers may make decisions on inaccurate or inappropriate information regarding quality.The purpose of this study was to examine the extent to which hospitals utilize social media and whether user-generated metrics on Facebook(®) correlate with a Hospital Compare(®) metric, specifically 30-day all cause unplanned hospital readmission rates.This was a retrospective cross-sectional study conducted among all U.S. hospitals performing outside the confidence interval for the national average on 30-day hospital readmission rates as reported on Hospital Compare. Participants were 315 hospitals performing better than U.S. national rate on 30-day readmissions and 364 hospitals performing worse than the U.S. national rate.The study analyzed ratings of hospitals on Facebook's five-star rating scale, 30-day readmission rates, and hospital characteristics including beds, teaching status, urban vs. rural location, and ownership type.Hospitals performing better than the national average on 30-day readmissions were more likely to use Facebook than lower-performing hospitals (93.3 % vs. 83.5 %; p},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Lee, Janie; Buist, Diana S M.; Houssami, Nehmat; Dowling, Emily; Halpern, Elkan F.; Gazelle, G. Scott; Lehman, Constance D.; Henderson, Louise M.; Hubbard, Rebecca A.
Five-year risk of interval-invasive second breast cancer Journal Article
In: J Natl Cancer Inst, vol. 107, no. 7, pp. djv109, 2015, ().
@article{Lee2015,
title = {Five-year risk of interval-invasive second breast cancer},
author = {Janie Lee and Diana S M. Buist and Nehmat Houssami and Emily Dowling and Elkan F. Halpern and G. Scott Gazelle and Constance D. Lehman and Louise M. Henderson and Rebecca A. Hubbard},
url = {http://www.ncbi.nlm.nih.gov/pubmed/25904721},
doi = {10.1093/jnci/djv109},
year = {2015},
date = {2015-07-01},
journal = {J Natl Cancer Inst},
volume = {107},
number = {7},
pages = {djv109},
institution = {Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA (JML, CDL); Department of Radiology and Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (JML, ECD, EFH, GSG); Group Health Researc},
abstract = {Earlier detection of second breast cancers after primary breast cancer (PBC) treatment improves survival, yet mammography is less accurate in women with prior breast cancer. The purpose of this study was to examine women presenting clinically with second breast cancers after negative surveillance mammography (interval cancers), and to estimate the five-year risk of interval-invasive second cancers for women with varying risk profiles.We evaluated a prospective cohort of 15 114 women with 47 717 surveillance mammograms diagnosed with stage 0-II unilateral PBC from 1996 through 2008 at facilities in the Breast Cancer Surveillance Consortium. We used discrete time survival models to estimate the association between odds of an interval-invasive second breast cancer and candidate predictors, including demographic, PBC, and imaging characteristics. All statistical tests were two-sided.The cumulative incidence of second breast cancers after five years was 54.4 per 1000 women, with 325 surveillance-detected and 138 interval-invasive second breast cancers. The five-year risk of interval-invasive second cancer for women with referent category characteristics was 0.60%. For women with the most and least favorable profiles, the five-year risk ranged from 0.07% to 6.11%. Multivariable modeling identified grade II PBC (odds ratio [OR] = 1.95, 95% confidence interval [CI] = 1.15 to 3.31), treatment with lumpectomy without radiation (OR = 3.27, 95% CI = 1.91 to 5.62), interval PBC presentation (OR = 2.01, 95% CI 1.28 to 3.16), and heterogeneously dense breasts on mammography (OR = 1.54, 95% CI = 1.01 to 2.36) as independent predictors of interval-invasive second breast cancers.PBC diagnosis and treatment characteristics contribute to variation in subsequent-interval second breast cancer risk. Consideration of these factors may be useful in developing tailored post-treatment imaging surveillance plans.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Niell, Bethany L.; Bennett, Debbie; Sharma, Amita; Gazelle, G. Scott
Extramammary Findings on Breast MR Examinations: Frequency, Clinical Relevance, and Patient Outcomes Journal Article
In: Radiology, vol. 276, no. 1, pp. 56-64, 2015, ().
@article{Niell2015,
title = {Extramammary Findings on Breast MR Examinations: Frequency, Clinical Relevance, and Patient Outcomes},
author = {Bethany L. Niell and Debbie Bennett and Amita Sharma and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/25584711},
doi = {10.1148/radiol.14141539},
year = {2015},
date = {2015-07-01},
urldate = {2015-07-01},
journal = {Radiology},
volume = {276},
number = {1},
pages = {56-64},
institution = {From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Avon Comprehensive Breast Evaluation Center, 55 Fruit St, Wang Building Suite 240, Boston, MA 02114 (B.L.N., D.B., G.S.G.); Department of Radiology, Massachusetts Ge},
abstract = {Purpose To evaluate the frequency of extramammary findings on breast magnetic resonance (MR) images, recommendations for further imaging evaluation of each finding, and the subsequent effect on patient outcomes and health care expenditures. Materials and Methods Institutional review board approval was acquired for this HIPAA-compliant study. Informed consent was waived. Review of the institutional database identified 2324 breast MR examinations performed in women from January 1, 2010, to December 31, 2010. Breast MR imaging reports were reviewed for extramammary findings. Extramammary findings were categorized by using the computed tomography (CT) colonography reporting and data system (C-RADS). The electronic medical record was reviewed for each patient with a C-RADS category E3 and E4 finding to assess clinical relevance and pathologic outcome. If an E3 or E4 finding was previously described and evaluated, the finding was downgraded and assigned a final C-RADS E2 category. The cost of additional imaging was estimated by using the Medicare physician fee schedule. Statistical significance was assessed by using χ(2) statistics. A P value less than .05 indicated statistical significance, and 95% exact confidence intervals (CIs) were constructed. Results Extramammary findings were identified in 391 of 2324 breast MR examinations (16.8%), which included 105 patients (4.5%) with E3 or E4 findings. Of the 2324 patients, 86 patients (3.7% [95% CI: 3.0%, 4.5%]) were recommended to undergo further imaging. After undergoing evaluation for additional imaging, a clinically important finding was found in nine patients (0.4% [95% CI: 0.2%, 0.7%]). Most frequently, hepatic lesions were the indication for additional imaging. Abdominal MR examinations accounted for 55% of costs related to additional imaging. Averaged across the entire cohort, further imaging evaluation and follow-up of incidental findings contributed an additional $16 to each breast MR imaging performed. Conclusion Additional imaging evaluation for E3 and E4 extramammary findings at breast MR imaging can identify clinically important disease without substantially increasing cost. (©) RSNA, 2015.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Lowry, Kathryn; Gazelle, G. Scott; Gilmore, Michael; Johanson, Colden; Munshi, Vidit; Choi, Sung Eun; Tramontano, Angela; Kong, Chung Yin; McMahon, Pamela M.
Personalizing annual lung cancer screening for patients with chronic obstructive pulmonary disease: A decision analysis Journal Article
In: Cancer, vol. 121, no. 10, pp. 1556-62, 2015, ().
@article{Lowry2015,
title = {Personalizing annual lung cancer screening for patients with chronic obstructive pulmonary disease: A decision analysis},
author = {Kathryn Lowry and G. Scott Gazelle and Michael Gilmore and Colden Johanson and Vidit Munshi and Sung Eun Choi and Angela Tramontano and Chung Yin Kong and Pamela M. McMahon},
url = {http://www.ncbi.nlm.nih.gov/pubmed/25652107},
doi = {10.1002/cncr.29225},
year = {2015},
date = {2015-05-01},
journal = {Cancer},
volume = {121},
number = {10},
pages = {1556-62},
institution = {Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Institute for Technology Assessment, Boston, Massachusetts.},
abstract = {Lung cancer screening with annual chest computed tomography (CT) is recommended for current and former smokers with a ≥30-pack-year smoking history. Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of developing lung cancer and may benefit from screening at lower pack-year thresholds.We used a previously validated simulation model to compare the health benefits of lung cancer screening in current and former smokers ages 55-80 with ≥30 pack-years with hypothetical programs using lower pack-year thresholds for individuals with COPD (≥20, ≥10, and ≥1 pack-years). Calibration targets for COPD prevalence and associated lung cancer risk were derived using the Framingham Offspring Study limited data set. We performed sensitivity analyses to evaluate the stability of results across different rates of adherence to screening, increased competing mortality risk from COPD, and increased surgical ineligibility in individuals with COPD. The primary outcome was projected life expectancy.Programs using lower pack-year thresholds for individuals with COPD yielded the highest life expectancy gains for a given number of screens. Highest life expectancy was achieved when lowering the pack-year threshold to ≥1 pack-year for individuals with COPD, which dominated all other screening strategies. These results were stable across different adherence rates to screening and increases in competing mortality risk for COPD and surgical ineligibility.Current and former smokers with COPD may disproportionately benefit from lung cancer screening. A lower pack-year threshold for screening eligibility may benefit this high-risk patient population. Cancer 2015. © 2015 American Cancer Society.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Harvey, H. Benjamin; Alkasab, Tarik K.; Pandharipande, Pari; Zhao, Jing; Halpern, Elkan F.; Salazar, Gloria M.; Abujudeh, Hani H.; Rosenthal, Daniel I.; Gazelle, G. Scott
Radiologist Compliance With Institutional Guidelines for Use of Nonroutine Communication of Diagnostic Imaging Results Journal Article
In: J Am Coll Radiol, vol. 12, no. 4, pp. 376-84, 2015, ().
@article{Harvey2014a,
title = {Radiologist Compliance With Institutional Guidelines for Use of Nonroutine Communication of Diagnostic Imaging Results},
author = {H. Benjamin Harvey and Tarik K. Alkasab and Pari Pandharipande and Jing Zhao and Elkan F. Halpern and Gloria M. Salazar and Hani H. Abujudeh and Daniel I. Rosenthal and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/25441481},
doi = {10.1016/j.jacr.2014.08.013},
year = {2015},
date = {2015-04-01},
urldate = {2015-04-01},
journal = {J Am Coll Radiol},
volume = {12},
number = {4},
pages = {376-84},
institution = {Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts.},
abstract = {The aim of this study was to evaluate radiologist compliance with
institutional guidelines for nonroutine communication of diagnostic
imaging results.From July 2012 through September 2013, 7,401 completed
advanced imaging cases were retrospectively reviewed by groups of
3 or more radiologists. The reviewing radiologists were asked to
reach consensus on two questions related to nonroutine communication:
(1) "Does the report describe a finding which requires nonroutine
communication to the patient's physicians?" and if so, (2) "Were
the department's guidelines for nonroutine communication followed?"
Consensus judgments were aggregated and analyzed on the basis of
subspecialty, level of acuity per the guidelines, and type of communication
used.Of the 7,401 studies reviewed, 960 (13.0%) were deemed to require
nonroutine results communication. The need for nonroutine communication
was most frequent with CT (16.6%), followed by MRI (11.1%) and
ultrasound (3.4%). For the divisions studied, nonroutine communication
was most frequently needed in thoracic (37.9%), followed by neurologic
(17.3%), emergency (15.8%), cardiac (13.7%), musculoskeletal (4.4%),
and abdominal (0.7%) imaging. Of the cases requiring nonroutine
communication, 39 (4%) yielded consensus that the guidelines were not appropriately followed: 21% (n = 8) involved level 1 findings (critical), 41% (n = 16) involved level 2 findings (acute), and 38% (n = 15) involved level 3 findings (nonacute). Failures of communication
involving level 1 findings primarily involved neurologic imaging,
including 4 cases of new cerebral infarct and 3 cases of new intracranial
hemorrhage.Established guidelines for nonroutine communication are
appropriately applied and durable, underscoring the high yield of
formalizing and implementing these guidelines across practice settings.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
institutional guidelines for nonroutine communication of diagnostic
imaging results.From July 2012 through September 2013, 7,401 completed
advanced imaging cases were retrospectively reviewed by groups of
3 or more radiologists. The reviewing radiologists were asked to
reach consensus on two questions related to nonroutine communication:
(1) "Does the report describe a finding which requires nonroutine
communication to the patient's physicians?" and if so, (2) "Were
the department's guidelines for nonroutine communication followed?"
Consensus judgments were aggregated and analyzed on the basis of
subspecialty, level of acuity per the guidelines, and type of communication
used.Of the 7,401 studies reviewed, 960 (13.0%) were deemed to require
nonroutine results communication. The need for nonroutine communication
was most frequent with CT (16.6%), followed by MRI (11.1%) and
ultrasound (3.4%). For the divisions studied, nonroutine communication
was most frequently needed in thoracic (37.9%), followed by neurologic
(17.3%), emergency (15.8%), cardiac (13.7%), musculoskeletal (4.4%),
and abdominal (0.7%) imaging. Of the cases requiring nonroutine
communication, 39 (4%) yielded consensus that the guidelines were not appropriately followed: 21% (n = 8) involved level 1 findings (critical), 41% (n = 16) involved level 2 findings (acute), and 38% (n = 15) involved level 3 findings (nonacute). Failures of communication
involving level 1 findings primarily involved neurologic imaging,
including 4 cases of new cerebral infarct and 3 cases of new intracranial
hemorrhage.Established guidelines for nonroutine communication are
appropriately applied and durable, underscoring the high yield of
formalizing and implementing these guidelines across practice settings.
Romanus, Dorothy; Cardarella, Stephanie; Cutler, David; Landrum, Mary Beth; Lindeman, Neal I.; Gazelle, G. Scott
Cost-Effectiveness of Multiplexed Predictive Biomarker Screening in Non-Small Cell Lung Cancer Journal Article
In: J Thorac Oncol, 2015, ().
@article{Romanus2015,
title = {Cost-Effectiveness of Multiplexed Predictive Biomarker Screening in Non-Small Cell Lung Cancer},
author = {Dorothy Romanus and Stephanie Cardarella and David Cutler and Mary Beth Landrum and Neal I. Lindeman and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/25590606},
doi = {10.1097/JTO.0000000000000474},
year = {2015},
date = {2015-01-01},
journal = {J Thorac Oncol},
institution = {Massachusetts General Hospital and Harvard University, Boston, MA Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA Harvard University, Cambridge, MA Harvard Medical School, Boston, MA Brigham and Women's Hospital and Harvard Medical Sch},
abstract = {Population-wide screening for epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) gene rearrangements to inform cancer therapy in non-small cell lung cancer (NSCLC) is recommended by guidelines. We estimated cost-effectiveness of multiplexed predictive biomarker screening in metastatic NSCLC from a societal perspective in the US.We constructed a microsimulation model to compare the life expectancy and costs of multiplexed testing and molecularly guided therapy vs treatment with cisplatin-pemetrexed (CisPem). All testing interventions included a two-step algorithm of concurrent EGFR mutation and ALK overexpression testing with immunohistochemistry (IHC) followed by ALK rearrangement confirmation with a fluorescence in situ hybridization (FISH) assay for IHC positive results. Three strategies were included: 'Test-treat' approach, where molecularly guided therapy was initiated after obtainment of test results; 'Empiric switch therapy', with concurrent initiation of CisPem and testing and immediate switch to test-result conditional treatment after one cycle of CisPem; and 'Empiric therapy' approach in which CisPem was continued for four cycles before start of a tyrosine kinase inhibitor (TKI).The incremental cost-effectiveness ratio (ICER) for 'Test-treat' compared to treatment with CisPem was $136,000 per quality-adjusted life year (QALY) gained. Both empiric treatment approaches had less favorable ICERs. 'Test-treat' and 'Empiric switch therapy' yielded higher expected outcomes in terms of QALYs and life-years (LYs) than 'Empiric therapy'. These results were robust across plausible ranges of model inputs.From a societal perspective, our cost-effectiveness results support the value of multiplexed genetic screening and molecularly guided therapy in metastatic NSCLC.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2014
Goehler, Alexander; Gazelle, G. Scott
Examining the use of comparative and cost-effectiveness analyses in radiology Journal Article
In: AJR Am J Roentgenol, vol. 203, no. 5, pp. 939–944, 2014, ().
@article{Goehler2014a,
title = {Examining the use of comparative and cost-effectiveness analyses in radiology},
author = {Alexander Goehler and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/25341130},
doi = {10.2214/AJR.14.12887},
year = {2014},
date = {2014-11-01},
urldate = {2014-11-01},
journal = {AJR Am J Roentgenol},
volume = {203},
number = {5},
pages = {939--944},
institution = {1 Department of Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, New Haven, CT 06520-8042.},
abstract = {This article explores key principles of comparative effectiveness analysis--in particular, how radiologic comparative and cost-effectiveness studies differ from other clinical trials. Exemplary studies are reviewed to show how comparative effectiveness has been implemented in radiology and how future studies might be conducted. Finally, the article closes with a discussion of several additional key themes relevant to quality and value in clinical radiology going forward.Comparative effectiveness is likely to require a paradigm shift in thinking within the discipline. For new radiologic applications to be accepted, we will need to show at least a significant change in treatment planning and at best a meaningful change in patient outcomes. This shift will require a forward-thinking approach to robust evidence generation for new imaging modalities or indications and the inclusion of other modes of value demonstration such as clinical decision support and intelligent data mining.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Alkasab, Tarik K.; Harvey, H. Benjamin; Gowda, Vrushab; Thrall, James H.; Rosenthal, Daniel I.; Gazelle, G. Scott
Consensus-Oriented Group Peer Review: A New Process to Review Radiologist Work Output Journal Article
In: J Am Coll Radiol, vol. 11, no. 2, pp. 131-138, 2014, ().
@article{Alkasab2013,
title = {Consensus-Oriented Group Peer Review: A New Process to Review Radiologist Work Output},
author = {Tarik K. Alkasab and H. Benjamin Harvey and Vrushab Gowda and James H. Thrall and Daniel I. Rosenthal and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/24139321},
doi = {10.1016/j.jacr.2013.04.013},
year = {2014},
date = {2014-10-01},
journal = {J Am Coll Radiol},
volume = {11},
number = {2},
pages = {131-138},
institution = {Department of Radiology, Massachusetts General Hospital, Boston,
Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA. Electronic address: .},
abstract = {The Joint Commission and other regulatory bodies have mandated that
health care organizations implement processes for ongoing physician
performance review. Software solutions, such as RADPEER™, have been
created to meet this need efficiently. However, the authors believe
that available systems are not optimally designed to produce changes
in practice and overlook many important aspects of quality by excessive
focus on diagnosis. The authors present a new model of peer review
known as consensus-oriented group review, which is based on group
discussion of cases in a conference setting and places greater emphasis
on feedback than traditional systems of radiology peer review. By
focusing on the process of peer review, consensus-oriented group
review is intended to optimize performance improvement and foster
group standards of practice. The authors also describe the software
tool developed to implement this process of enriched peer review.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
health care organizations implement processes for ongoing physician
performance review. Software solutions, such as RADPEER™, have been
created to meet this need efficiently. However, the authors believe
that available systems are not optimally designed to produce changes
in practice and overlook many important aspects of quality by excessive
focus on diagnosis. The authors present a new model of peer review
known as consensus-oriented group review, which is based on group
discussion of cases in a conference setting and places greater emphasis
on feedback than traditional systems of radiology peer review. By
focusing on the process of peer review, consensus-oriented group
review is intended to optimize performance improvement and foster
group standards of practice. The authors also describe the software
tool developed to implement this process of enriched peer review.
Nolte, Julia; Neumann, Till; Manne, Jennifer M.; Lo, Janet; Neumann, Anja; Mostardt, Sarah; Abbara, Suhny; Hoffmann, Udo; Brady, Thomas J.; Wasem, Juergen; Grinspoon, Steven K.; Gazelle, G. Scott; Goehler, Alexander
Cost-effectiveness analysis of coronary artery disease screening in HIV-infected men Journal Article
In: Eur J Prev Cardiol, vol. 21, no. 8, pp. 972-9, 2014, ().
@article{Nolte2013,
title = {Cost-effectiveness analysis of coronary artery disease screening in HIV-infected men},
author = {Julia Nolte and Till Neumann and Jennifer M. Manne and Janet Lo and Anja Neumann and Sarah Mostardt and Suhny Abbara and Udo Hoffmann and Thomas J. Brady and Juergen Wasem and Steven K. Grinspoon and G. Scott Gazelle and Alexander Goehler},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23539717},
doi = {10.1177/2047487313483607},
year = {2014},
date = {2014-08-01},
journal = {Eur J Prev Cardiol},
volume = {21},
number = {8},
pages = {972-9},
institution = {Harvard Medical School, Boston, USA.},
abstract = {BACKGROUND: HIV-infected patients are at increased risk of coronary
artery disease (CAD). We evaluated the cost-effectiveness of cardiac
screening for HIV-positive men at intermediate or greater CAD risk.
DESIGN: We developed a lifetime microsimulation model of CAD incidence
and progression in HIV-infected men. METHODS: Input parameters were
derived from two HIV cohort studies and the literature. We compared
no CAD screening with stress testing and coronary computed tomography
angiography (CCTA)-based strategies. Patients with test results indicating
3-vessel/left main CAD underwent invasive coronary angiography (ICA)
and received coronary artery bypass graft surgery. In the stress
testing + medication and CCTA + medication strategies, patients with
1-2-vessel CAD results received lifetime medical treatment without
further diagnostics whereas in the stress testing + intervention
and CCTA + intervention strategies, patients with these results underwent
ICA and received percutaneous coronary intervention. RESULTS: Compared
to no screening, the stress testing + medication, stress testing + intervention,
CCTA + medication, and CCTA + intervention strategies resulted in
14, 11, 19, and 14 quality-adjusted life days per patient and incremental
cost-effectiveness ratios of 49,261, 57,817, 34,887 and 56,518 Euros
per quality-adjusted life year (QALY), respectively. Screening only
at higher CAD risk thresholds was more cost-effective. Repeated screening
was clinically beneficial compared to one-time screening, but only
stress testing + medication every 5 years remained cost-effective.
At a willingness-to-pay threshold of 83,000 €/QALY (∼100,000 US$/QALY),
implementing any CAD screening was cost-effective with a probability
of 75-95%. CONCLUSIONS: Screening HIV-positive men for CAD would
be clinically beneficial and comes at a cost-effectiveness ratio
comparable to other accepted interventions in HIV care.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
artery disease (CAD). We evaluated the cost-effectiveness of cardiac
screening for HIV-positive men at intermediate or greater CAD risk.
DESIGN: We developed a lifetime microsimulation model of CAD incidence
and progression in HIV-infected men. METHODS: Input parameters were
derived from two HIV cohort studies and the literature. We compared
no CAD screening with stress testing and coronary computed tomography
angiography (CCTA)-based strategies. Patients with test results indicating
3-vessel/left main CAD underwent invasive coronary angiography (ICA)
and received coronary artery bypass graft surgery. In the stress
testing + medication and CCTA + medication strategies, patients with
1-2-vessel CAD results received lifetime medical treatment without
further diagnostics whereas in the stress testing + intervention
and CCTA + intervention strategies, patients with these results underwent
ICA and received percutaneous coronary intervention. RESULTS: Compared
to no screening, the stress testing + medication, stress testing + intervention,
CCTA + medication, and CCTA + intervention strategies resulted in
14, 11, 19, and 14 quality-adjusted life days per patient and incremental
cost-effectiveness ratios of 49,261, 57,817, 34,887 and 56,518 Euros
per quality-adjusted life year (QALY), respectively. Screening only
at higher CAD risk thresholds was more cost-effective. Repeated screening
was clinically beneficial compared to one-time screening, but only
stress testing + medication every 5 years remained cost-effective.
At a willingness-to-pay threshold of 83,000 €/QALY (∼100,000 US$/QALY),
implementing any CAD screening was cost-effective with a probability
of 75-95%. CONCLUSIONS: Screening HIV-positive men for CAD would
be clinically beneficial and comes at a cost-effectiveness ratio
comparable to other accepted interventions in HIV care.
Goehler, Alexander; McMahon, Pamela M.; Lumish, Heidi S.; Wu, Carol; Munshi, Vidit; Gilmore, Michael; Chung, Jonathan H.; Ghoshhajra, Brian B.; Mark, Daniel; Truong, Quynh A.; Gazelle, G. Scott; Hoffmann, Udo
In: Circulation, vol. 130, no. 8, pp. 668-75, 2014, ().
@article{Goehler2014,
title = {Cost-Effectiveness of Follow-Up of Pulmonary Nodules Incidentally Detected on Cardiac CT Angiography in Patients with Suspected Coronary Artery Disease},
author = {Alexander Goehler and Pamela M. McMahon and Heidi S. Lumish and Carol Wu and Vidit Munshi and Michael Gilmore and Jonathan H. Chung and Brian B. Ghoshhajra and Daniel Mark and Quynh A. Truong and G. Scott Gazelle and Udo Hoffmann},
url = {http://www.ncbi.nlm.nih.gov/pubmed/25015342},
doi = {10.1161/CIRCULATIONAHA.113.007306},
year = {2014},
date = {2014-08-01},
urldate = {2014-08-01},
journal = {Circulation},
volume = {130},
number = {8},
pages = {668-75},
institution = {Massachusetts General Hospital; Harvard Medical School, Boston, MA.},
abstract = {-Pulmonary nodules (PN) are often incidentally detected during coronary
CT angiography (CCTA) which is increasingly used to evaluate patients
with chest pain symptoms. However, the efficiency of following up
on incidentally detected PN is unknown.-We determined demographic
and clinical characteristics of stable symptomatic patients referred
for CCTA in whom incidentally detected PN warranted follow-up. A
validated lung cancer simulation model was populated with data from
these patients and clinical and economic consequences of follow-up
per Fleischner guidelines versus no follow-up were simulated. Of
the 3,665 patients referred to CCTA, 591 (16%) had PN requiring
follow-up. Mean age of patients with PN was 59±10 years, 66% were
male, 67% had ever smoked, and 21% had obstructive CAD. The projected
overall lung cancer incidence was 5.8% in these patients, but the
majority died from CAD (38%) and other causes (57%). Follow-up
of PN was associated with a 4.6% relative reduction in cumulative
lung cancer mortality (absolute mortality:FU: 4.33% vs. non-FU:
4.54%), more downstream testing (FU: 2.34 CTs/patient vs. non-FU:
1.01 CTs/patient), and an average increase of quality-adjusted life
of seven days. Costs per quality adjusted life year (QALY) gained
were $154,700 to follow-up the entire cohort and $129,800/QALY when
only smokers were included.-Follow-up of PN incidentally detected
in patients undergoing CCTA for chest pain evaluation is associated
with a small reduction in lung cancer mortality. However, significant
downstream testing contributes to limited efficiency as demonstrated
by a high cost per QALY, especially in non-smokers.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
CT angiography (CCTA) which is increasingly used to evaluate patients
with chest pain symptoms. However, the efficiency of following up
on incidentally detected PN is unknown.-We determined demographic
and clinical characteristics of stable symptomatic patients referred
for CCTA in whom incidentally detected PN warranted follow-up. A
validated lung cancer simulation model was populated with data from
these patients and clinical and economic consequences of follow-up
per Fleischner guidelines versus no follow-up were simulated. Of
the 3,665 patients referred to CCTA, 591 (16%) had PN requiring
follow-up. Mean age of patients with PN was 59±10 years, 66% were
male, 67% had ever smoked, and 21% had obstructive CAD. The projected
overall lung cancer incidence was 5.8% in these patients, but the
majority died from CAD (38%) and other causes (57%). Follow-up
of PN was associated with a 4.6% relative reduction in cumulative
lung cancer mortality (absolute mortality:FU: 4.33% vs. non-FU:
4.54%), more downstream testing (FU: 2.34 CTs/patient vs. non-FU:
1.01 CTs/patient), and an average increase of quality-adjusted life
of seven days. Costs per quality adjusted life year (QALY) gained
were $154,700 to follow-up the entire cohort and $129,800/QALY when
only smokers were included.-Follow-up of PN incidentally detected
in patients undergoing CCTA for chest pain evaluation is associated
with a small reduction in lung cancer mortality. However, significant
downstream testing contributes to limited efficiency as demonstrated
by a high cost per QALY, especially in non-smokers.
Kong, Chung Yin; Meng, Lesley; Omer, Zehra; Swan, J. Shannon; Srouji, Serene; Gazelle, G. Scott; Fennessy, Fiona M.
MRI-Guided Focused Ultrasound Surgery for Uterine Fibroid Treatment: A Cost-Effectiveness Analysis Journal Article
In: AJR Am J Roentgenol, vol. 203, no. 2, pp. 361–371, 2014, ().
@article{Kong2014a,
title = {MRI-Guided Focused Ultrasound Surgery for Uterine Fibroid Treatment: A Cost-Effectiveness Analysis},
author = {Chung Yin Kong and Lesley Meng and Zehra Omer and J. Shannon Swan and Serene Srouji and G. Scott Gazelle and Fiona M. Fennessy},
url = {http://www.ncbi.nlm.nih.gov/pubmed/25055272},
doi = {10.2214/AJR.13.11446},
year = {2014},
date = {2014-08-01},
urldate = {2014-08-01},
journal = {AJR Am J Roentgenol},
volume = {203},
number = {2},
pages = {361--371},
institution = {1 Department of Radiology, Massachusetts General Hospital, Institute for Technology Assessment, 101 Merrimac St, 10th Fl, Boston, MA 02114.},
abstract = {OBJECTIVE. The purpose of this article is to evaluate the cost effectiveness
of a treatment strategy for symptomatic uterine fibroids that uses
MRI-guided focused ultrasound as a first-line therapy relative to
uterine artery embolization (UAE) or hysterectomy. MATERIALS AND
METHODS. We developed a decision-analytic model to compare the cost
effectiveness of three first-line treatment strategies: MRI-guided
focused ultrasound, UAE, and hysterectomy. Treatment-specific short-
and long-term utilities, lifetime costs, and quality-adjusted life
years (QALYs) were incorporated, allowing us to conduct an incremental
cost-effectiveness analysis, using a societal willingness-to-pay
(WTP) threshold of $50,000/QALY to designate a strategy as cost effective.
Sensitivity analyses were subsequently performed on all key parameters.
RESULTS. In the base-case analysis, UAE as a first-line treatment
of symptomatic fibroids was the most effective and expensive strategy
(22.75 QALYs; $22,968), followed by MRI-guided focused ultrasound
(22.73 QALYs; $20,252) and hysterectomy (22.54 QALYs; $11,253). MRI-guided
focused ultrasound was cost effective relative to hysterectomy, with
an associated incremental cost-effectiveness ratio (ICER) of $47,891/QALY.
The ICER of UAE relative to MRI-guided focused ultrasound was $234,565/QALY,
exceeding the WTP threshold of $50,000/QALY, therefore rendering
MRI-guided focused ultrasound also cost effective relative to UAE.
In sensitivity analyses, results were robust to changes in most parameters
but were sensitive to changes in probabilities of recurrence, symptom
relief, and quality-of-life measures. CONCLUSION. First-line treatment
of eligible women with MRI-guided focused ultra-sound is a cost-effective
noninvasive strategy. For those not eligible for MRI-guided focused
ultra-sound, UAE remains a cost-effective option. These recommendations
integrate both the short- and long-term decrements in quality of
life associated with the specific treatment modalities.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
of a treatment strategy for symptomatic uterine fibroids that uses
MRI-guided focused ultrasound as a first-line therapy relative to
uterine artery embolization (UAE) or hysterectomy. MATERIALS AND
METHODS. We developed a decision-analytic model to compare the cost
effectiveness of three first-line treatment strategies: MRI-guided
focused ultrasound, UAE, and hysterectomy. Treatment-specific short-
and long-term utilities, lifetime costs, and quality-adjusted life
years (QALYs) were incorporated, allowing us to conduct an incremental
cost-effectiveness analysis, using a societal willingness-to-pay
(WTP) threshold of $50,000/QALY to designate a strategy as cost effective.
Sensitivity analyses were subsequently performed on all key parameters.
RESULTS. In the base-case analysis, UAE as a first-line treatment
of symptomatic fibroids was the most effective and expensive strategy
(22.75 QALYs; $22,968), followed by MRI-guided focused ultrasound
(22.73 QALYs; $20,252) and hysterectomy (22.54 QALYs; $11,253). MRI-guided
focused ultrasound was cost effective relative to hysterectomy, with
an associated incremental cost-effectiveness ratio (ICER) of $47,891/QALY.
The ICER of UAE relative to MRI-guided focused ultrasound was $234,565/QALY,
exceeding the WTP threshold of $50,000/QALY, therefore rendering
MRI-guided focused ultrasound also cost effective relative to UAE.
In sensitivity analyses, results were robust to changes in most parameters
but were sensitive to changes in probabilities of recurrence, symptom
relief, and quality-of-life measures. CONCLUSION. First-line treatment
of eligible women with MRI-guided focused ultra-sound is a cost-effective
noninvasive strategy. For those not eligible for MRI-guided focused
ultra-sound, UAE remains a cost-effective option. These recommendations
integrate both the short- and long-term decrements in quality of
life associated with the specific treatment modalities.
Lubitz, Carrie C.; Kong, Chung Yin; McMahon, Pamela M.; Daniels, Gilbert H.; Chen, Yufei; Economopoulos, Konstantinos; Gazelle, G. Scott; Weinstein, Milton C.
Annual financial impact of well-differentiated thyroid cancer care in the United States Journal Article
In: Cancer, vol. 120, no. 9, pp. 1345-52, 2014, ().
@article{LubitzCan2014,
title = {Annual financial impact of well-differentiated thyroid cancer care in the United States},
author = {Carrie C. Lubitz and Chung Yin Kong and Pamela M. McMahon and Gilbert H. Daniels and Yufei Chen and Konstantinos Economopoulos and G. Scott Gazelle and Milton C. Weinstein},
url = {http://www.ncbi.nlm.nih.gov/pubmed/24481684},
doi = {10.1002/cncr.28562},
year = {2014},
date = {2014-05-01},
urldate = {2014-05-01},
journal = {Cancer},
volume = {120},
number = {9},
pages = {1345-52},
institution = {Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts.},
abstract = {Well-differentiated thyroid cancer (WDTC) is a prevalent disease,
which is increasing in incidence faster than any other cancer. Substantial
direct medical care costs are related to the diagnosis and treatment
of newly diagnosed patients as well as the ongoing surveillance of
patients who have a long life expectancy. Prior analyses of the aggregate
health care costs attributable to WDTC in the United States have
not been reported.A stacked cohort cost analysis was performed on
the US population from 1985 to 2013 to estimate the number of WDTC
survivors in 2013. Incidence rates, and cancer-specific and overall
survival were based on Surveillance, Epidemiology, and End Results
(SEER) data. Current and projected direct medical care costs attributable
to the care of patients with WDTC were then estimated. Health care-related
costs and event probabilities were based on Medicare reimbursement
schedules and the literature.Estimated overall societal cost of WDTC
care in 2013 for all US patients diagnosed after 1985 is $1.6 billion.
Diagnosis, surgery, and adjuvant therapy for newly diagnosed patients
(41%) constitutes the greatest proportion of costs, followed by
surveillance of survivors (37%), and nonoperative death costs attributable
to thyroid cancer care (22%). Projected 2030 costs (in 2013 US dollars)
based on current incidence trends exceed $3.5 billion.Health care
costs of WDTC are substantial. Unlike other cancers, the majority
of the cost is incurred in the initial and continuing phases of care.
With the projected increasing incidence, population, and survival
trends, costs will continue to escalate. Cancer 2014. © 2014 American
Cancer Society.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
which is increasing in incidence faster than any other cancer. Substantial
direct medical care costs are related to the diagnosis and treatment
of newly diagnosed patients as well as the ongoing surveillance of
patients who have a long life expectancy. Prior analyses of the aggregate
health care costs attributable to WDTC in the United States have
not been reported.A stacked cohort cost analysis was performed on
the US population from 1985 to 2013 to estimate the number of WDTC
survivors in 2013. Incidence rates, and cancer-specific and overall
survival were based on Surveillance, Epidemiology, and End Results
(SEER) data. Current and projected direct medical care costs attributable
to the care of patients with WDTC were then estimated. Health care-related
costs and event probabilities were based on Medicare reimbursement
schedules and the literature.Estimated overall societal cost of WDTC
care in 2013 for all US patients diagnosed after 1985 is $1.6 billion.
Diagnosis, surgery, and adjuvant therapy for newly diagnosed patients
(41%) constitutes the greatest proportion of costs, followed by
surveillance of survivors (37%), and nonoperative death costs attributable
to thyroid cancer care (22%). Projected 2030 costs (in 2013 US dollars)
based on current incidence trends exceed $3.5 billion.Health care
costs of WDTC are substantial. Unlike other cancers, the majority
of the cost is incurred in the initial and continuing phases of care.
With the projected increasing incidence, population, and survival
trends, costs will continue to escalate. Cancer 2014. © 2014 American
Cancer Society.
Harvey, H. Benjamin; Gowda, Vrushab; Gazelle, G. Scott; Pandharipande, Pari
The Ephemeral Accountable Care Organization-An Unintended Consequence of the Medicare Shared® Savings Program Journal Article
In: J Am Coll Radiol, vol. 11, no. 2, pp. 121–124, 2014, ().
@article{Harvey2014,
title = {The Ephemeral Accountable Care Organization-An Unintended Consequence of the Medicare Shared® Savings Program},
author = {H. Benjamin Harvey and Vrushab Gowda and G. Scott Gazelle and Pari Pandharipande},
url = {http://www.ncbi.nlm.nih.gov/pubmed/24360903},
doi = {10.1016/j.jacr.2013.07.012},
year = {2014},
date = {2014-02-01},
urldate = {2014-02-01},
journal = {J Am Coll Radiol},
volume = {11},
number = {2},
pages = {121--124},
institution = {Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital Institute for Technology Assessment, Boston, Massachusetts. Electronic address: pari@mgh-it},
abstract = {A fundamental element of health care payment reform under the Affordable
Care Act is the development of Accountable Care Organizations (ACOs).
The ACO model employs shared-risk contracts to better align the interests
of health care providers and payers with the intent of driving efficiency
and quality in care. The Medicare Shared Savings Program is the most
popular of the Medicare ACO programs, with over 200 health systems
across the nation participating at this time. However, a pitfall
in the way that the Medicare Shared Savings Program is structured,
specifically the benchmarking and rebasing method, could make it
difficult for even top-performing ACOs to achieve sustained success,
thereby threatening the long-term viability of the program. In this
paper, we present this pitfall to the radiology community as well
as potential solutions that can be considered by CMS moving forward.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Care Act is the development of Accountable Care Organizations (ACOs).
The ACO model employs shared-risk contracts to better align the interests
of health care providers and payers with the intent of driving efficiency
and quality in care. The Medicare Shared Savings Program is the most
popular of the Medicare ACO programs, with over 200 health systems
across the nation participating at this time. However, a pitfall
in the way that the Medicare Shared Savings Program is structured,
specifically the benchmarking and rebasing method, could make it
difficult for even top-performing ACOs to achieve sustained success,
thereby threatening the long-term viability of the program. In this
paper, we present this pitfall to the radiology community as well
as potential solutions that can be considered by CMS moving forward.
2013
Wong, Hannah; Sistrom, Chris L.; Benzer, Theodore I.; Halpern, Elkan F.; Morra, Dante J.; Gazelle, G. Scott; Ferris, Timothy G.; Weilburg, Jeffrey B.
Use of imaging in the emergency department: physicians have limited effect on variation Journal Article
In: Radiology, vol. 268, no. 3, pp. 779–789, 2013, ().
@article{WongRad2013,
title = {Use of imaging in the emergency department: physicians have limited effect on variation},
author = {Hannah Wong and Chris L. Sistrom and Theodore I. Benzer and Elkan F. Halpern and Dante J. Morra and G. Scott Gazelle and Timothy G. Ferris and Jeffrey B. Weilburg},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23801769},
doi = {10.1148/radiol.13130972},
year = {2013},
date = {2013-09-01},
urldate = {2013-09-01},
journal = {Radiology},
volume = {268},
number = {3},
pages = {779--789},
institution = {School of Health Policy and Management, York University, Toronto, Ontario, Canada.},
abstract = {To quantify interphysician variation in imaging use during emergency
department (ED) visits and examine the contribution of factors to
this variation at the patient, visit, and physician level.This study
was HIPAA compliant and approved by the institutional review board
of Partners Healthcare System (Boston, Mass), with waiver of informed
consent. In this retrospective study of 88 851 consecutive ED visits
during 2011 at a large urban teaching hospital, a hierarchical logistic
regression model was used to identify multiple predictors for the
probability that low- or high-cost imaging would be ordered during
a given visit. Physician-specific random effects were estimated to
articulate (by odds ratio) and quantify (by intraclass correlation
coefficient [ICC]) interphysician variation.Patient- and visit-level
factors found to be statistically significant predictors of imaging
use included measures of ED busyness, prior ED visit, referral source
to the ED, and ED arrival mode. Physician-level factors (eg, sex,
years since graduation, annual workload, and residency training)
did not correlate with imaging use. The remaining amount of interphysician
variation was very low (ICC, 0.97% for low-cost imaging; ICC, 1.07%
for high-cost imaging). These physician-specific odds ratios of imaging
estimates were moderately reliable at 0.78 (95% confidence interval
[CI]: 0.77, 0.79) for low-cost imaging and 0.76 (95% CI: 0.74, 0.78)
for high-cost imaging.After careful and comprehensive case-mix adjustment
by using hierarchical logistic regression, only about 1% of the
variability in ED imaging utilization was attributable to physicians.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
department (ED) visits and examine the contribution of factors to
this variation at the patient, visit, and physician level.This study
was HIPAA compliant and approved by the institutional review board
of Partners Healthcare System (Boston, Mass), with waiver of informed
consent. In this retrospective study of 88 851 consecutive ED visits
during 2011 at a large urban teaching hospital, a hierarchical logistic
regression model was used to identify multiple predictors for the
probability that low- or high-cost imaging would be ordered during
a given visit. Physician-specific random effects were estimated to
articulate (by odds ratio) and quantify (by intraclass correlation
coefficient [ICC]) interphysician variation.Patient- and visit-level
factors found to be statistically significant predictors of imaging
use included measures of ED busyness, prior ED visit, referral source
to the ED, and ED arrival mode. Physician-level factors (eg, sex,
years since graduation, annual workload, and residency training)
did not correlate with imaging use. The remaining amount of interphysician
variation was very low (ICC, 0.97% for low-cost imaging; ICC, 1.07%
for high-cost imaging). These physician-specific odds ratios of imaging
estimates were moderately reliable at 0.78 (95% confidence interval
[CI]: 0.77, 0.79) for low-cost imaging and 0.76 (95% CI: 0.74, 0.78)
for high-cost imaging.After careful and comprehensive case-mix adjustment
by using hierarchical logistic regression, only about 1% of the
variability in ED imaging utilization was attributable to physicians.
Pandharipande, Pari; Eisenberg, Jonathan; Avery, Laura L.; Gunn, Martin L.; Kang, Stella K.; Megibow, Alec J.; Turan, Ekin; Harvey, H. Benjamin; Kong, Chung Yin; Dowling, Emily; Halpern, Elkan F.; Donelan, Karen; Gazelle, G. Scott
JOURNAL CLUB: Ħow Radiation Exposure Ħistories Influence Physician Imaging Đecisions: A Multicenter Radiologist Survey Study Journal Article
In: AJR Am J Roentgenol, vol. 200, no. 6, pp. 1275–1283, 2013, ().
@article{Pandharipande2013,
title = {JOURNAL CLUB: {H}ow Radiation Exposure {H}istories Influence Physician Imaging {D}ecisions: A Multicenter Radiologist Survey Study},
author = {Pari Pandharipande and Jonathan Eisenberg and Laura L. Avery and Martin L. Gunn and Stella K. Kang and Alec J. Megibow and Ekin Turan and H. Benjamin Harvey and Chung Yin Kong and Emily Dowling and Elkan F. Halpern and Karen Donelan and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23701064},
doi = {10.2214/AJR.12.10011},
year = {2013},
date = {2013-06-01},
journal = {AJR Am J Roentgenol},
volume = {200},
number = {6},
pages = {1275--1283},
institution = {1 Institute for Technology Assessment, Department of Radiology, Massachusetts
General Hospital, 101 Merrimac St, 10th Fl, Boston, MA 02114.},
abstract = {OBJECTIVE. The purpose of this article is to evaluate the influence
of patient radiation exposure histories on radiologists' imaging
decisions. MATERIALS AND METHODS. We conducted a physician survey
study in three academic medical centers. Radiologists were asked
to make an imaging recommendation for a hypothetical patient with
a history of multiple CT scans. We queried radiologists' decision
making, evaluating whether they incorporated cancer risks from previous
imaging, reported acceptance (or rejection) of the linear no-threshold
model, and understood linear no-threshold model implications in this
setting. Consistency between radiologists' decisions and their linear
no-threshold model beliefs was evaluated; those acting in accordance
with the linear no-threshold model were expected to disregard previously
incurred cancer risks. A Fisher exact test was used to verify the
generalizability of results across institutions and training levels
(residents, fellows, and attending physicians). RESULTS. Fifty-six
percent (322/578) of radiologists completed the survey. Most (92%
[295/322]) incorporated risks from the patient's exposure history
during decision making. Most (61% [196/322]) also reported acceptance
of the linear no-threshold model. Fewer (25% [79/322]) rejected
the linear no-threshold model; 15% (47/322) could not judge. Among
radiologists reporting linear no-threshold model acceptance or rejection,
the minority (36% [98/275]) made decisions that were consistent
with their linear no-threshold model beliefs. This finding was not statistically different across institutions (p = 0.070) or training levels (p = 0.183). Few radiologists (4% [13/322]) had an accurate
understanding of linear no-threshold model implications. CONCLUSION.
Most radiologists, when faced with patient exposure histories, make
decisions that contradict their self-reported acceptance of the linear
no-threshold model and the linear no-threshold model itself. These
findings underscore a need for educational initiatives.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
of patient radiation exposure histories on radiologists' imaging
decisions. MATERIALS AND METHODS. We conducted a physician survey
study in three academic medical centers. Radiologists were asked
to make an imaging recommendation for a hypothetical patient with
a history of multiple CT scans. We queried radiologists' decision
making, evaluating whether they incorporated cancer risks from previous
imaging, reported acceptance (or rejection) of the linear no-threshold
model, and understood linear no-threshold model implications in this
setting. Consistency between radiologists' decisions and their linear
no-threshold model beliefs was evaluated; those acting in accordance
with the linear no-threshold model were expected to disregard previously
incurred cancer risks. A Fisher exact test was used to verify the
generalizability of results across institutions and training levels
(residents, fellows, and attending physicians). RESULTS. Fifty-six
percent (322/578) of radiologists completed the survey. Most (92%
[295/322]) incorporated risks from the patient's exposure history
during decision making. Most (61% [196/322]) also reported acceptance
of the linear no-threshold model. Fewer (25% [79/322]) rejected
the linear no-threshold model; 15% (47/322) could not judge. Among
radiologists reporting linear no-threshold model acceptance or rejection,
the minority (36% [98/275]) made decisions that were consistent
with their linear no-threshold model beliefs. This finding was not statistically different across institutions (p = 0.070) or training levels (p = 0.183). Few radiologists (4% [13/322]) had an accurate
understanding of linear no-threshold model implications. CONCLUSION.
Most radiologists, when faced with patient exposure histories, make
decisions that contradict their self-reported acceptance of the linear
no-threshold model and the linear no-threshold model itself. These
findings underscore a need for educational initiatives.
Wong, Hannah; Sistrom, Chris L.; Benzer, Theodore I.; Halpern, Elkan F.; Morra, Dante J.; Gazelle, G. Scott; Ferris, Timothy G.; Weilburg, Jeffrey B.
Use of Imaging in the Emergency Department: Physicians Have Limited Effect on Variation Journal Article
In: Radiology, 2013, ().
@article{Wong2013,
title = {Use of Imaging in the Emergency Department: Physicians Have Limited Effect on Variation},
author = {Hannah Wong and Chris L. Sistrom and Theodore I. Benzer and Elkan F. Halpern and Dante J. Morra and G. Scott Gazelle and Timothy G. Ferris and Jeffrey B. Weilburg},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23801769},
doi = {10.1148/radiol.13130972},
year = {2013},
date = {2013-06-01},
urldate = {2013-06-01},
journal = {Radiology},
institution = {School of Health Policy and Management, York University, Toronto, Ontario, Canada; Department of Emergency Medicine, Institute for Technology Assessment, Physician's Organization, and Department of Radiology, Massachusetts General Hospital, Boston,},
abstract = {Purpose:To quantify interphysician variation in imaging use during
emergency department (ED) visits and examine the contribution of
factors to this variation at the patient, visit, and physician level.Materials
and Methods:This study was HIPAA compliant and approved by the institutional
review board of Partners Healthcare System (Boston, Mass), with waiver
of informed consent. In this retrospective study of 88 851 consecutive
ED visits during 2011 at a large urban teaching hospital, a hierarchical
logistic regression model was used to identify multiple predictors
for the probability that low- or high-cost imaging would be ordered
during a given visit. Physician-specific random effects were estimated
to articulate (by odds ratio) and quantify (by intraclass correlation
coefficient [ICC]) interphysician variation.Results:Patient- and
visit-level factors found to be statistically significant predictors
of imaging use included measures of ED busyness, prior ED visit,
referral source to the ED, and ED arrival mode. Physician-level factors
(eg, sex, years since graduation, annual workload, and residency
training) did not correlate with imaging use. The remaining amount
of interphysician variation was very low (ICC, 0.97% for low-cost
imaging; ICC, 1.07% for high-cost imaging). These physician-specific
odds ratios of imaging estimates were moderately reliable at 0.78
(95% confidence interval [CI]: 0.77, 0.79) for low-cost imaging
and 0.76 (95% CI: 0.74, 0.78) for high-cost imaging.Conclusion:After
careful and comprehensive case-mix adjustment by using hierarchical
logistic regression, only about 1% of the variability in ED imaging
utilization was attributable to physicians.© RSNA, 2013Supplemental
material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13130972/-/DC1.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
emergency department (ED) visits and examine the contribution of
factors to this variation at the patient, visit, and physician level.Materials
and Methods:This study was HIPAA compliant and approved by the institutional
review board of Partners Healthcare System (Boston, Mass), with waiver
of informed consent. In this retrospective study of 88 851 consecutive
ED visits during 2011 at a large urban teaching hospital, a hierarchical
logistic regression model was used to identify multiple predictors
for the probability that low- or high-cost imaging would be ordered
during a given visit. Physician-specific random effects were estimated
to articulate (by odds ratio) and quantify (by intraclass correlation
coefficient [ICC]) interphysician variation.Results:Patient- and
visit-level factors found to be statistically significant predictors
of imaging use included measures of ED busyness, prior ED visit,
referral source to the ED, and ED arrival mode. Physician-level factors
(eg, sex, years since graduation, annual workload, and residency
training) did not correlate with imaging use. The remaining amount
of interphysician variation was very low (ICC, 0.97% for low-cost
imaging; ICC, 1.07% for high-cost imaging). These physician-specific
odds ratios of imaging estimates were moderately reliable at 0.78
(95% confidence interval [CI]: 0.77, 0.79) for low-cost imaging
and 0.76 (95% CI: 0.74, 0.78) for high-cost imaging.Conclusion:After
careful and comprehensive case-mix adjustment by using hierarchical
logistic regression, only about 1% of the variability in ED imaging
utilization was attributable to physicians.© RSNA, 2013Supplemental
material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13130972/-/DC1.
Tramontano, Angela; Cipriano, Lauren; Kong, Chung Yin; Shepard, Jo-Anne O.; Lanuti, Michael; Gazelle, G. Scott; McMahon, Pamela M.
In: AJR Am J Roentgenol, vol. 200, no. 5, pp. 1020–1027, 2013, ().
@article{Tramontano2013,
title = {Microsimulation model predicts survival benefit of radiofrequency
ablation and stereotactic body radiotherapy versus radiotherapy for
treating inoperable stage I non-small cell lung cancer},
author = {Angela Tramontano and Lauren Cipriano and Chung Yin Kong and Jo-Anne O. Shepard and Michael Lanuti and G. Scott Gazelle and Pamela M. McMahon},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23617484},
doi = {10.2214/AJR.12.8968},
year = {2013},
date = {2013-05-01},
journal = {AJR Am J Roentgenol},
volume = {200},
number = {5},
pages = {1020--1027},
institution = {1 Institute for Technology Assessment, Massachusetts General Hospital,
101 Merrimac St. 10th Fl, Boston, MA, 02114.},
abstract = {OBJECTIVE. A subset of patients with stage IA and IB non-small cell
lung cancer (NSCLC) is ineligible for surgical resection and undergoes
radiation therapy. Radiofrequency ablation (RFA) and stereotactic
body radiotherapy are newer potentially attractive alternative therapies.
MATERIALS AND METHODS. We added RFA and stereotactic body radiotherapy
treatment modules to a microsimulation model that simulates lung
cancer's natural history, detection, and treatment. Natural history
parameters were previously estimated via calibration against tumor
registry data and cohort studies; the model was validated with screening
study and cohort data. RFA model parameters were calibrated against
2-year survival from the Radiofrequency Ablation of Pulmonary Tumor
Response Evaluation (RAPTURE) study, and stereotactic body radiotherapy
model parameters were calibrated against 3-year survival from a phase
2 prospective trial. We simulated lifetime histories of identical
patients with early-stage NSCLC who were ineligible for resection,
who were treated with radiation therapy, RFA, or stereotactic body
radiotherapy under a range of scenarios. From 5,000,000 simulated
individuals, we selected a cohort of patients with stage I medically inoperable cancer for analysis (n = 2056 per treatment scenario).
Main outcomes were life expectancy gains. RESULTS. RFA or stereotactic
body radiotherapy treatment in patients with peripheral stage IA
or IB NSCLC who were nonoperative candidates resulted in life expectancy
gains of 1.71 and 1.46 life-years, respectively, compared with universal
radiation therapy. A strategy where patients with central tumors
underwent stereotactic body radiotherapy and those with peripheral
tumors underwent RFA resulted in a gain of 2.02 life-years compared
with universal radiation therapy. Findings were robust with respect
to changes in model parameters. CONCLUSION. Microsimulation modeling
results suggest that RFA and stereotactic body radiotherapy could
provide life expectancy gains to patients with stage IA or IB NSCLC
who are ineligible for resection.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
lung cancer (NSCLC) is ineligible for surgical resection and undergoes
radiation therapy. Radiofrequency ablation (RFA) and stereotactic
body radiotherapy are newer potentially attractive alternative therapies.
MATERIALS AND METHODS. We added RFA and stereotactic body radiotherapy
treatment modules to a microsimulation model that simulates lung
cancer's natural history, detection, and treatment. Natural history
parameters were previously estimated via calibration against tumor
registry data and cohort studies; the model was validated with screening
study and cohort data. RFA model parameters were calibrated against
2-year survival from the Radiofrequency Ablation of Pulmonary Tumor
Response Evaluation (RAPTURE) study, and stereotactic body radiotherapy
model parameters were calibrated against 3-year survival from a phase
2 prospective trial. We simulated lifetime histories of identical
patients with early-stage NSCLC who were ineligible for resection,
who were treated with radiation therapy, RFA, or stereotactic body
radiotherapy under a range of scenarios. From 5,000,000 simulated
individuals, we selected a cohort of patients with stage I medically inoperable cancer for analysis (n = 2056 per treatment scenario).
Main outcomes were life expectancy gains. RESULTS. RFA or stereotactic
body radiotherapy treatment in patients with peripheral stage IA
or IB NSCLC who were nonoperative candidates resulted in life expectancy
gains of 1.71 and 1.46 life-years, respectively, compared with universal
radiation therapy. A strategy where patients with central tumors
underwent stereotactic body radiotherapy and those with peripheral
tumors underwent RFA resulted in a gain of 2.02 life-years compared
with universal radiation therapy. Findings were robust with respect
to changes in model parameters. CONCLUSION. Microsimulation modeling
results suggest that RFA and stereotactic body radiotherapy could
provide life expectancy gains to patients with stage IA or IB NSCLC
who are ineligible for resection.
Chubiz, Jessica Cott; Lee, Janie; Gilmore, Michael; Kong, Chung Yin; Lowry, Kathryn; Halpern, Elkan F.; McMahon, Pamela M.; Ryan, Paula D.; Gazelle, G. Scott
Cost-effectiveness of alternating magnetic resonance imaging and digital mammography screening in BRCA1 and BRCA2 gene mutation carriers Journal Article
In: Cancer, vol. 119, no. 6, pp. 1266–1276, 2013, ().
@article{CottChubiz2013,
title = {Cost-effectiveness of alternating magnetic resonance imaging and digital mammography screening in BRCA1 and BRCA2 gene mutation carriers},
author = {Jessica Cott Chubiz and Janie Lee and Michael Gilmore and Chung Yin Kong and Kathryn Lowry and Elkan F. Halpern and Pamela M. McMahon and Paula D. Ryan and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23184400},
doi = {10.1002/cncr.27864},
year = {2013},
date = {2013-03-01},
journal = {Cancer},
volume = {119},
number = {6},
pages = {1266--1276},
institution = {Institute for Technology Assessment, Massachusetts General Hospital,
Boston, Massachusetts.},
abstract = {Current clinical guidelines recommend earlier, more intensive breast
cancer screening with both magnetic resonance imaging (MRI) and mammography
for women with breast cancer susceptibility gene (BRCA) mutations.
Unspecified details of screening schedules are a challenge for implementing
guidelines.A Markov Monte Carlo computer model was used to simulate
screening in asymptomatic women who were BRCA1 and BRCA2 mutation
carriers. Three dual-modality strategies were compared with digital
mammography (DM) alone: 1) DM and MRI alternating at 6-month intervals
beginning at age 25 years (Alt25), 2) annual MRI beginning at age
25 years with alternating DM added at age 30 years (MRI25/Alt30),
and 3) DM and MRI alternating at 6-month intervals beginning at age
30 years (Alt30). Primary outcomes were quality-adjusted life years
(QALYs), lifetime costs (in 2010 US dollars), and incremental cost-effectiveness
(dollars per QALY gained). Additional outcomes included potential
harms of screening, and lifetime costs stratified into component
categories (screening and diagnosis, treatment, mortality, and patient
time costs).All 3 dual-modality screening strategies increased QALYs
and costs. Alt30 screening had the lowest incremental costs per additional
QALY gained (BRCA1, $74,200 per QALY; BRCA2, $215,700 per QALY).
False-positive test results increased substantially with dual-modality
screening and occurred more frequently in BRCA2 carriers. Downstream
savings in both breast cancer treatment and mortality costs were
outweighed by increases in up-front screening and diagnosis costs.
The results were influenced most by estimates of breast cancer risk
and MRI costs.Alternating MRI and DM screening at 6-month intervals
beginning at age 30 years was identified as a clinically effective
approach to applying current guidelines, and was more cost-effective
in BRCA1 gene mutation carriers compared with BRCA2 gene mutation
carriers. Cancer 2013. © 2012 American Cancer Society.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
cancer screening with both magnetic resonance imaging (MRI) and mammography
for women with breast cancer susceptibility gene (BRCA) mutations.
Unspecified details of screening schedules are a challenge for implementing
guidelines.A Markov Monte Carlo computer model was used to simulate
screening in asymptomatic women who were BRCA1 and BRCA2 mutation
carriers. Three dual-modality strategies were compared with digital
mammography (DM) alone: 1) DM and MRI alternating at 6-month intervals
beginning at age 25 years (Alt25), 2) annual MRI beginning at age
25 years with alternating DM added at age 30 years (MRI25/Alt30),
and 3) DM and MRI alternating at 6-month intervals beginning at age
30 years (Alt30). Primary outcomes were quality-adjusted life years
(QALYs), lifetime costs (in 2010 US dollars), and incremental cost-effectiveness
(dollars per QALY gained). Additional outcomes included potential
harms of screening, and lifetime costs stratified into component
categories (screening and diagnosis, treatment, mortality, and patient
time costs).All 3 dual-modality screening strategies increased QALYs
and costs. Alt30 screening had the lowest incremental costs per additional
QALY gained (BRCA1, $74,200 per QALY; BRCA2, $215,700 per QALY).
False-positive test results increased substantially with dual-modality
screening and occurred more frequently in BRCA2 carriers. Downstream
savings in both breast cancer treatment and mortality costs were
outweighed by increases in up-front screening and diagnosis costs.
The results were influenced most by estimates of breast cancer risk
and MRI costs.Alternating MRI and DM screening at 6-month intervals
beginning at age 30 years was identified as a clinically effective
approach to applying current guidelines, and was more cost-effective
in BRCA1 gene mutation carriers compared with BRCA2 gene mutation
carriers. Cancer 2013. © 2012 American Cancer Society.
Pandharipande, Pari; Eisenberg, Jonathan; Lee, Richard J.; Gilmore, Michael; Turan, Ekin; Singh, Sarabjeet; Kalra, Mannudeep K.; Liu, Bob; Kong, Chung Yin; Gazelle, G. Scott
Patients with Testicular Cancer Undergoing CT Surveillance Demonstrate a Pitfall of Radiation-induced Cancer Risk Estimates: The Timing Paradox Journal Article
In: Radiology, vol. 266, no. 3, pp. 896-904, 2013, ().
@article{Pandharipande2012,
title = {Patients with Testicular Cancer Undergoing CT Surveillance Demonstrate a Pitfall of Radiation-induced Cancer Risk Estimates: The Timing Paradox},
author = {Pari Pandharipande and Jonathan Eisenberg and Richard J. Lee and Michael Gilmore and Ekin Turan and Sarabjeet Singh and Mannudeep K. Kalra and Bob Liu and Chung Yin Kong and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23249573},
doi = {10.1148/radiol.12121015},
year = {2013},
date = {2013-03-01},
urldate = {2013-03-01},
journal = {Radiology},
volume = {266},
number = {3},
pages = {896-904},
institution = {Massachusetts General Hospital Institute for Technology Assessment, Department of Radiology, and Department of Medicine, Hematology/Oncology, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114.},
abstract = {Purpose:To demonstrate a limitation of lifetime radiation-induced
cancer risk metrics in the setting of testicular cancer surveillance-in
particular, their failure to capture the delayed timing of radiation-induced
cancers over the course of a patient's lifetime.Materials and Methods:Institutional
review board approval was obtained for the use of computed tomographic
(CT) dosimetry data in this study. Informed consent was waived. This
study was HIPAA compliant. A Markov model was developed to project
outcomes in patients with testicular cancer who were undergoing CT
surveillance in the decade after orchiectomy. To quantify effects
of early versus delayed risks, life expectancy losses and lifetime
mortality risks due to testicular cancer were compared with life
expectancy losses and lifetime mortality risks due to radiation-induced
cancers from CT. Projections of life expectancy loss, unlike lifetime
risk estimates, account for the timing of risks over the course of
a lifetime, which enabled evaluation of the described limitation
of lifetime risk estimates. Markov chain Monte Carlo methods were
used to estimate the uncertainty of the results.Results:As an example
of evidence yielded, 33-year-old men with stage I seminoma who were
undergoing CT surveillance were projected to incur a slightly higher
lifetime mortality risk from testicular cancer (598 per 100 000;
95% uncertainty interval [UI]: 302, 894) than from radiation-induced
cancers (505 per 100 000; 95% UI: 280, 730). However, life expectancy
loss attributable to testicular cancer (83 days; 95% UI: 42, 124)
was more than three times greater than life expectancy loss attributable
to radiation-induced cancers (24 days; 95% UI: 13, 35). Trends were
consistent across modeled scenarios.Conclusion:Lifetime radiation
risk estimates, when used for decision making, may overemphasize
radiation-induced cancer risks relative to short-term health risks.©
RSNA, 2012Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12121015/-/DC1.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
cancer risk metrics in the setting of testicular cancer surveillance-in
particular, their failure to capture the delayed timing of radiation-induced
cancers over the course of a patient's lifetime.Materials and Methods:Institutional
review board approval was obtained for the use of computed tomographic
(CT) dosimetry data in this study. Informed consent was waived. This
study was HIPAA compliant. A Markov model was developed to project
outcomes in patients with testicular cancer who were undergoing CT
surveillance in the decade after orchiectomy. To quantify effects
of early versus delayed risks, life expectancy losses and lifetime
mortality risks due to testicular cancer were compared with life
expectancy losses and lifetime mortality risks due to radiation-induced
cancers from CT. Projections of life expectancy loss, unlike lifetime
risk estimates, account for the timing of risks over the course of
a lifetime, which enabled evaluation of the described limitation
of lifetime risk estimates. Markov chain Monte Carlo methods were
used to estimate the uncertainty of the results.Results:As an example
of evidence yielded, 33-year-old men with stage I seminoma who were
undergoing CT surveillance were projected to incur a slightly higher
lifetime mortality risk from testicular cancer (598 per 100 000;
95% uncertainty interval [UI]: 302, 894) than from radiation-induced
cancers (505 per 100 000; 95% UI: 280, 730). However, life expectancy
loss attributable to testicular cancer (83 days; 95% UI: 42, 124)
was more than three times greater than life expectancy loss attributable
to radiation-induced cancers (24 days; 95% UI: 13, 35). Trends were
consistent across modeled scenarios.Conclusion:Lifetime radiation
risk estimates, when used for decision making, may overemphasize
radiation-induced cancer risks relative to short-term health risks.©
RSNA, 2012Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12121015/-/DC1.
Hartman, Rebecca; Chang, Connie Y.; Wo, Jennifer Y.; Eisenberg, Jonathan; Hong, Theodore S.; Harisinghani, Mukesh G.; Gazelle, G. Scott; Pandharipande, Pari
Optimizing Adjuvant Treatment Decisions for Stage T2 Rectal Cancer Based on Mesorectal Node Size: A Decision Analysis Journal Article
In: Acad Radiol, vol. 20, no. 1, pp. 79-89, 2013, ().
@article{Hartman2012,
title = {Optimizing Adjuvant Treatment Decisions for Stage T2 Rectal Cancer Based on Mesorectal Node Size: A Decision Analysis},
author = {Rebecca Hartman and Connie Y. Chang and Jennifer Y. Wo and Jonathan Eisenberg and Theodore S. Hong and Mukesh G. Harisinghani and G. Scott Gazelle and Pari Pandharipande},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22947271},
year = {2013},
date = {2013-01-01},
urldate = {2013-01-01},
journal = {Acad Radiol},
volume = {20},
number = {1},
pages = {79-89},
institution = {Massachusetts General Hospital Institute for Technology Assessment, 101 Merrimac Street, 10th Floor, Boston, MA 02114; Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts.},
abstract = {RATIONALE AND OBJECTIVES: The aim of this study was to optimize treatment
decisions for patients with suspected stage T2 rectal cancer on the
basis of mesorectal lymph node size at magnetic resonance imaging.
MATERIALS AND METHODS: A decision-analytic model was developed to
predict outcomes for patients with stage T2 rectal cancer at magnetic
resonance imaging. Node-positive patients were assumed to benefit
from chemoradiation prior to surgery. Imperfect magnetic resonance
imaging performance for primary cancer and mesorectal nodal staging
was incorporated. Five triage strategies were considered for administering
preoperative chemoradiation: treat all patients; treat for any mesorectal
node \>3, \>5, and \>7 mm in size; and treat no patients. If nodal metastases
or unsuspected stage T3 disease went untreated preoperatively, postoperative
chemoradiation was needed, resulting in poorer outcomes. For each
strategy, rates of acute and long-term chemoradiation toxicity and
of 5-year local recurrence were computed. Effects of input parameter
uncertainty were evaluated in sensitivity analysis. RESULTS: The
optimal strategy depended on the outcome prioritized. Acute and long-term
chemoradiation toxicity rates were minimized by triaging only patients
with nodes \>7 mm to preoperative chemoradiation (18.9% and 10.8%,
respectively). A treat-all strategy minimized the 5-year local recurrence
rate (5.6%). A 7-mm nodal triage threshold increased the 5-year
local recurrence rate to 8.0%; when no patients were treated preoperatively,
the local recurrence rate was 10.1%. With improved primary tumor
staging, all outcomes could be further optimized. CONCLUSIONS: Mesorectal
nodal size thresholds for preoperative chemoradiation should depend
on the outcome prioritized: higher size thresholds reduce chemoradiation
toxicity but increase recurrence rates. Improvements in nodal staging
will have greater impact if primary tumor staging can be improved.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
decisions for patients with suspected stage T2 rectal cancer on the
basis of mesorectal lymph node size at magnetic resonance imaging.
MATERIALS AND METHODS: A decision-analytic model was developed to
predict outcomes for patients with stage T2 rectal cancer at magnetic
resonance imaging. Node-positive patients were assumed to benefit
from chemoradiation prior to surgery. Imperfect magnetic resonance
imaging performance for primary cancer and mesorectal nodal staging
was incorporated. Five triage strategies were considered for administering
preoperative chemoradiation: treat all patients; treat for any mesorectal
node >3, >5, and >7 mm in size; and treat no patients. If nodal metastases
or unsuspected stage T3 disease went untreated preoperatively, postoperative
chemoradiation was needed, resulting in poorer outcomes. For each
strategy, rates of acute and long-term chemoradiation toxicity and
of 5-year local recurrence were computed. Effects of input parameter
uncertainty were evaluated in sensitivity analysis. RESULTS: The
optimal strategy depended on the outcome prioritized. Acute and long-term
chemoradiation toxicity rates were minimized by triaging only patients
with nodes >7 mm to preoperative chemoradiation (18.9% and 10.8%,
respectively). A treat-all strategy minimized the 5-year local recurrence
rate (5.6%). A 7-mm nodal triage threshold increased the 5-year
local recurrence rate to 8.0%; when no patients were treated preoperatively,
the local recurrence rate was 10.1%. With improved primary tumor
staging, all outcomes could be further optimized. CONCLUSIONS: Mesorectal
nodal size thresholds for preoperative chemoradiation should depend
on the outcome prioritized: higher size thresholds reduce chemoradiation
toxicity but increase recurrence rates. Improvements in nodal staging
will have greater impact if primary tumor staging can be improved.
2012
Goyal, Rohit; Gazelle, G. Scott; Swan, J. Shannon
Expanding patient-reported outcomes to oral health complications from systemic cancer therapy Journal Article
In: Journal of clinical oncology : official journal of the American Society of Clinical Oncology, vol. 30, pp. 60, 2012, ISSN: 1527-7755, ().
@article{Goyal2012,
title = {Expanding patient-reported outcomes to oral health complications from systemic cancer therapy},
author = {Rohit Goyal and G. Scott Gazelle and J. Shannon Swan},
url = {http://www.ncbi.nlm.nih.gov/pubmed/28147102},
doi = {10.1200/jco.2012.30.34_suppl.60},
issn = {1527-7755},
year = {2012},
date = {2012-12-01},
urldate = {2012-12-01},
journal = {Journal of clinical oncology : official journal of the American Society of Clinical Oncology},
volume = {30},
pages = {60},
abstract = {60 Background: Cross-disciplinary patient reported outcomes (PROs) assess the full range of side effects from systemic cancer therapy. For oral health complications, however, the validity of oral-health specific and generic health-related quality-of-life (QoL) instruments is unknown for cancer patients. This study evaluates the performance, measurement, and prediction characteristics of the Oral Health Impact Profile (OHIP-14) and EQ-5D in cancer patients with bisphosphonate-associated Osteonecrosis of the Jaw (ONJ). 34 cancer patients assessed the QoL of their own ONJ with the OHIP-14 and evaluated the QoL of 4 standardized ONJ Health States with the EQ-5D, as previously published. For each instrument, the standard response mean (SRM), effect size (ES), and ability to distinguish minimally important differences (MID) were evaluated for ONJ compared to baseline (longitudinal responsiveness). Instrument MIDs (cross-sectional responsiveness) were also calculated. Performance of a published general dentistry algorithm to predict EQ-5D values from OHIP-14 results was tested. The OHIP-14 and EQ-5D instruments demonstrated moderate to large longitudinal and cross-sectional responsiveness. Pain was one of the most responsive domains for both instruments. Ceiling/floor effects were most prominent for OHIP-14. A general dentistry algorithm did not adequately predict EQ-5D values for cancer patients. This study provides the first empirical evidence for the performance, measurement, and prediction characteristics of oral-health specific and generic QoL instruments for the oral health side effects of systemic cancer treatment. Instrument validity is supported for oral health complications in cancer patients. These results provide benchmarks for PROs at the intersection of oral medicine and surgery, dentistry, and oncology. [Table: see text].},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Knudsen, Amy; Hur, Chin; Gazelle, G. Scott; Schrag, Deborah; McFarland, Elizabeth G.; Kuntz, Karen M.
Rescreening of persons with a negative colonoscopy result: results from a microsimulation model Journal Article
In: Ann Intern Med, vol. 157, no. 9, pp. 611–620, 2012, ().
@article{Knudsen2012,
title = {Rescreening of persons with a negative colonoscopy result: results from a microsimulation model},
author = {Amy Knudsen and Chin Hur and G. Scott Gazelle and Deborah Schrag and Elizabeth G. McFarland and Karen M. Kuntz},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23128861},
doi = {10.7326/0003-4819-157-9-201211060-00005},
year = {2012},
date = {2012-11-01},
journal = {Ann Intern Med},
volume = {157},
number = {9},
pages = {611--620},
abstract = {Persons with a negative result on screening colonoscopy are recommended to repeat the procedure in 10 years.To assess the effectiveness and costs of colonoscopy versus other rescreening strategies after an initial negative colonoscopy result.Microsimulation model.Literature and data from the Surveillance, Epidemiology, and End Results program.Persons aged 50 years who had no adenomas or cancer detected on screening colonoscopy.Lifetime.Societal.No further screening or rescreening starting at age 60 years with colonoscopy every 10 years, annual highly sensitive guaiac fecal occult blood testing (HSFOBT), annual fecal immunochemical testing (FIT), or computed tomographic colonography (CTC) every 5 years.Lifetime cases of colorectal cancer, life expectancy, and lifetime costs per 1000 persons, assuming either perfect or imperfect adherence.Rescreening with any method substantially reduced the risk for colorectal cancer compared with no further screening (range, 7.7 to 12.6 lifetime cases per 1000 persons [perfect adherence] and 17.7 to 20.9 lifetime cases per 1000 persons [imperfect adherence] vs. 31.3 lifetime cases per 1000 persons with no further screening).
In both adherence scenarios, the differences in life-years across rescreening strategies were small (range, 30 893 to 30 902 life-years per 1000 persons [perfect adherence] vs. 30 865 to 30 869 life-years per 1000 persons [imperfect adherence]). Rescreening with HSFOBT, FIT, or CTC had fewer complications and was less costly than continuing colonoscopy.Results were sensitive to test-specific adherence rates.Data on adherence to rescreening were limited.Compared with the currently recommended strategy of continuing colonoscopy every 10 years after an initial negative examination, rescreening at age 60 years with annual HSFOBT, annual FIT, or CTC every 5 years provides approximately the same benefit in life-years with fewer complications at a lower cost. Therefore, it is reasonable to use other methods to rescreen persons with negative colonoscopy results.National Cancer Institute.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In both adherence scenarios, the differences in life-years across rescreening strategies were small (range, 30 893 to 30 902 life-years per 1000 persons [perfect adherence] vs. 30 865 to 30 869 life-years per 1000 persons [imperfect adherence]). Rescreening with HSFOBT, FIT, or CTC had fewer complications and was less costly than continuing colonoscopy.Results were sensitive to test-specific adherence rates.Data on adherence to rescreening were limited.Compared with the currently recommended strategy of continuing colonoscopy every 10 years after an initial negative examination, rescreening at age 60 years with annual HSFOBT, annual FIT, or CTC every 5 years provides approximately the same benefit in life-years with fewer complications at a lower cost. Therefore, it is reasonable to use other methods to rescreen persons with negative colonoscopy results.National Cancer Institute.
Santos, Isa C T; Gazelle, G. Scott; Luís A Rocha Travares, JM
Modeling of the medical device development process. Journal Article
In: Expert Rev Med Devices, vol. 9, no. 5, pp. 537-43, 2012, ().
@article{santos_medical_2012,
title = { Modeling of the medical device development process. },
author = {Isa C T Santos and G. Scott Gazelle and Lu\'{i}s A Rocha Travares, JM},
doi = {10.1586/erd.12.36},
year = {2012},
date = {2012-09-11},
journal = {Expert Rev Med Devices},
volume = {9},
number = {5},
pages = {537-43},
abstract = {Models are abstract representations of reality that are built, analyzed and manipulated to augment the understanding of that reality. They can either be mental or codified but, in both cases, they contribute to good decision-making by ensuring that the right people use the right information at the right time. In order to reduce time to market, companies commonly adopt product development processes (PDP) and the medical device sector is no different. However, one can question which is the most adequate PDP model to follow or what information that model should contain, or even how the information should be represented. Here, the authors review the existing PDP models dedicated to medical devices. The model's representation and usability are also debated in order to assist developers to select the most suitable model and adapt it to their needs and reality. },
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Hoffmann, Udo; Truong, Quynh A; Schoenfeld, David A; Chou, Eric T; Woodard, Pamela K; Nagurney, John T; Pope, J Hector; Hauser, Thomas H; White, Craig; Weiner, Scott G; Kalanjian, Shant; Mullins, Michael E; Mikati, Issam; Peacock, W Frank; Zakroysky, Pearl; Hayden, Douglas; Goehler, Alexander; Lee, Hang; Gazelle, G. Scott; Wiviott, Stephen D; Fleg, Jerome L; Udelson, James E
Coronary CT angiography versus standard evaluation in acute chest pain Journal Article
In: The New England journal of medicine, vol. 367, no. 4, pp. 299–308, 2012, ISSN: 1533-4406, ().
@article{hoffmann_coronary_2012,
title = {Coronary CT angiography versus standard evaluation in acute chest pain},
author = {Udo Hoffmann and Quynh A Truong and David A Schoenfeld and Eric T Chou and Pamela K Woodard and John T Nagurney and J Hector Pope and Thomas H Hauser and Craig White and Scott G Weiner and Shant Kalanjian and Michael E Mullins and Issam Mikati and W Frank Peacock and Pearl Zakroysky and Douglas Hayden and Alexander Goehler and Hang Lee and G. Scott Gazelle and Stephen D Wiviott and Jerome L Fleg and James E Udelson},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22830462},
doi = {10.1056/NEJMoa1201161},
issn = {1533-4406},
year = {2012},
date = {2012-07-01},
journal = {The New England journal of medicine},
volume = {367},
number = {4},
pages = {299--308},
abstract = {BACKGROUND
It is unclear whether an evaluation incorporating coronary computed tomographic angiography (CCTA) is more effective than standard evaluation in the emergency department in patients with symptoms suggestive of acute coronary syndromes.
METHODS
In this multicenter trial, we randomly assigned patients 40 to 74 years of age with symptoms suggestive of acute coronary syndromes but without ischemic electrocardiographic changes or an initial positive troponin test to early CCTA or to standard evaluation in the emergency department on weekdays during daylight hours between April 2010 and January 2012. The primary end point was length of stay in the hospital. Secondary end points included rates of discharge from the emergency department, major adverse cardiovascular events at 28 days, and cumulative costs. Safety end points were undetected acute coronary syndromes.
RESULTS
The rate of acute coronary syndromes among 1000 patients with a mean (±SD) age of 54±8 years (47% women) was 8%. After early CCTA, as compared with standard evaluation, the mean length of stay in the hospital was reduced by 7.6 hours (Ptextless0.001) and more patients were discharged directly from the emergency department (47% vs. 12%, Ptextless0.001). There were no undetected acute coronary syndromes and no significant differences in major adverse cardiovascular events at 28 days. After CCTA, there was more downstream testing and higher radiation exposure. The cumulative mean cost of care was similar in the CCTA group and the standard-evaluation group ($4,289 and $4,060, respectively; P=0.65).
CONCLUSIONS
In patients in the emergency department with symptoms suggestive of acute coronary syndromes, incorporating CCTA into a triage strategy improved the efficiency of clinical decision making, as compared with a standard evaluation in the emergency department, but it resulted in an increase in downstream testing and radiation exposure with no decrease in the overall costs of care. (Funded by the National Heart, Lung, and Blood Institute; ROMICAT-II ClinicalTrials.gov number, NCT01084239.).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
It is unclear whether an evaluation incorporating coronary computed tomographic angiography (CCTA) is more effective than standard evaluation in the emergency department in patients with symptoms suggestive of acute coronary syndromes.
METHODS
In this multicenter trial, we randomly assigned patients 40 to 74 years of age with symptoms suggestive of acute coronary syndromes but without ischemic electrocardiographic changes or an initial positive troponin test to early CCTA or to standard evaluation in the emergency department on weekdays during daylight hours between April 2010 and January 2012. The primary end point was length of stay in the hospital. Secondary end points included rates of discharge from the emergency department, major adverse cardiovascular events at 28 days, and cumulative costs. Safety end points were undetected acute coronary syndromes.
RESULTS
The rate of acute coronary syndromes among 1000 patients with a mean (±SD) age of 54±8 years (47% women) was 8%. After early CCTA, as compared with standard evaluation, the mean length of stay in the hospital was reduced by 7.6 hours (Ptextless0.001) and more patients were discharged directly from the emergency department (47% vs. 12%, Ptextless0.001). There were no undetected acute coronary syndromes and no significant differences in major adverse cardiovascular events at 28 days. After CCTA, there was more downstream testing and higher radiation exposure. The cumulative mean cost of care was similar in the CCTA group and the standard-evaluation group ($4,289 and $4,060, respectively; P=0.65).
CONCLUSIONS
In patients in the emergency department with symptoms suggestive of acute coronary syndromes, incorporating CCTA into a triage strategy improved the efficiency of clinical decision making, as compared with a standard evaluation in the emergency department, but it resulted in an increase in downstream testing and radiation exposure with no decrease in the overall costs of care. (Funded by the National Heart, Lung, and Blood Institute; ROMICAT-II ClinicalTrials.gov number, NCT01084239.).
McMahon, Pamela M.; Kong, Chung Yin; Johnson, Bruce E.; Weinstein, Milton C.; Weeks, Jane C.; Tramontano, Angela; Cipriano, Lauren; Bouzan, Colleen; Gazelle, G. Scott
Chapter 9: The MGH-HMS lung cancer policy model: tobacco control versus screening Journal Article
In: Risk Anal, vol. 32 Suppl 1, pp. S117–S124, 2012, ().
@article{mcmahon_chapter_2012,
title = {Chapter 9: The MGH-HMS lung cancer policy model: tobacco control versus screening},
author = {Pamela M. McMahon and Chung Yin Kong and Bruce E. Johnson and Milton C. Weinstein and Jane C. Weeks and Angela Tramontano and Lauren Cipriano and Colleen Bouzan and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed?term=22882882},
doi = {10.1111/j.1539-6924.2011.01652.x},
year = {2012},
date = {2012-07-01},
urldate = {2012-07-01},
journal = {Risk Anal},
volume = {32 Suppl 1},
pages = {S117\textendashS124},
abstract = {The natural history model underlying the MGH Lung Cancer Policy Model (LCPM) does not include the two-stage clonal expansion model employed in other CISNET lung models. We used the LCPM to predict numbers of U.S. lung cancer deaths for ages 30-84 between 1975 and 2000 under four scenarios as part of the comparative modeling analysis described in this issue. The LCPM is a comprehensive microsimulation model of lung cancer development, progression, detection, treatment, and survival. Individual-level patient histories are aggregated to estimate cohort or population-level outcomes. Lung cancer states are defined according to underlying disease variables, test results, and clinical events. By simulating detailed clinical procedures, the LCPM can predict benefits and harms attributable to a variety of patient management practices, including annual screening programs. Under the scenario of observed smoking patterns, predicted numbers of deaths from the calibrated LCPM were within 2% of observed over all years (1975-2000). The LCPM estimated that historical tobacco control policies achieved 28.6% (25.2% in men, 30.5% in women) of the potential reduction in U.S. lung cancer deaths had smoking had been eliminated entirely. The hypothetical adoption in 1975 of annual helical CT screening of all persons aged 55-74 with at least 30 pack-years of cigarette exposure to historical tobacco control would have yielded a proportion realized of 39.0% (42.0% in men, 33.3% in women). The adoption of annual screening would have prevented less than half as many lung cancer deaths as the elimination of cigarette smoking.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Eisenberg, Jonathan; Harvey, H. Benjamin; Moore, Donald A; Gazelle, G. Scott; Pandharipande, Pari
Falling prey to the sunk cost bias: a potential harm of patient radiation dose histories Journal Article
In: Radiology, vol. 263, no. 3, pp. 626–628, 2012, ISSN: 1527-1315, ().
@article{eisenberg_falling_2012,
title = {Falling prey to the sunk cost bias: a potential harm of patient radiation dose histories},
author = {Jonathan Eisenberg and H. Benjamin Harvey and Donald A Moore and G. Scott Gazelle and Pari Pandharipande},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22623688},
doi = {10.1148/radiol.12112459},
issn = {1527-1315},
year = {2012},
date = {2012-06-01},
journal = {Radiology},
volume = {263},
number = {3},
pages = {626--628},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Moolgavkar, S. H.; Holford, T. R.; Levy, D. T.; Kong, Chung Yin; Foy, M.; Clarke, L.; Jeon, J.; Hazelton, W. D.; Meza, R.; Schultz, F.; McCarthy, W.; Boer, R.; Gorlova, O.; Gazelle, G. Scott; Kimmel, M.; McMahon, Pamela M.; Koning, H. J.; Feuer, E. J.
Impact of reduced tobacco smoking on lung cancer mortality in the United States during 1975-2000 Journal Article
In: J Natl Cancer Inst, vol. 104, no. 7, pp. 541-8, 2012, ISSN: 1460-2105 (Electronic) 0027-8874, ().
@article{Moolgavkar2012,
title = {Impact of reduced tobacco smoking on lung cancer mortality in the United States during 1975-2000},
author = {S. H. Moolgavkar and T. R. Holford and D. T. Levy and Chung Yin Kong and M. Foy and L. Clarke and J. Jeon and W. D. Hazelton and R. Meza and F. Schultz and W. McCarthy and R. Boer and O. Gorlova and G. Scott Gazelle and M. Kimmel and Pamela M. McMahon and H. J. Koning and E. J. Feuer},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22423009},
issn = {1460-2105 (Electronic) 0027-8874},
year = {2012},
date = {2012-04-01},
urldate = {2012-04-01},
journal = {J Natl Cancer Inst},
volume = {104},
number = {7},
pages = {541-8},
abstract = {BACKGROUND: Considerable effort has been expended on tobacco control
strategies in the United States since the mid-1950s. However, we
have little quantitative information on how changes in smoking behaviors
have impacted lung cancer mortality. We quantified the cumulative
impact of changes in smoking behaviors that started in the mid-1950s
on lung cancer mortality in the United States over the period 1975-2000.
METHODS: A consortium of six groups of investigators used common
inputs consisting of simulated cohort-wise smoking histories for
the birth cohorts of 1890 through 1970 and independent models to
estimate the number of US lung cancer deaths averted during 1975-2000
as a result of changes in smoking behavior that began in the mid-1950s.
We also estimated the number of deaths that could have been averted
had tobacco control been completely effective in eliminating smoking
after the Surgeon General's first report on Smoking and Health in
1964. RESULTS: Approximately 795,851 US lung cancer deaths were averted
during the period 1975-2000: 552,574 among men and 243,277 among
women. In the year 2000 alone, approximately 70,218 lung cancer deaths
were averted: 44,135 among men and 26,083 among women. However, these
numbers are estimated to represent approximately 32% of lung cancer
deaths that could have potentially been averted during the period
1975-2000, 38% of the lung cancer deaths that could have been averted
in 1991-2000, and 44% of lung cancer deaths that could have been
averted in 2000. CONCLUSIONS: Our results reflect the cumulative
impact of changes in smoking behavior since the 1950s. Despite a
large impact of changing smoking behaviors on lung cancer deaths,
lung cancer remains a major public health problem. Continued efforts
at tobacco control are critical to further reduce the burden of this
disease.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
strategies in the United States since the mid-1950s. However, we
have little quantitative information on how changes in smoking behaviors
have impacted lung cancer mortality. We quantified the cumulative
impact of changes in smoking behaviors that started in the mid-1950s
on lung cancer mortality in the United States over the period 1975-2000.
METHODS: A consortium of six groups of investigators used common
inputs consisting of simulated cohort-wise smoking histories for
the birth cohorts of 1890 through 1970 and independent models to
estimate the number of US lung cancer deaths averted during 1975-2000
as a result of changes in smoking behavior that began in the mid-1950s.
We also estimated the number of deaths that could have been averted
had tobacco control been completely effective in eliminating smoking
after the Surgeon General's first report on Smoking and Health in
1964. RESULTS: Approximately 795,851 US lung cancer deaths were averted
during the period 1975-2000: 552,574 among men and 243,277 among
women. In the year 2000 alone, approximately 70,218 lung cancer deaths
were averted: 44,135 among men and 26,083 among women. However, these
numbers are estimated to represent approximately 32% of lung cancer
deaths that could have potentially been averted during the period
1975-2000, 38% of the lung cancer deaths that could have been averted
in 1991-2000, and 44% of lung cancer deaths that could have been
averted in 2000. CONCLUSIONS: Our results reflect the cumulative
impact of changes in smoking behavior since the 1950s. Despite a
large impact of changing smoking behaviors on lung cancer deaths,
lung cancer remains a major public health problem. Continued efforts
at tobacco control are critical to further reduce the burden of this
disease.
Lowry, Kathryn; Lee, Janie; Kong, Chung Yin; McMahon, Pamela M.; Gilmore, Michael; Chubiz, Jessica Cott; Pisano, E. D.; Gatsonis, C.; Ryan, P. D.; Ozanne, Elissa; Gazelle, G. Scott
Annual screening strategies in BRCA1 and BRCA2 gene mutation carriers: a comparative effectiveness analysis Journal Article
In: Cancer, vol. 118, no. 8, pp. 2021-30, 2012, ISSN: 1097-0142 (Electronic) 0008-543X, ().
@article{Lowry2012,
title = {Annual screening strategies in BRCA1 and BRCA2 gene mutation carriers: a comparative effectiveness analysis},
author = {Kathryn Lowry and Janie Lee and Chung Yin Kong and Pamela M. McMahon and Michael Gilmore and Jessica Cott Chubiz and E. D. Pisano and C. Gatsonis and P. D. Ryan and Elissa Ozanne and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/21935911},
issn = {1097-0142 (Electronic) 0008-543X},
year = {2012},
date = {2012-04-01},
urldate = {2012-04-01},
journal = {Cancer},
volume = {118},
number = {8},
pages = {2021-30},
abstract = {BACKGROUND: Although breast cancer screening with mammography and
magnetic resonance imaging (MRI) is recommended for breast cancer-susceptibility
gene (BRCA) mutation carriers, there is no current consensus on the
optimal screening regimen. METHODS: The authors used a computer simulation
model to compare 6 annual screening strategies (film mammography
[FM], digital mammography [DM], FM and magnetic resonance imaging
[MRI] or DM and MRI contemporaneously, and alternating FM/MRI or
DM/MRI at 6-month intervals) beginning at ages 25 years, 30 years,
35 years, and 40 years, and 2 strategies of annual MRI with delayed
alternating DM/FM versus clinical surveillance alone. Strategies
were evaluated without and with mammography-induced breast cancer
risk using 2 models of excess relative risk. Input parameters were
obtained from the medical literature, publicly available databases,
and calibration. RESULTS: Without radiation risk effects, alternating
DM/MRI starting at age 25 years provided the highest life expectancy
(BRCA1, 72.52 years, BRCA2, 77.63 years). When radiation risk was
included, a small proportion of diagnosed cancers was attributable
to radiation exposure (BRCA1, \<2%; BRCA2, \<4%). With radiation risk,
alternating DM/MRI at age 25 years or annual MRI at age 25 years/delayed
alternating DM at age 30 years was the most effective, depending
on the radiation risk model used. Alternating DM/MRI starting at
age 25 years also produced the highest number of false-positive screens
per woman (BRCA1, 4.5 BRCA2, 8.1). CONCLUSIONS: Annual MRI at age
25 years/delayed alternating DM at age 30 years is probably the most
effective screening strategy in BRCA mutation carriers. Screening
benefits, associated risks, and personal acceptance of false-positive
results should be considered in choosing the optimal screening strategy
for individual women.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
magnetic resonance imaging (MRI) is recommended for breast cancer-susceptibility
gene (BRCA) mutation carriers, there is no current consensus on the
optimal screening regimen. METHODS: The authors used a computer simulation
model to compare 6 annual screening strategies (film mammography
[FM], digital mammography [DM], FM and magnetic resonance imaging
[MRI] or DM and MRI contemporaneously, and alternating FM/MRI or
DM/MRI at 6-month intervals) beginning at ages 25 years, 30 years,
35 years, and 40 years, and 2 strategies of annual MRI with delayed
alternating DM/FM versus clinical surveillance alone. Strategies
were evaluated without and with mammography-induced breast cancer
risk using 2 models of excess relative risk. Input parameters were
obtained from the medical literature, publicly available databases,
and calibration. RESULTS: Without radiation risk effects, alternating
DM/MRI starting at age 25 years provided the highest life expectancy
(BRCA1, 72.52 years, BRCA2, 77.63 years). When radiation risk was
included, a small proportion of diagnosed cancers was attributable
to radiation exposure (BRCA1, <2%; BRCA2, <4%). With radiation risk,
alternating DM/MRI at age 25 years or annual MRI at age 25 years/delayed
alternating DM at age 30 years was the most effective, depending
on the radiation risk model used. Alternating DM/MRI starting at
age 25 years also produced the highest number of false-positive screens
per woman (BRCA1, 4.5 BRCA2, 8.1). CONCLUSIONS: Annual MRI at age
25 years/delayed alternating DM at age 30 years is probably the most
effective screening strategy in BRCA mutation carriers. Screening
benefits, associated risks, and personal acceptance of false-positive
results should be considered in choosing the optimal screening strategy
for individual women.
Kong, Chung Yin; Lee, Janie; McMahon, Pamela M.; Lowry, Kathryn; Omer, Zehra; Eisenberg, Jonathan; Pandharipande, Pari; Gazelle, G. Scott
Using radiation risk models in cancer screening simulations: important assumptions and effects on outcome projections Journal Article
In: Radiology, vol. 262, no. 3, pp. 977–984, 2012, ISSN: 1527-1315, ().
@article{kong_using_2012,
title = {Using radiation risk models in cancer screening simulations: important assumptions and effects on outcome projections},
author = {Chung Yin Kong and Janie Lee and Pamela M. McMahon and Kathryn Lowry and Zehra Omer and Jonathan Eisenberg and Pari Pandharipande and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22357897},
doi = {10.1148/radiol.11110352},
issn = {1527-1315},
year = {2012},
date = {2012-03-01},
urldate = {2012-03-01},
journal = {Radiology},
volume = {262},
number = {3},
pages = {977--984},
abstract = {PURPOSE
To evaluate the effect of incorporating radiation risk into microsimulation (first-order Monte Carlo) models for breast and lung cancer screening to illustrate effects of including radiation risk on patient outcome projections.
MATERIALS AND METHODS
All data used in this study were derived from publicly available or deidentified human subject data. Institutional review board approval was not required. The challenges of incorporating radiation risk into simulation models are illustrated with two cancer screening models (Breast Cancer Model and Lung Cancer Policy Model) adapted to include radiation exposure effects from mammography and chest computed tomography (CT), respectively. The primary outcome projected by the breast model was life expectancy (LE) for BRCA1 mutation carriers. Digital mammographic screening beginning at ages 25, 30, 35, and 40 years was evaluated in the context of screenings with false-positive results and radiation exposure effects. The primary outcome of the lung model was lung cancer-specific mortality reduction due to annual screening, comparing two diagnostic CT protocols for lung nodule evaluation. The Metropolis-Hastings algorithm was used to estimate the mean values of the results with 95% uncertainty intervals (UIs).
RESULTS
Without radiation exposure effects, the breast model indicated that annual digital mammography starting at age 25 years maximized LE (72.03 years; 95% UI: 72.01 years, 72.05 years) and had the highest number of screenings with false-positive results (2.0 per woman). When radiation effects were included, annual digital mammography beginning at age 30 years maximized LE (71.90 years; 95% UI: 71.87 years, 71.94 years) with a lower number of screenings with false-positive results (1.4 per woman). For annual chest CT screening of 50-year-old females with no follow-up for nodules smaller than 4 mm in diameter, the lung model predicted lung cancer-specific mortality reduction of 21.50% (95% UI: 20.90%, 22.10%) without radiation risk and 17.75% (95% UI: 16.97%, 18.41%) with radiation risk.
CONCLUSION
Because including radiation exposure risk can influence long-term projections from simulation models, it is important to include these risks when conducting modeling-based assessments of diagnostic imaging.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
To evaluate the effect of incorporating radiation risk into microsimulation (first-order Monte Carlo) models for breast and lung cancer screening to illustrate effects of including radiation risk on patient outcome projections.
MATERIALS AND METHODS
All data used in this study were derived from publicly available or deidentified human subject data. Institutional review board approval was not required. The challenges of incorporating radiation risk into simulation models are illustrated with two cancer screening models (Breast Cancer Model and Lung Cancer Policy Model) adapted to include radiation exposure effects from mammography and chest computed tomography (CT), respectively. The primary outcome projected by the breast model was life expectancy (LE) for BRCA1 mutation carriers. Digital mammographic screening beginning at ages 25, 30, 35, and 40 years was evaluated in the context of screenings with false-positive results and radiation exposure effects. The primary outcome of the lung model was lung cancer-specific mortality reduction due to annual screening, comparing two diagnostic CT protocols for lung nodule evaluation. The Metropolis-Hastings algorithm was used to estimate the mean values of the results with 95% uncertainty intervals (UIs).
RESULTS
Without radiation exposure effects, the breast model indicated that annual digital mammography starting at age 25 years maximized LE (72.03 years; 95% UI: 72.01 years, 72.05 years) and had the highest number of screenings with false-positive results (2.0 per woman). When radiation effects were included, annual digital mammography beginning at age 30 years maximized LE (71.90 years; 95% UI: 71.87 years, 71.94 years) with a lower number of screenings with false-positive results (1.4 per woman). For annual chest CT screening of 50-year-old females with no follow-up for nodules smaller than 4 mm in diameter, the lung model predicted lung cancer-specific mortality reduction of 21.50% (95% UI: 20.90%, 22.10%) without radiation risk and 17.75% (95% UI: 16.97%, 18.41%) with radiation risk.
CONCLUSION
Because including radiation exposure risk can influence long-term projections from simulation models, it is important to include these risks when conducting modeling-based assessments of diagnostic imaging.
Hacker, Karen; Choi, Yoon Susan; Trebino, Lisa; Hicks, Leroi; Friedman, Elisa; Blanchfield, Bonnie B.; Gazelle, G. Scott
Exploring the impact of language services on utilization and clinical outcomes for diabetics Journal Article
In: PloS one, vol. 7, no. 6, pp. e38507, 2012, ISSN: 1932-6203, ().
@article{hacker_exploring_2012,
title = {Exploring the impact of language services on utilization and clinical outcomes for diabetics},
author = {Karen Hacker and Yoon Susan Choi and Lisa Trebino and Leroi Hicks and Elisa Friedman and Bonnie B. Blanchfield and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22675571},
doi = {10.1371/journal.pone.0038507},
issn = {1932-6203},
year = {2012},
date = {2012-01-01},
urldate = {2012-01-01},
journal = {PloS one},
volume = {7},
number = {6},
pages = {e38507},
abstract = {BACKGROUND
Significant health disparities exist between limited English proficient and English-proficient patients. Little is known about the impact of language services on chronic disease outcomes such as for diabetes.
METHODS/PRINCIPAL FINDINGS
To determine whether the amount and type of language services received during primary care visits had an impact on diabetes-related outcomes (hospitalization, emergency room utilization, glycemic control) in limited English proficient patients, a retrospective cohort design was utilized. Hospital and medical record data was examined for 1425 limited English proficient patients in the Cambridge Health Alliance diabetes registry. We categorized patients receiving usual care into 7 groups based on the amount and combination of language services (language concordant providers, formal interpretation and nothing) received at primary care visits during a 9 month period. Bivariate analyses and multiple logistic regression were used to determine relationships between language service categories and outcomes in the subsequent 6 months. Thirty-one percent of patients (445) had no documentation of interpreter use or seeing a language concordant provider in any visits. Patients who received 100% of their primary care visits with language concordant providers were least likely to have diabetes-related emergency department visits compared to other groups (ptextless0001) in the following 6 months. Patients with higher numbers of co-morbidities were more likely to receive formal interpretation.
CONCLUSIONS/SIGNIFICANCE
Language concordant providers may help reduce health care utilization for limited English proficient patients with diabetes. However, given the lack of such providers in sufficient numbers to meet patients' communication needs, strategies are needed to both increase their numbers and ensure that the highest risk patients receive the most appropriate language services. In addition, systems serving diverse populations must clarify why some limited English proficient patients do not receive language services at some or all of their visits and whether this has an impact on quality of care.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Significant health disparities exist between limited English proficient and English-proficient patients. Little is known about the impact of language services on chronic disease outcomes such as for diabetes.
METHODS/PRINCIPAL FINDINGS
To determine whether the amount and type of language services received during primary care visits had an impact on diabetes-related outcomes (hospitalization, emergency room utilization, glycemic control) in limited English proficient patients, a retrospective cohort design was utilized. Hospital and medical record data was examined for 1425 limited English proficient patients in the Cambridge Health Alliance diabetes registry. We categorized patients receiving usual care into 7 groups based on the amount and combination of language services (language concordant providers, formal interpretation and nothing) received at primary care visits during a 9 month period. Bivariate analyses and multiple logistic regression were used to determine relationships between language service categories and outcomes in the subsequent 6 months. Thirty-one percent of patients (445) had no documentation of interpreter use or seeing a language concordant provider in any visits. Patients who received 100% of their primary care visits with language concordant providers were least likely to have diabetes-related emergency department visits compared to other groups (ptextless0001) in the following 6 months. Patients with higher numbers of co-morbidities were more likely to receive formal interpretation.
CONCLUSIONS/SIGNIFICANCE
Language concordant providers may help reduce health care utilization for limited English proficient patients with diabetes. However, given the lack of such providers in sufficient numbers to meet patients' communication needs, strategies are needed to both increase their numbers and ensure that the highest risk patients receive the most appropriate language services. In addition, systems serving diverse populations must clarify why some limited English proficient patients do not receive language services at some or all of their visits and whether this has an impact on quality of care.
2011
Goehler, Alexander; Geisler, Benjamin; Manne, J. M.; Jahn, B.; Conrads-Frank, Annette; Schnell-Inderst, P.; Gazelle, G. Scott; Siebert, Uwe
Decision-analytic models to simulate health outcomes and costs in heart failure: a systematic review Journal Article
In: PharmacoEconomics, vol. 29, no. 9, pp. 753-69, 2011, ISSN: 1179-2027 (Electronic) 1170-7690, ().
@article{Goehler2011a,
title = {Decision-analytic models to simulate health outcomes and costs in heart failure: a systematic review},
author = {Alexander Goehler and Benjamin Geisler and J. M. Manne and B. Jahn and Annette Conrads-Frank and P. Schnell-Inderst and G. Scott Gazelle and Uwe Siebert},
url = {http://www.ncbi.nlm.nih.gov/pubmed/21557632},
issn = {1179-2027 (Electronic) 1170-7690},
year = {2011},
date = {2011-09-01},
urldate = {2011-09-01},
journal = {PharmacoEconomics},
volume = {29},
number = {9},
pages = {753-69},
abstract = {Chronic heart failure (CHF) is a critical public health issue with
increasing effect on the healthcare budgets of developed countries.
Various decision-analytic modelling approaches exist to estimate
the cost effectiveness of health technologies for CHF. We sought
to systematically identify these models and describe their structures.
We performed a systematic literature review in MEDLINE/PreMEDLINE,
EMBASE, EconLit and the Cost-Effectiveness Analysis Registry using
a combination of search terms for CHF and decision-analytic models.
The inclusion criterion required 'use of a mathematical model evaluating
both costs and health consequences for CHF management strategies'.
Studies that were only economic evaluations alongside a clinical
trial or that were purely descriptive studies were excluded. We identified
34 modelling studies investigating different interventions including screening (n = 1), diagnostics (n = 1), pharmaceuticals (n = 15), devices (n = 13), disease management programmes (n = 3) and cardiac transplantation (n = 1) in CHF. The identified models primarily focused
on middle-aged to elderly patients with stable but progressed heart
failure with systolic left ventricular dysfunction. Modelling approaches
varied substantially and included 27 Markov models, three discrete-event
simulation models and four mathematical equation sets models; 19
studies reported QALYs. Three models were externally validated. In
addition to a detailed description of study characteristics, the
model structure and output, the manuscript also contains a synthesis
and critical appraisal for each of the modelling approaches. Well
designed decision models are available for the evaluation of different
CHF health technologies. Most models depend on New York Heart Association
(NYHA) classes or number of hospitalizations as proxy for disease
severity and progression. As the diagnostics and biomarkers evolve,
there is the hope for better intermediate endpoints for modelling
disease progression as those that are currently in use all have limitations.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
increasing effect on the healthcare budgets of developed countries.
Various decision-analytic modelling approaches exist to estimate
the cost effectiveness of health technologies for CHF. We sought
to systematically identify these models and describe their structures.
We performed a systematic literature review in MEDLINE/PreMEDLINE,
EMBASE, EconLit and the Cost-Effectiveness Analysis Registry using
a combination of search terms for CHF and decision-analytic models.
The inclusion criterion required 'use of a mathematical model evaluating
both costs and health consequences for CHF management strategies'.
Studies that were only economic evaluations alongside a clinical
trial or that were purely descriptive studies were excluded. We identified
34 modelling studies investigating different interventions including screening (n = 1), diagnostics (n = 1), pharmaceuticals (n = 15), devices (n = 13), disease management programmes (n = 3) and cardiac transplantation (n = 1) in CHF. The identified models primarily focused
on middle-aged to elderly patients with stable but progressed heart
failure with systolic left ventricular dysfunction. Modelling approaches
varied substantially and included 27 Markov models, three discrete-event
simulation models and four mathematical equation sets models; 19
studies reported QALYs. Three models were externally validated. In
addition to a detailed description of study characteristics, the
model structure and output, the manuscript also contains a synthesis
and critical appraisal for each of the modelling approaches. Well
designed decision models are available for the evaluation of different
CHF health technologies. Most models depend on New York Heart Association
(NYHA) classes or number of hospitalizations as proxy for disease
severity and progression. As the diagnostics and biomarkers evolve,
there is the hope for better intermediate endpoints for modelling
disease progression as those that are currently in use all have limitations.
Abujudeh, H. H.; Kaewlai, R.; McMahon, Pamela M.; Binder, W.; Novelline, R. A.; Gazelle, G. Scott; Thrall, J. H.
In: AJR Am J Roentgenol, vol. 196, no. 2, pp. 238-43, 2011, ISSN: 1546-3141 (Electronic) 0361-803X, ().
@article{Abujudeh2011,
title = {Abdominopelvic CT increases diagnostic certainty and guides management decisions: a prospective investigation of 584 patients in a large academic medical center},
author = {H. H. Abujudeh and R. Kaewlai and Pamela M. McMahon and W. Binder and R. A. Novelline and G. Scott Gazelle and J. H. Thrall},
url = {http://www.ncbi.nlm.nih.gov/pubmed/21257870},
issn = {1546-3141 (Electronic) 0361-803X},
year = {2011},
date = {2011-02-01},
urldate = {2011-02-01},
journal = {AJR Am J Roentgenol},
volume = {196},
number = {2},
pages = {238-43},
abstract = {OBJECTIVE: The objective of our study was to prospectively determine
how CT affects physicians' diagnostic certainty and management decisions
in the setting of patients with nontraumatic abdominal complaints
presenting to the emergency department. SUBJECTS AND METHODS: We
included 584 patients presenting with nontraumatic abdominal complaints
to the emergency department from November 2006 through February 2008.
Emergency department clinicians were prospectively surveyed both
before abdominal CT (pre-CT) and after abdominal CT (post-CT) to
determine the leading diagnosis, the diagnostic certainty, and the
management decisions. Changes were assessed by Fisher's exact test
and the log likelihood ratio. RESULTS: The most common diagnoses
were renal colic (119/584, 20.4%) and intestinal obstruction (80/584,
13.7%). CT altered the leading diagnosis in 49% of the patients (284/584,
p \< 0.00001) and increased mean physician diagnostic certainty from
70.5% (pre-CT) to 92.2% (post-CT) (p \< 0.001; log likelihood ratio,
2.48). The management plan was changed by CT in 42% (244/583) (p
\< 0.0001). Physicians planned to admit 75.3% of the patients (440/584)
to the hospital before CT; that plan was changed to hospital discharge
with follow-up in 24.1% of patients (106/440) after CT. Surgery was
planned for 79 patients before CT, whereas hospital discharge was
planned for 25.3% of these patients (20/79) after CT. CONCLUSION:
In the management of patients presenting to the emergency department
with nontraumatic abdominal complaints, CT changes the leading diagnosis,
increases diagnostic certainty, and changes potential patient management
decisions.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
how CT affects physicians' diagnostic certainty and management decisions
in the setting of patients with nontraumatic abdominal complaints
presenting to the emergency department. SUBJECTS AND METHODS: We
included 584 patients presenting with nontraumatic abdominal complaints
to the emergency department from November 2006 through February 2008.
Emergency department clinicians were prospectively surveyed both
before abdominal CT (pre-CT) and after abdominal CT (post-CT) to
determine the leading diagnosis, the diagnostic certainty, and the
management decisions. Changes were assessed by Fisher's exact test
and the log likelihood ratio. RESULTS: The most common diagnoses
were renal colic (119/584, 20.4%) and intestinal obstruction (80/584,
13.7%). CT altered the leading diagnosis in 49% of the patients (284/584,
p < 0.00001) and increased mean physician diagnostic certainty from
70.5% (pre-CT) to 92.2% (post-CT) (p < 0.001; log likelihood ratio,
2.48). The management plan was changed by CT in 42% (244/583) (p
< 0.0001). Physicians planned to admit 75.3% of the patients (440/584)
to the hospital before CT; that plan was changed to hospital discharge
with follow-up in 24.1% of patients (106/440) after CT. Surgery was
planned for 79 patients before CT, whereas hospital discharge was
planned for 25.3% of these patients (20/79) after CT. CONCLUSION:
In the management of patients presenting to the emergency department
with nontraumatic abdominal complaints, CT changes the leading diagnosis,
increases diagnostic certainty, and changes potential patient management
decisions.
McMahon, Pamela M.; Kong, Chung Yin; Bouzan, Colleen; Weinstein, M. C.; Cipriano, Lauren; Tramontano, Angela; Johnson, B. E.; Weeks, J. C.; Gazelle, G. Scott
Cost-effectiveness of computed tomography screening for lung cancer in the United States Journal Article
In: J Thorac Oncol, vol. 6, pp. 1841–8, 2011, ISSN: 1556-1380 (Electronic) 1556-0864, ().
@article{mcmahon_cost-effectiveness_2011,
title = {Cost-effectiveness of computed tomography screening for lung cancer in the United States},
author = {Pamela M. McMahon and Chung Yin Kong and Colleen Bouzan and M. C. Weinstein and Lauren Cipriano and Angela Tramontano and B. E. Johnson and J. C. Weeks and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/21892105},
doi = {Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't},
issn = {1556-1380 (Electronic) 1556-0864},
year = {2011},
date = {2011-01-01},
journal = {J Thorac Oncol},
volume = {6},
pages = {1841--8},
abstract = {INTRODUCTION: A randomized trial has demonstrated that lung cancer screening reduces mortality. Identifying participant and program characteristics that influence the cost-effectiveness of screening will help translate trial results into benefits at the population level. METHODS: Six U.S. cohorts (men and women aged 50, 60, or 70 years) were simulated in an existing patient-level lung cancer model. Smoking histories reflected observed U.S. patterns. We simulated lifetime histories of 500,000 identical individuals per cohort in each scenario. Costs per quality-adjusted life-year gained ($/QALY) were estimated for each program: computed tomography screening; stand-alone smoking cessation therapies (4-30% 1-year abstinence); and combined programs. RESULTS: Annual screening of current and former smokers aged 50 to 74 years costs between $126,000 and $169,000/QALY (minimum 20 pack-years of smoking) or $110,000 and $166,000/QALY (40 pack-year minimum), when compared with no screening and assuming background quit rates. Screening was beneficial but had a higher cost per QALY when the model included radiation-induced lung cancers. If screen participation doubled background quit rates, the cost of annual screening (at age 50 years, 20 pack-year minimum) was below $75,000/QALY. If screen participation halved background quit rates, benefits from screening were nearly erased. If screening had no effect on quit rates, annual screening costs more but provided fewer QALYs than annual cessation therapies. Annual combined screening/cessation therapy programs at age 50 years costs $130,500 to $159,700/QALY, when compared with annual stand-alone cessation. CONCLUSIONS: The cost-effectiveness of computed tomography screening will likely be strongly linked to achievable smoking cessation rates. Trials and further modeling should explore the consequences of relationships between smoking behaviors and screen participation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Miksad, Rebecca; Lai, Kuan-Chi; Dodson, T. B.; Woo, S. B.; Treister, N. S.; Akinyemi, Omosalewa; Bihrle, Marian; Maytal, G.; August, M.; Gazelle, G. Scott; Swan, J. Shannon
Quality of life implications of bisphosphonate-associated osteonecrosis of the jaw Journal Article
In: Oncologist, vol. 16, no. 1, pp. 121-32, 2011, ISSN: 1549-490X (Electronic) 1083-7159, ().
@article{Miksad2011,
title = {Quality of life implications of bisphosphonate-associated osteonecrosis
of the jaw},
author = {Rebecca Miksad and Kuan-Chi Lai and T. B. Dodson and S. B. Woo and N. S. Treister and Omosalewa Akinyemi and Marian Bihrle and G. Maytal and M. August and G. Scott Gazelle and J. Shannon Swan},
url = {http://www.ncbi.nlm.nih.gov/pubmed/21212433},
issn = {1549-490X (Electronic) 1083-7159},
year = {2011},
date = {2011-01-01},
journal = {Oncologist},
volume = {16},
number = {1},
pages = {121-32},
abstract = {PURPOSE: Potentially debilitating, osteonecrosis of the jaw (ONJ)
is an emerging complication of bisphosphonates. However, its effect
on quality of life (QoL) is unknown. We determined the ONJ-related
QoL decline in a cancer patient cohort. PATIENTS AND METHODS: Thirty-four
cancer patients with bisphosphonate-associated ONJ completed a telephone
survey (October 2007 through May 2008). The Oral Health Impact Profile
14 (OHIP) retrospectively assessed participant oral health-related
QoL before and after ONJ. Standardized ONJ descriptions were developed
in a multidisciplinary, iterative process and were evaluated with
three frequently used preference-based QoL measurement methods on
a 0 (death) to 1 (perfect health) scale: Visual Analogue Scale (VAS),
Time Trade-Off (TTO), and EQ-5D. RESULTS: ONJ significantly (p \<
.001) increased OHIP scores (worse QoL) for additive (3.56-16.53)
and weighted (7.0-17.5) methods. Seven individual OHIP items significantly
increased (Bonferroni correction p \< .0035): pain, eating discomfort,
self-consciousness, unsatisfactory diet, interrupted meals, irritability,
and decreased life satisfaction. Mean preference-based QoL values
significantly decreased (p \< .001) with worsening ONJ stage (VAS,
TTO, and EQ-5D): no ONJ (0.76, 0.86, 0.82), ONJ stage 1 (0.69, 0.82,
0.78), ONJ stage 2 (0.51, 0.67, 0.55), and ONJ stage 3 (0.37, 0.61,
0.32). As ONJ worsened, EQ-5D domain scores significantly increased
(p \< .001). Pain/discomfort and anxiety/depression contributed most
to declining QoL. CONCLUSIONS: ONJ significantly affects QoL, a detriment
that increases with worsening ONJ. QoL impairments for ONJ stages
2 and 3 are similar to other treatment side effects that influence
decision-making. Bisphosphonate-associated ONJ QoL is an important
consideration for patients, clinicians, and policy makers.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
is an emerging complication of bisphosphonates. However, its effect
on quality of life (QoL) is unknown. We determined the ONJ-related
QoL decline in a cancer patient cohort. PATIENTS AND METHODS: Thirty-four
cancer patients with bisphosphonate-associated ONJ completed a telephone
survey (October 2007 through May 2008). The Oral Health Impact Profile
14 (OHIP) retrospectively assessed participant oral health-related
QoL before and after ONJ. Standardized ONJ descriptions were developed
in a multidisciplinary, iterative process and were evaluated with
three frequently used preference-based QoL measurement methods on
a 0 (death) to 1 (perfect health) scale: Visual Analogue Scale (VAS),
Time Trade-Off (TTO), and EQ-5D. RESULTS: ONJ significantly (p <
.001) increased OHIP scores (worse QoL) for additive (3.56-16.53)
and weighted (7.0-17.5) methods. Seven individual OHIP items significantly
increased (Bonferroni correction p < .0035): pain, eating discomfort,
self-consciousness, unsatisfactory diet, interrupted meals, irritability,
and decreased life satisfaction. Mean preference-based QoL values
significantly decreased (p < .001) with worsening ONJ stage (VAS,
TTO, and EQ-5D): no ONJ (0.76, 0.86, 0.82), ONJ stage 1 (0.69, 0.82,
0.78), ONJ stage 2 (0.51, 0.67, 0.55), and ONJ stage 3 (0.37, 0.61,
0.32). As ONJ worsened, EQ-5D domain scores significantly increased
(p < .001). Pain/discomfort and anxiety/depression contributed most
to declining QoL. CONCLUSIONS: ONJ significantly affects QoL, a detriment
that increases with worsening ONJ. QoL impairments for ONJ stages
2 and 3 are similar to other treatment side effects that influence
decision-making. Bisphosphonate-associated ONJ QoL is an important
consideration for patients, clinicians, and policy makers.
Cipriano, Lauren; Romanus, Dorothy; Earle, C. C.; Neville, B. A.; Halpern, Elkan F.; Gazelle, G. Scott; McMahon, Pamela M.
Lung cancer treatment costs, including patient responsibility, by disease stage and treatment modality, 1992 to 2003 Journal Article
In: Value Health, vol. 14, no. 1, pp. 41-52, 2011, ISSN: 1524-4733 (Electronic) 1098-3015, ().
@article{Cipriano2011,
title = {Lung cancer treatment costs, including patient responsibility, by
disease stage and treatment modality, 1992 to 2003},
author = {Lauren Cipriano and Dorothy Romanus and C. C. Earle and B. A. Neville and Elkan F. Halpern and G. Scott Gazelle and Pamela M. McMahon},
url = {http://www.ncbi.nlm.nih.gov/pubmed/21211485},
issn = {1524-4733 (Electronic) 1098-3015},
year = {2011},
date = {2011-01-01},
journal = {Value Health},
volume = {14},
number = {1},
pages = {41-52},
abstract = {OBJECTIVES: The objective of this analysis was to estimate costs for
lung cancer care and evaluate trends in the share of treatment costs
that are the responsibility of Medicare beneficiaries. METHODS: The
Surveillance, Epidemiology, and End Results (SEER)-Medicare data
from 1991-2003 for 60,231 patients with lung cancer were used to
estimate monthly and patient-liability costs for clinical phases
of lung cancer (prediagnosis, staging, initial, continuing, and terminal),
stratified by treatment, stage, and non-small- versus small-cell
lung cancer. Lung cancer-attributable costs were estimated by subtracting
each patient's own prediagnosis costs. Costs were estimated as the
sum of Medicare reimbursements (payments from Medicare to the service
provider), co-insurance reimbursements, and patient-liability costs
(deductibles and "co-payments" that are the patient's responsibility).
Costs and patient-liability costs were fit with regression models
to compare trends by calendar year, adjusting for age at diagnosis.
RESULTS: The monthly treatment costs for a 72-year-old patient, diagnosed
with lung cancer in 2000, in the first 6 months ranged from $2687
(no active treatment) to $9360 (chemo-radiotherapy); costs varied
by stage at diagnosis and histologic type. Patient liability represented
up to 21.6% of care costs and increased over the period 1992-2003
for most stage and treatment categories, even when care costs decreased
or remained unchanged. The greatest monthly patient liability was
incurred by chemo-radiotherapy patients, which ranged from $1617
to $2004 per month across cancer stages. CONCLUSIONS: Costs for lung
cancer care are substantial, and Medicare is paying a smaller proportion
of the total cost over time.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
lung cancer care and evaluate trends in the share of treatment costs
that are the responsibility of Medicare beneficiaries. METHODS: The
Surveillance, Epidemiology, and End Results (SEER)-Medicare data
from 1991-2003 for 60,231 patients with lung cancer were used to
estimate monthly and patient-liability costs for clinical phases
of lung cancer (prediagnosis, staging, initial, continuing, and terminal),
stratified by treatment, stage, and non-small- versus small-cell
lung cancer. Lung cancer-attributable costs were estimated by subtracting
each patient's own prediagnosis costs. Costs were estimated as the
sum of Medicare reimbursements (payments from Medicare to the service
provider), co-insurance reimbursements, and patient-liability costs
(deductibles and "co-payments" that are the patient's responsibility).
Costs and patient-liability costs were fit with regression models
to compare trends by calendar year, adjusting for age at diagnosis.
RESULTS: The monthly treatment costs for a 72-year-old patient, diagnosed
with lung cancer in 2000, in the first 6 months ranged from $2687
(no active treatment) to $9360 (chemo-radiotherapy); costs varied
by stage at diagnosis and histologic type. Patient liability represented
up to 21.6% of care costs and increased over the period 1992-2003
for most stage and treatment categories, even when care costs decreased
or remained unchanged. The greatest monthly patient liability was
incurred by chemo-radiotherapy patients, which ranged from $1617
to $2004 per month across cancer stages. CONCLUSIONS: Costs for lung
cancer care are substantial, and Medicare is paying a smaller proportion
of the total cost over time.
Gazelle, G. Scott; Kessler, L.; Lee, D. W.; McGinn, T.; Menzin, J.; Neumann, P. J.; Amerongen, D.; White, L. A.; on Comparative Effectiveness Research for, Ima Working Group
A framework for assessing the value of diagnostic imaging in the era of comparative effectiveness research Journal Article
In: Radiology, vol. 261, pp. 692–8, 2011, ISSN: 1527-1315 (Electronic) 0033-8419, ().
@article{gazelle_framework_2011,
title = {A framework for assessing the value of diagnostic imaging in the era of comparative effectiveness research},
author = {G. Scott Gazelle and L. Kessler and D. W. Lee and T. McGinn and J. Menzin and P. J. Neumann and D. Amerongen and L. A. White and Ima Working Group on Comparative Effectiveness Research for},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22095993},
doi = {Research Support, Non-U.S. Gov't},
issn = {1527-1315 (Electronic) 0033-8419},
year = {2011},
date = {2011-01-01},
urldate = {2011-01-01},
journal = {Radiology},
volume = {261},
pages = {692--8},
abstract = {In June 2009, the Federal Coordinating Council for Comparative Effectiveness Research submitted a report to the President and Congress in which the Council described the purpose of comparative effectiveness research (CER) as developing evidence-based information for interventions and determining under what circumstances an intervention is effective (1). With the enactment of the Patient Protection and Affordable Care Act, a Patient-centered Outcomes Research Institute (PCORI) was established to assist decision makers in making evidence-based health decisions through synthesis and dissemination of clinical CER of health interventions (2). Its founding has underscored a heightened need for health policy makers to consider the impact of health care technologies on final outcomes of interest--for example, functional status, quality of life, disability, major clinical events, and mortality (3-5).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Blanchfield, Bonnie B.; Gazelle, G. Scott; Khaliif, M.; Arocha, I. S.; Hacker, K.
A framework to identify the costs of providing language interpretation services Journal Article
In: J Health Care Poor Underserved, vol. 22, pp. 523–31, 2011, ISSN: 1548-6869 (Electronic) 1049-2089, ().
@article{blanchfield_framework_2011,
title = {A framework to identify the costs of providing language interpretation services},
author = {Bonnie B. Blanchfield and G. Scott Gazelle and M. Khaliif and I. S. Arocha and K. Hacker},
url = {http://www.ncbi.nlm.nih.gov/pubmed/21551931},
doi = {Research Support, Non-U.S. Gov't},
issn = {1548-6869 (Electronic) 1049-2089},
year = {2011},
date = {2011-01-01},
urldate = {2011-01-01},
journal = {J Health Care Poor Underserved},
volume = {22},
pages = {523--31},
abstract = {The availability of language services for patients with limited English proficiency has become a standard of care in the United States. Finding the resources to pay for language programs is challenging for providers, payers, and policymakers. There is no federal payment policy and states are developing policies using different methodologies for determining costs and reimbursement rates. This paper establishes a conceptual framework that identifies program costs, can be used across health care entities, and can be understood by administrators, researchers, and policymakers to guide research and analysis and establish a common ground for informed strategic discussion of payment and reimbursement policy. Using case study methods, a framework was established to identify costs and included determining the perspective of the cost analysis as well as distinguishing between the financial accounting costs (direct, indirect, and overhead costs) and the economic opportunity and subsequent utilization costs.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Kong, Chung Yin; Nattinger, Kevin; Hayeck, Tristan; Omer, Zehra; Wang, Y. C.; Spechler, S. J.; McMahon, Pamela M.; Gazelle, G. Scott; Hur, Chin
The impact of obesity on the rise in esophageal adenocarcinoma incidence: estimates from a disease simulation model Journal Article
In: Cancer Epidemiol Biomarkers Prev, vol. 20, pp. 2450–6, 2011, ISSN: 1538-7755 (Electronic) 1055-9965, ().
@article{kong_impact_2011,
title = {The impact of obesity on the rise in esophageal adenocarcinoma incidence: estimates from a disease simulation model},
author = {Chung Yin Kong and Kevin Nattinger and Tristan Hayeck and Zehra Omer and Y. C. Wang and S. J. Spechler and Pamela M. McMahon and G. Scott Gazelle and Chin Hur},
url = {http://www.ncbi.nlm.nih.gov/pubmed/21930957},
doi = {Research Support, N.I.H., Extramural},
issn = {1538-7755 (Electronic) 1055-9965},
year = {2011},
date = {2011-01-01},
urldate = {2011-01-01},
journal = {Cancer Epidemiol Biomarkers Prev},
volume = {20},
pages = {2450--6},
abstract = {BACKGROUND: The United States has experienced an alarming and unexplained increase in the incidence of esophageal adenocarcinoma (EAC) since the 1970s. A concurrent increase in obesity has led some to suggest a relationship between the two trends. We explore the extent of this relationship. METHODS: Using a previously validated disease simulation model of white males in the United States, we estimated EAC incidence 1973 to 2005 given constant obesity prevalence and low population progression rates consistent with the early 1970s. Introducing only the observed, rising obesity prevalence, we calculated the incremental incidence caused by obesity. We compared these with EAC incidence data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry to determine obesity's contribution to the rise therein. Incidences were converted to absolute numbers of cases using U.S. population data. RESULTS: Using constant obesity prevalence, we projected a total of 30,555 EAC cases cumulatively over 1973 to 2005 and 1,151 in 2005 alone. Incorporating the observed obesity trend resulted in 35,767 cumulative EACs and 1,608 in 2005. Estimates derived from SEER data showed 111,223 cumulative and 7,173 cases in 2005. We conclude that the rise in obesity accounted for 6.5% of the increase in EAC cases that occurred from 1973 to 2005 and 7.6% in the year 2005. CONCLUSION: Using published OR for EAC among obese individuals, we found that only a small percentage of the rise in EAC incidence is attributable to secular trends in obesity. IMPACT: Other factors, alone and in combination, should be explored as causes of the EAC epidemic.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Boland, G. W.; Thrall, J. H.; Gazelle, G. Scott; Samir, A.; Rosenthal, D. I.; Dreyer, K. J.; Alkasab, T. K.
Decision support for radiologist report recommendations Journal Article
In: J Am Coll Radiol, vol. 8, pp. 819–23, 2011, ISSN: 1558-349X (Electronic) 1546-1440, ().
@article{boland_decision_2011,
title = {Decision support for radiologist report recommendations},
author = {G. W. Boland and J. H. Thrall and G. Scott Gazelle and A. Samir and D. I. Rosenthal and K. J. Dreyer and T. K. Alkasab},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22136994},
doi = {10.1016/j.jacr.2011.08.003},
issn = {1558-349X (Electronic) 1546-1440},
year = {2011},
date = {2011-01-01},
urldate = {2011-01-01},
journal = {J Am Coll Radiol},
volume = {8},
pages = {819--23},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2010
Pandharipande, Pari; Gervais, D. A.; Hartman, Rebecca; Harisinghani, M. G.; Feldman, A. S.; Mueller, P. R.; Gazelle, G. Scott
Renal mass biopsy to guide treatment decisions for small incidental renal tumors: a cost-effectiveness analysis Journal Article
In: Radiology, vol. 256, no. 3, pp. 836-46, 2010, ISSN: 1527-1315 (Electronic) 0033-8419, ().
@article{Pandharipande2010,
title = {Renal mass biopsy to guide treatment decisions for small incidental
renal tumors: a cost-effectiveness analysis},
author = {Pari Pandharipande and D. A. Gervais and Rebecca Hartman and M. G. Harisinghani and A. S. Feldman and P. R. Mueller and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/20720070},
issn = {1527-1315 (Electronic) 0033-8419},
year = {2010},
date = {2010-09-01},
journal = {Radiology},
volume = {256},
number = {3},
pages = {836-46},
abstract = {PURPOSE: To evaluate the effectiveness, cost, and cost-effectiveness
of using renal mass biopsy to guide treatment decisions for small
incidentally detected renal tumors. MATERIALS AND METHODS: A decision-analytic
Markov model was developed to estimate life expectancy and lifetime costs for patients with small (\< or = 4-cm) renal tumors. Two strategies
were compared: renal mass biopsy to triage patients to surgery or
imaging surveillance and empiric nephron-sparing surgery. The model
incorporated biopsy performance, the probability of track seeding
with malignant cells, the prevalence and growth of benign and malignant
tumors, treatment effectiveness and costs, and patient outcomes.
An incremental cost-effectiveness analysis was performed to identify
strategy preference under a willingness-to-pay threshold of $75,000
per quality-adjusted life-year (QALY). Effects of changes in key
parameters on strategy preference were evaluated in sensitivity analysis.
RESULTS: Under base-case assumptions, the biopsy strategy yielded
a minimally greater quality-adjusted life expectancy (4 days) than
did empiric surgery at a lower lifetime cost ($3466), dominating
surgery from a cost-effectiveness perspective. Over the majority
of parameter ranges tested in one-way sensitivity analysis, the biopsy
strategy dominated surgery or was cost-effective relative to surgery
based on a $75,000-per-QALY willingness-to-pay threshold. In two-way
sensitivity analysis, surgery yielded greater life expectancy when
the prevalence of malignancy and propensity for biopsy-negative cancers
to metastasize were both higher than expected or when the sensitivity
and specificity of biopsy were both lower than expected. CONCLUSION:
The use of biopsy to guide treatment decisions for small incidentally
detected renal tumors is cost-effective and can prevent unnecessary
surgery in many cases.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
of using renal mass biopsy to guide treatment decisions for small
incidentally detected renal tumors. MATERIALS AND METHODS: A decision-analytic
Markov model was developed to estimate life expectancy and lifetime costs for patients with small (< or = 4-cm) renal tumors. Two strategies
were compared: renal mass biopsy to triage patients to surgery or
imaging surveillance and empiric nephron-sparing surgery. The model
incorporated biopsy performance, the probability of track seeding
with malignant cells, the prevalence and growth of benign and malignant
tumors, treatment effectiveness and costs, and patient outcomes.
An incremental cost-effectiveness analysis was performed to identify
strategy preference under a willingness-to-pay threshold of $75,000
per quality-adjusted life-year (QALY). Effects of changes in key
parameters on strategy preference were evaluated in sensitivity analysis.
RESULTS: Under base-case assumptions, the biopsy strategy yielded
a minimally greater quality-adjusted life expectancy (4 days) than
did empiric surgery at a lower lifetime cost ($3466), dominating
surgery from a cost-effectiveness perspective. Over the majority
of parameter ranges tested in one-way sensitivity analysis, the biopsy
strategy dominated surgery or was cost-effective relative to surgery
based on a $75,000-per-QALY willingness-to-pay threshold. In two-way
sensitivity analysis, surgery yielded greater life expectancy when
the prevalence of malignancy and propensity for biopsy-negative cancers
to metastasize were both higher than expected or when the sensitivity
and specificity of biopsy were both lower than expected. CONCLUSION:
The use of biopsy to guide treatment decisions for small incidentally
detected renal tumors is cost-effective and can prevent unnecessary
surgery in many cases.
Boland, G. W.; Halpern, Elkan F.; Gazelle, G. Scott
Radiologist report turnaround time: impact of pay-for-performance measures Journal Article
In: AJR Am J Roentgenol, vol. 195, no. 3, pp. 707-11, 2010, ISSN: 1546-3141 (Electronic) 0361-803X, ().
@article{Boland2010,
title = {Radiologist report turnaround time: impact of pay-for-performance
measures},
author = {G. W. Boland and Elkan F. Halpern and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/20729450},
issn = {1546-3141 (Electronic) 0361-803X},
year = {2010},
date = {2010-09-01},
journal = {AJR Am J Roentgenol},
volume = {195},
number = {3},
pages = {707-11},
abstract = {OBJECTIVE: Expedited finalized radiologist report turnaround times
(RTAT) are considered an important quality care metric in medicine.
This study was performed to evaluate the impact of a radiologist
pay-for-performance (PFP) program on reducing RTAT. MATERIALS AND
METHODS: A radiologist PFP program was used to assess its impact
on RTAT for all departmental reports from 11 subspecialty divisions.
Study periods were 3 months before (baseline period) and immediately
after (immediate period) the introduction of the program and 2 years
later after the program had terminated (post period). Three RTAT
components were evaluated for individual radiologists and for each
radiology division: examination completion (C) to final signature
(F), C to preliminary signature (P), and P to F. RESULTS: Eighty-one
radiologists met the inclusion criterion for the study and performed
a final signature on 99,959 reports during the baseline period, 104,673
reports during the immediate period, and 91,379 reports during the
post period. Mean C-F, C-P, and P-F for all reports decreased significantly
from baseline to immediate to post period (p \< 0.0001), with the
largest effect on the P-F component. Similarly, divisional C-F, C-P,
and P-F also significantly decreased (p \< 0.0001) for all divisions
except the C-F for nuclear and neurovascular radiology from baseline
to immediate period and the C-P component from baseline to post period
for cardiac radiology. CONCLUSION: A radiologist PFP program appears
to have a marked effect on expediting final report turnaround times,
which continues after its termination.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
(RTAT) are considered an important quality care metric in medicine.
This study was performed to evaluate the impact of a radiologist
pay-for-performance (PFP) program on reducing RTAT. MATERIALS AND
METHODS: A radiologist PFP program was used to assess its impact
on RTAT for all departmental reports from 11 subspecialty divisions.
Study periods were 3 months before (baseline period) and immediately
after (immediate period) the introduction of the program and 2 years
later after the program had terminated (post period). Three RTAT
components were evaluated for individual radiologists and for each
radiology division: examination completion (C) to final signature
(F), C to preliminary signature (P), and P to F. RESULTS: Eighty-one
radiologists met the inclusion criterion for the study and performed
a final signature on 99,959 reports during the baseline period, 104,673
reports during the immediate period, and 91,379 reports during the
post period. Mean C-F, C-P, and P-F for all reports decreased significantly
from baseline to immediate to post period (p < 0.0001), with the
largest effect on the P-F component. Similarly, divisional C-F, C-P,
and P-F also significantly decreased (p < 0.0001) for all divisions
except the C-F for nuclear and neurovascular radiology from baseline
to immediate period and the C-P component from baseline to post period
for cardiac radiology. CONCLUSION: A radiologist PFP program appears
to have a marked effect on expediting final report turnaround times,
which continues after its termination.
Ho, W.; Broughton, D. E.; Donelan, Karen; Gazelle, G. Scott; Hur, Chin
Analysis of barriers to and patients' preferences for CT colonography for colorectal cancer screening in a nonadherent urban population Journal Article
In: AJR Am J Roentgenol, vol. 195, no. 2, pp. 393-7, 2010, ISSN: 1546-3141 (Electronic) 0361-803X, ().
@article{Ho2010,
title = {Analysis of barriers to and patients' preferences for CT colonography for colorectal cancer screening in a nonadherent urban population},
author = {W. Ho and D. E. Broughton and Karen Donelan and G. Scott Gazelle and Chin Hur},
url = {http://www.ncbi.nlm.nih.gov/pubmed/20651195},
issn = {1546-3141 (Electronic) 0361-803X},
year = {2010},
date = {2010-08-01},
urldate = {2010-08-01},
journal = {AJR Am J Roentgenol},
volume = {195},
number = {2},
pages = {393-7},
abstract = {OBJECTIVE: The aim of this study was to evaluate patients' barriers
against colorectal cancer screening tests and to assess patients'
preferences and cost influences for CT colonography (CTC) in a nonadherent
urban subpopulation. SUBJECTS AND METHODS: Patients who had been
offered colorectal cancer screening but were nonadherent were asked
to participate in this questionnaire study. Patients' demographic
information was obtained, and patients' reasons for not being screened
were explored. Subjects were given an information sheet that described
a CTC procedure and then were asked about their willingness to undergo
CTC and about other relevant factors, such as fees. RESULTS: One
hundred seventy-five patients were invited to participate; 53 declined
and 54 did not respond, which left 68 subjects to be included in
the analysis. After being informed about CTC screening, most (83%)
subjects stated that they would be willing to undergo a CTC study.
However, 70% stated that they would not be willing to pay out-of-pocket
fees if insurance did not cover the study, and even among the 30%
who were willing to pay the fees, the average amount they were willing
to pay (mean, $244; median, $150) was well below currently charged
rates. CONCLUSION: Our study suggests that most nonadherent patients
would be willing to undergo CTC as long as out-of-pocket fees are
reasonable.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
against colorectal cancer screening tests and to assess patients'
preferences and cost influences for CT colonography (CTC) in a nonadherent
urban subpopulation. SUBJECTS AND METHODS: Patients who had been
offered colorectal cancer screening but were nonadherent were asked
to participate in this questionnaire study. Patients' demographic
information was obtained, and patients' reasons for not being screened
were explored. Subjects were given an information sheet that described
a CTC procedure and then were asked about their willingness to undergo
CTC and about other relevant factors, such as fees. RESULTS: One
hundred seventy-five patients were invited to participate; 53 declined
and 54 did not respond, which left 68 subjects to be included in
the analysis. After being informed about CTC screening, most (83%)
subjects stated that they would be willing to undergo a CTC study.
However, 70% stated that they would not be willing to pay out-of-pocket
fees if insurance did not cover the study, and even among the 30%
who were willing to pay the fees, the average amount they were willing
to pay (mean, $244; median, $150) was well below currently charged
rates. CONCLUSION: Our study suggests that most nonadherent patients
would be willing to undergo CTC as long as out-of-pocket fees are
reasonable.
Lee, Janie; McMahon, Pamela M.; Kong, Chung Yin; Kopans, D. B.; Ryan, P. D.; Ozanne, Elissa; Halpern, Elkan F.; Gazelle, G. Scott
Cost-effectiveness of breast MR imaging and screen-film mammography for screening BRCA1 gene mutation carriers Journal Article
In: Radiology, vol. 254, no. 3, pp. 793-800, 2010, ISSN: 1527-1315 (Electronic) 0033-8419, ().
@article{Lee2010,
title = {Cost-effectiveness of breast MR imaging and screen-film mammography
for screening BRCA1 gene mutation carriers},
author = {Janie Lee and Pamela M. McMahon and Chung Yin Kong and D. B. Kopans and P. D. Ryan and Elissa Ozanne and Elkan F. Halpern and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/20177093},
issn = {1527-1315 (Electronic) 0033-8419},
year = {2010},
date = {2010-03-01},
journal = {Radiology},
volume = {254},
number = {3},
pages = {793-800},
abstract = {Purpose: To evaluate the clinical effectiveness and cost-effectiveness
of screening strategies in which MR imaging and screen-film mammography
were used, alone and in combination, in women with BRCA1 mutations.
Materials and Methods: Because this study did not involve primary
data collection from individual patients, institutional review board
approval was not needed. By using a simulation model, we compared
three annual screening strategies for a cohort of 25-year-old BRCA1
mutation carriers, as follows: (a) screen-film mammography, (b) MR
imaging, and (c) combined MR imaging and screen-film mammography
(combined screening). The model was used to estimate quality-adjusted
life-years (QALYs) and lifetime costs. Incremental cost-effectiveness
ratios were calculated. Input parameters were obtained from the medical
literature, existing databases, and calibration. Costs (2007 U.S.
dollars) and quality-of-life adjustments were derived from Medicare
reimbursement rates and the medical literature. Sensitivity analysis
was performed to evaluate the effect of uncertainty in parameter
estimates on model results. Results: In the base-case analysis, annual
combined screening was most effective (44.62 QALYs), and had the
highest cost ($110973), followed by annual MR imaging alone (44.50
QALYs, $108641), and annual mammography alone (44.46 QALYs, $100336).
Adding annual MR imaging to annual mammographic screening cost $69125
for each additional QALY gained. Sensitivity analysis indicated that,
when the screening MR imaging cost increased to $960 (base case,
$577), or breast cancer risk by age 70 years decreased below 58%
(base case, 65%), or the sensitivity of combined screening decreased
below 76% (base case, 94%), the cost of adding MR imaging to mammography
exceeded $100000 per QALY. Conclusion: Annual combined screening
provides the greatest life expectancy and is likely cost-effective
when the value placed on gaining an additional QALY is in the range
of $50000-$100000. (c) RSNA, 2010 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09091086/-/DC1.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
of screening strategies in which MR imaging and screen-film mammography
were used, alone and in combination, in women with BRCA1 mutations.
Materials and Methods: Because this study did not involve primary
data collection from individual patients, institutional review board
approval was not needed. By using a simulation model, we compared
three annual screening strategies for a cohort of 25-year-old BRCA1
mutation carriers, as follows: (a) screen-film mammography, (b) MR
imaging, and (c) combined MR imaging and screen-film mammography
(combined screening). The model was used to estimate quality-adjusted
life-years (QALYs) and lifetime costs. Incremental cost-effectiveness
ratios were calculated. Input parameters were obtained from the medical
literature, existing databases, and calibration. Costs (2007 U.S.
dollars) and quality-of-life adjustments were derived from Medicare
reimbursement rates and the medical literature. Sensitivity analysis
was performed to evaluate the effect of uncertainty in parameter
estimates on model results. Results: In the base-case analysis, annual
combined screening was most effective (44.62 QALYs), and had the
highest cost ($110973), followed by annual MR imaging alone (44.50
QALYs, $108641), and annual mammography alone (44.46 QALYs, $100336).
Adding annual MR imaging to annual mammographic screening cost $69125
for each additional QALY gained. Sensitivity analysis indicated that,
when the screening MR imaging cost increased to $960 (base case,
$577), or breast cancer risk by age 70 years decreased below 58%
(base case, 65%), or the sensitivity of combined screening decreased
below 76% (base case, 94%), the cost of adding MR imaging to mammography
exceeded $100000 per QALY. Conclusion: Annual combined screening
provides the greatest life expectancy and is likely cost-effective
when the value placed on gaining an additional QALY is in the range
of $50000-$100000. (c) RSNA, 2010 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09091086/-/DC1.
Huang, Ed; Gazelle, G. Scott; Hur, Chin
Consensus guidelines in the management of branch duct intraductal papillary mucinous neoplasm: a cost-effectiveness analysis Journal Article
In: Dig Dis Sci, vol. 55, no. 3, pp. 852-60, 2010, ISSN: 1573-2568 (Electronic) 0163-2116, ().
@article{Huang2010,
title = {Consensus guidelines in the management of branch duct intraductal
papillary mucinous neoplasm: a cost-effectiveness analysis},
author = {Ed Huang and G. Scott Gazelle and Chin Hur},
url = {http://www.ncbi.nlm.nih.gov/pubmed/19834805},
issn = {1573-2568 (Electronic) 0163-2116},
year = {2010},
date = {2010-03-01},
journal = {Dig Dis Sci},
volume = {55},
number = {3},
pages = {852-60},
abstract = {BACKGROUND AND AIMS: Based on consensus guidelines, surgical resection
of branch duct intraductal papillary mucinous neoplasm (BD-IPMN) is indicated in patients with symptoms of cyst size \>or=30 mm, intramural
nodules, or dilated main pancreatic duct greater than 6 mm. The aim
of this study was to determine the cost effectiveness of consensus
guideline implementation in the management of BD-IPMN. METHODS: We
developed a decision analytic model to compare the costs and effectiveness
of three management strategies for a cohort of 60-year-old patients
with branch duct IPMN: (1) surveillance using consensus guidelines
for surgical resection (surveillance strategy), (2) surgical resection
based on symptoms without surveillance (no surveillance strategy),
and (3) immediate surgery (surgery strategy). The primary outcomes
were quality-adjusted life years (QALYs), cost, and incremental cost-effectiveness
ratio (ICER). Sensitivity analysis was performed over a wide ranges
of estimates. RESULTS: The no surveillance strategy was the least
costly, but also the least effective, while the surgery strategy
was the most costly and most effective. Compared to the no surveillance
strategy, the surveillance strategy cost an additional $20,096 per
QALY. The incremental cost-effectiveness ratio of the surgery strategy
compared with the surveillance strategy was $132,436 per QALY. In
a probabilistic sensitivity analysis, if society was willing to pay
$50,000 per quality-adjusted life year gained, then 88.1% of patients
using the surveillance strategy would be within budget. CONCLUSIONS:
Immediate surgery is the most effective, but may be prohibitively
expensive. The surveillance strategy is a cost-effective option compared
to no surveillance.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
of branch duct intraductal papillary mucinous neoplasm (BD-IPMN) is indicated in patients with symptoms of cyst size >or=30 mm, intramural
nodules, or dilated main pancreatic duct greater than 6 mm. The aim
of this study was to determine the cost effectiveness of consensus
guideline implementation in the management of BD-IPMN. METHODS: We
developed a decision analytic model to compare the costs and effectiveness
of three management strategies for a cohort of 60-year-old patients
with branch duct IPMN: (1) surveillance using consensus guidelines
for surgical resection (surveillance strategy), (2) surgical resection
based on symptoms without surveillance (no surveillance strategy),
and (3) immediate surgery (surgery strategy). The primary outcomes
were quality-adjusted life years (QALYs), cost, and incremental cost-effectiveness
ratio (ICER). Sensitivity analysis was performed over a wide ranges
of estimates. RESULTS: The no surveillance strategy was the least
costly, but also the least effective, while the surgery strategy
was the most costly and most effective. Compared to the no surveillance
strategy, the surveillance strategy cost an additional $20,096 per
QALY. The incremental cost-effectiveness ratio of the surgery strategy
compared with the surveillance strategy was $132,436 per QALY. In
a probabilistic sensitivity analysis, if society was willing to pay
$50,000 per quality-adjusted life year gained, then 88.1% of patients
using the surveillance strategy would be within budget. CONCLUSIONS:
Immediate surgery is the most effective, but may be prohibitively
expensive. The surveillance strategy is a cost-effective option compared
to no surveillance.
Abujudeh, H. H.; Boland, G. W.; Kaewlai, R.; Rabiner, P.; Halpern, Elkan F.; Gazelle, G. Scott; Thrall, J. H.
Abdominal and pelvic computed tomography (CT) interpretation: discrepancy rates among experienced radiologists Journal Article
In: Eur Radiol, vol. 20, pp. 1952-7, 2010, ().
@article{Abujudeh2010,
title = {Abdominal and pelvic computed tomography (CT) interpretation: discrepancy rates among experienced radiologists},
author = {H. H. Abujudeh and G. W. Boland and R. Kaewlai and P. Rabiner and Elkan F. Halpern and G. Scott Gazelle and J. H. Thrall},
url = {http://www.ncbi.nlm.nih.gov/pubmed/20336300},
year = {2010},
date = {2010-01-01},
journal = {Eur Radiol},
volume = {20},
pages = {1952-7},
abstract = {OBJECTIVE: To assess the discrepancy rate for the interpretation of
abdominal and pelvic computed tomography (CT) examinations among
experienced radiologists. METHODS: Ninety abdominal and pelvic CT
examinations reported by three experienced radiologists who specialize
in abdominal imaging were randomly selected from the radiological
database. The same radiologists, blinded to previous interpretation,
were asked to re-interpret 60 examinations: 30 of their previous
interpretations and 30 interpreted by others. All reports were assessed
for the degree of discrepancy between initial and repeat interpretations
according to a three-level scoring system: no discrepancy, minor,
or major discrepancy. Inter- and intrareader discrepancy rates and
causes were evaluated. RESULTS: CT examinations included in the investigation
were performed on 90 patients (43 men, mean age 59 years, SD 14,
range 19-88) for the following indications: follow-up/evaluation
of malignancy (69/90, 77, pancreatitis (5/90, 6, urinary tract stone
(4/90, 4 or other (12/90, 13. Interobserver and intraobserver major
discrepancy rates were 26 and 32 respectively. Major discrepancies
were due to missed findings, different opinions regarding interval
change of clinically significant findings, and the presence of recommendation.
CONCLUSIONS: Major discrepancy of between 26 and 32% was observed
in the interpretation of abdominal and pelvic CT examinations.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
abdominal and pelvic computed tomography (CT) examinations among
experienced radiologists. METHODS: Ninety abdominal and pelvic CT
examinations reported by three experienced radiologists who specialize
in abdominal imaging were randomly selected from the radiological
database. The same radiologists, blinded to previous interpretation,
were asked to re-interpret 60 examinations: 30 of their previous
interpretations and 30 interpreted by others. All reports were assessed
for the degree of discrepancy between initial and repeat interpretations
according to a three-level scoring system: no discrepancy, minor,
or major discrepancy. Inter- and intrareader discrepancy rates and
causes were evaluated. RESULTS: CT examinations included in the investigation
were performed on 90 patients (43 men, mean age 59 years, SD 14,
range 19-88) for the following indications: follow-up/evaluation
of malignancy (69/90, 77, pancreatitis (5/90, 6, urinary tract stone
(4/90, 4 or other (12/90, 13. Interobserver and intraobserver major
discrepancy rates were 26 and 32 respectively. Major discrepancies
were due to missed findings, different opinions regarding interval
change of clinically significant findings, and the presence of recommendation.
CONCLUSIONS: Major discrepancy of between 26 and 32% was observed
in the interpretation of abdominal and pelvic CT examinations.
Hur, Chin; Hayeck, Tristan; Yeh, Jennifer; Richards, Ethan M.; Spechler, Stuart J.; Gazelle, G. Scott; Kong, Chung Yin
Development, calibration, and validation of a U.S. white male population-based simulation model of esophageal adenocarcinoma Journal Article
In: vol. 5, pp. e9483–, 2010, ().
@article{Hur2010,
title = {Development, calibration, and validation of a U.S. white male population-based simulation model of esophageal adenocarcinoma},
author = {Chin Hur and Tristan Hayeck and Jennifer Yeh and Ethan M. Richards and Stuart J. Spechler and G. Scott Gazelle and Chung Yin Kong},
url = {http://www.ncbi.nlm.nih.gov/pubmed/20208996},
year = {2010},
date = {2010-01-01},
urldate = {2010-01-01},
booktitle = {PLoS One},
volume = {5},
pages = {e9483--},
abstract = {The incidence of esophageal adenocarcinoma (EAC) has risen rapidly
in the U.S. and western world. The aim of the study was to begin
the investigation of this rapid rise by developing, calibrating,
and validating a mathematical disease simulation model of EAC using
available epidemiologic data.The model represents the natural history
of EAC, including the essential biologic health states from normal
mucosa to detected cancer. Progression rates between health states
were estimated via calibration, which identified distinct parameter
sets producing model outputs that fit epidemiologic data; specifically,
the prevalence of pre-cancerous lesions and EAC cancer incidence
from the published literature and Surveillance, Epidemiology, and
End Results (SEER) data. As an illustrative example of a clinical
and policy application, the calibrated and validated model retrospectively
analyzed the potential benefit of an aspirin chemoprevention program.Model
outcomes approximated calibration targets; results of the model's
fit and validation are presented. Approximately 7,000 cases of EAC
could have been prevented over a 30-year period if all white males
started aspirin chemoprevention at age 40 in 1965.The model serves
as the foundation for future analyses to determine a cost-effective
screening and management strategy to prevent EAC morbidity and mortality.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
in the U.S. and western world. The aim of the study was to begin
the investigation of this rapid rise by developing, calibrating,
and validating a mathematical disease simulation model of EAC using
available epidemiologic data.The model represents the natural history
of EAC, including the essential biologic health states from normal
mucosa to detected cancer. Progression rates between health states
were estimated via calibration, which identified distinct parameter
sets producing model outputs that fit epidemiologic data; specifically,
the prevalence of pre-cancerous lesions and EAC cancer incidence
from the published literature and Surveillance, Epidemiology, and
End Results (SEER) data. As an illustrative example of a clinical
and policy application, the calibrated and validated model retrospectively
analyzed the potential benefit of an aspirin chemoprevention program.Model
outcomes approximated calibration targets; results of the model's
fit and validation are presented. Approximately 7,000 cases of EAC
could have been prevented over a 30-year period if all white males
started aspirin chemoprevention at age 40 in 1965.The model serves
as the foundation for future analyses to determine a cost-effective
screening and management strategy to prevent EAC morbidity and mortality.
Hayeck, Tristan; Kong, Chung Yin; Spechler, S. J.; Gazelle, G. Scott; Hur, Chin
The prevalence of Barrett's esophagus in the US: estimates from a simulation model confirmed by SEER data Journal Article
In: vol. 23, pp. 451-457–, 2010, ().
@article{Hayeck2010,
title = {The prevalence of Barrett's esophagus in the US: estimates from a simulation model confirmed by SEER data},
author = {Tristan Hayeck and Chung Yin Kong and S. J. Spechler and G. Scott Gazelle and Chin Hur},
url = {http://www.ncbi.nlm.nih.gov/pubmed/20353441},
year = {2010},
date = {2010-01-01},
urldate = {2010-01-01},
booktitle = {Dis Esophagus},
volume = {23},
pages = {451-457--},
abstract = {Barrett's esophagus (BE) is the precursor and the biggest risk factor
for esophageal adenocarcinoma (EAC), the solid cancer with the fastest
rising incidence in the US and western world. Current strategies
to decrease morbidity and mortality from EAC have focused on identifying
and surveying patients with BE using upper endoscopy. An accurate
estimate of the number of patients with BE in the population is important
to inform public health policy and to prioritize resources for potential
screening and management programs. However, the true prevalence of
BE is difficult to ascertain because the condition frequently is
symptomatically silent, and the numerous clinical studies that have
analyzed BE prevalence have produced a wide range of estimates. The
aim of this study was to use a computer simulation disease model
of EAC to determine the estimates for BE prevalence that best align
with US Surveillance Epidemiology and End Results (SEER) cancer registry
data. A previously developed mathematical model of EAC was modified
to perform this analysis. The model consists of six health states:
normal, gastroesophageal reflux disease (GERD), BE, undetected cancer,
detected cancer, and death. Published literature regarding the transition
rates between these states were used to provide boundaries. During
the one million computer simulations that were performed, these transition
rates were systematically varied, producing differing prevalences
for the numerous health states. Two filters were sequentially applied
to select out superior simulations that were most consistent with
clinical data. First, among these million simulations, the 1000 that
best reproduced SEER cancer incidence data were selected. Next, of
those 1000 best simulations, the 100 with an overall calculated BE
to Detected Cancer rates closest to published estimates were selected.
Finally, the prevalence of BE in the final set of best 100 simulations
was analyzed. We present histogram data depicting BE prevalences
for all one million simulations, the 1000 simulations that best approximate
SEER data, and the final set of 100 simulations. Using the best 100
simulations, we estimate the prevalence of BE to be 5.6% (5.49-5.70.
Using our model, an estimated prevalence for BE in the general population
of 5.6% (5.49-5.70 accurately predicts incidence rates for EAC reported
to the US SEER cancer registry. Future clinical studies are needed
to confirm our estimate.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
for esophageal adenocarcinoma (EAC), the solid cancer with the fastest
rising incidence in the US and western world. Current strategies
to decrease morbidity and mortality from EAC have focused on identifying
and surveying patients with BE using upper endoscopy. An accurate
estimate of the number of patients with BE in the population is important
to inform public health policy and to prioritize resources for potential
screening and management programs. However, the true prevalence of
BE is difficult to ascertain because the condition frequently is
symptomatically silent, and the numerous clinical studies that have
analyzed BE prevalence have produced a wide range of estimates. The
aim of this study was to use a computer simulation disease model
of EAC to determine the estimates for BE prevalence that best align
with US Surveillance Epidemiology and End Results (SEER) cancer registry
data. A previously developed mathematical model of EAC was modified
to perform this analysis. The model consists of six health states:
normal, gastroesophageal reflux disease (GERD), BE, undetected cancer,
detected cancer, and death. Published literature regarding the transition
rates between these states were used to provide boundaries. During
the one million computer simulations that were performed, these transition
rates were systematically varied, producing differing prevalences
for the numerous health states. Two filters were sequentially applied
to select out superior simulations that were most consistent with
clinical data. First, among these million simulations, the 1000 that
best reproduced SEER cancer incidence data were selected. Next, of
those 1000 best simulations, the 100 with an overall calculated BE
to Detected Cancer rates closest to published estimates were selected.
Finally, the prevalence of BE in the final set of best 100 simulations
was analyzed. We present histogram data depicting BE prevalences
for all one million simulations, the 1000 simulations that best approximate
SEER data, and the final set of 100 simulations. Using the best 100
simulations, we estimate the prevalence of BE to be 5.6% (5.49-5.70.
Using our model, an estimated prevalence for BE in the general population
of 5.6% (5.49-5.70 accurately predicts incidence rates for EAC reported
to the US SEER cancer registry. Future clinical studies are needed
to confirm our estimate.
2009
Greenblatt, Wesley; Hur, Chin; Knudsen, Amy; Evans, J. A.; Chung, D. C.; Gazelle, G. Scott
Cost-effectiveness of prophylactic surgery for duodenal cancer in familial adenomatous polyposis Journal Article
In: Cancer Epidemiol Biomarkers Prev, vol. 18, no. 10, pp. 2677-84, 2009, ISSN: 1538-7755 (Electronic) 1055-9965, ().
@article{Greenblatt2009,
title = {Cost-effectiveness of prophylactic surgery for duodenal cancer in
familial adenomatous polyposis},
author = {Wesley Greenblatt and Chin Hur and Amy Knudsen and J. A. Evans and D. C. Chung and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/19789369},
issn = {1538-7755 (Electronic) 1055-9965},
year = {2009},
date = {2009-10-01},
journal = {Cancer Epidemiol Biomarkers Prev},
volume = {18},
number = {10},
pages = {2677-84},
abstract = {BACKGROUND: Duodenal cancer is the leading cause of cancer death in
familial adenomatous polyposis after colorectal cancer. The lifetime
risk for developing duodenal cancer is 4% to 10%. Current treatment
guidelines recommend endoscopic surveillance with a prophylactic
pancreaticoduodenectomy in advanced duodenal polyposis, defined using
the Spigelman staging system. Because no clinical trials have assessed
this recommendation, a modeling approach was used to evaluate the
cost-effectiveness of various treatment strategies. METHODS: A Markov
model was constructed to estimate the life expectancy and cost of
three different strategies: pancreaticoduodenectomy at Spigelman
stage III, pancreaticoduodenectomy at Spigelman stage IV, and pancreaticoduodenectomy
at cancer diagnosis. A cohort of 30-year-old familial adenomatous
polyposis patients with total colectomies was simulated until age
80. The analysis was from a societal perspective. Extensive sensitivity
analysis was performed to assess the impact of model uncertainty
on results. RESULTS: At all stages of polyposis and all ages \<80
years, prophylactic surgery at Spigelman stage IV resulted in the
greatest life expectancy. Surgery at stage IV was more effective
and more expensive than surgery at cancer diagnosis, with an incremental
cost of $3,200 per quality-adjusted life year gained. Surgery at
stage III was not a viable option. The results were robust to wide
variation in model parameters but were sensitive to the post-pancreaticoduodenectomy
quality of life score. CONCLUSIONS: Prophylactic pancreaticoduodenectomy
at stage IV duodenal polyposis in familial adenomatous polyposis
is a cost-effective approach that results in greater life expectancy
than surgery at either stage III or cancer diagnosis.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
familial adenomatous polyposis after colorectal cancer. The lifetime
risk for developing duodenal cancer is 4% to 10%. Current treatment
guidelines recommend endoscopic surveillance with a prophylactic
pancreaticoduodenectomy in advanced duodenal polyposis, defined using
the Spigelman staging system. Because no clinical trials have assessed
this recommendation, a modeling approach was used to evaluate the
cost-effectiveness of various treatment strategies. METHODS: A Markov
model was constructed to estimate the life expectancy and cost of
three different strategies: pancreaticoduodenectomy at Spigelman
stage III, pancreaticoduodenectomy at Spigelman stage IV, and pancreaticoduodenectomy
at cancer diagnosis. A cohort of 30-year-old familial adenomatous
polyposis patients with total colectomies was simulated until age
80. The analysis was from a societal perspective. Extensive sensitivity
analysis was performed to assess the impact of model uncertainty
on results. RESULTS: At all stages of polyposis and all ages <80
years, prophylactic surgery at Spigelman stage IV resulted in the
greatest life expectancy. Surgery at stage IV was more effective
and more expensive than surgery at cancer diagnosis, with an incremental
cost of $3,200 per quality-adjusted life year gained. Surgery at
stage III was not a viable option. The results were robust to wide
variation in model parameters but were sensitive to the post-pancreaticoduodenectomy
quality of life score. CONCLUSIONS: Prophylactic pancreaticoduodenectomy
at stage IV duodenal polyposis in familial adenomatous polyposis
is a cost-effective approach that results in greater life expectancy
than surgery at either stage III or cancer diagnosis.
Hur, Chin; Broughton, D. E.; Kong, Chung Yin; Ozanne, Elissa; Richards, E. B.; Truong, T.; Gazelle, G. Scott
Patient preferences for the chemoprevention of colorectal cancer Journal Article
In: Dig Dis Sci, vol. 54, no. 10, pp. 2207-14, 2009, ISSN: 1573-2568 (Electronic) 0163-2116, ().
@article{Hur2009,
title = {Patient preferences for the chemoprevention of colorectal cancer},
author = {Chin Hur and D. E. Broughton and Chung Yin Kong and Elissa Ozanne and E. B. Richards and T. Truong and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/19057995},
issn = {1573-2568 (Electronic) 0163-2116},
year = {2009},
date = {2009-10-01},
journal = {Dig Dis Sci},
volume = {54},
number = {10},
pages = {2207-14},
abstract = {Although evidence suggests that aspirin and celecoxib may reduce the
risk of colorectal cancer (CRC), these drugs can also cause harmful
side effects. The aim of this study was to characterize patient preferences
for celecoxib and aspirin. Participants completed a computer-based
patient decision-making questionnaire that included an educational
component outlining the benefits and harms of celecoxib and aspirin.
Under the base conditions 7.4% would take celecoxib and 43.6% would
take aspirin; males were more willing than females to take aspirin.
Patients identified the increased risk of myocardial infarction and
gastrointestinal events as the primary reasons for their unwillingness
to take celecoxib and aspirin, respectively. A majority of subjects
would not take either drug, after considering their benefits and
harms, although participants were almost six times more likely to
take aspirin than celecoxib. These data serve to inform physicians
and researchers regarding the variability and factors that affect
patient preferences for CRC chemoprevention.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
risk of colorectal cancer (CRC), these drugs can also cause harmful
side effects. The aim of this study was to characterize patient preferences
for celecoxib and aspirin. Participants completed a computer-based
patient decision-making questionnaire that included an educational
component outlining the benefits and harms of celecoxib and aspirin.
Under the base conditions 7.4% would take celecoxib and 43.6% would
take aspirin; males were more willing than females to take aspirin.
Patients identified the increased risk of myocardial infarction and
gastrointestinal events as the primary reasons for their unwillingness
to take celecoxib and aspirin, respectively. A majority of subjects
would not take either drug, after considering their benefits and
harms, although participants were almost six times more likely to
take aspirin than celecoxib. These data serve to inform physicians
and researchers regarding the variability and factors that affect
patient preferences for CRC chemoprevention.
Pandharipande, Pari; Mora, J. T.; Uppot, R. N.; Goehler, Alexander; Braschi, M.; Halpern, Elkan F.; Gazelle, G. Scott; Harisinghani, M. G.
Lymphotropic nanoparticle-enhanced MRI for independent prediction of lymph node malignancy: a logistic regression model Journal Article
In: AJR Am J Roentgenol, vol. 193, no. 3, pp. W230-7, 2009, ISSN: 1546-3141 (Electronic) 0361-803X, ().
@article{Pandharipande2009,
title = {Lymphotropic nanoparticle-enhanced MRI for independent prediction of lymph node malignancy: a logistic regression model},
author = {Pari Pandharipande and J. T. Mora and R. N. Uppot and Alexander Goehler and M. Braschi and Elkan F. Halpern and G. Scott Gazelle and M. G. Harisinghani},
url = {http://www.ncbi.nlm.nih.gov/pubmed/19696264},
issn = {1546-3141 (Electronic) 0361-803X},
year = {2009},
date = {2009-09-01},
journal = {AJR Am J Roentgenol},
volume = {193},
number = {3},
pages = {W230-7},
abstract = {OBJECTIVE: The purpose of this study was to determine whether use
of lymphotropic nanoparticle-enhanced MRI can improve the ability
to characterize lymph nodes as benign or malignant beyond size criteria
alone. MATERIALS AND METHODS: The cases of 42 consecutively registered
patients with a known primary malignant tumor of the genitourinary
tract who underwent both lymphotropic nanoparticle-enhanced MRI and
CT-guided biopsy of a lymph node at our institution from 2000 to
2005 were retrospectively identified. Lymphotropic nanoparticle-enhanced
MRI included T2(*)-weighted gradient-recalled echo imaging before
and 24-36 hours after i.v. administration of lymphotropic iron oxide
nanoparticles. Two positivity criteria for lymph node malignancy
were evaluated independently: lack of nanoparticle uptake at lymphotropic
nanoparticle-enhanced MRI and short-axis length of 1 cm or greater.
Sensitivity and specificity were calculated for each criterion with
biopsy results as the standard of reference. Logistic regression
analysis was used to determine the association (odds ratio) between
lymphotropic nanoparticle-enhanced MRI findings and the presence
of lymph node malignancy when controlling for short-axis length.
RESULTS: Metastatic lesions were detected at histologic examination
in 67% (28/42) of nodes. According to the lymphotropic nanoparticle-enhanced
MRI criterion, sensitivity for malignancy was 100% (28/28 nodes),
and specificity was 64% (9/14 nodes). According to the short-axis
criterion, sensitivity was 79% (22/28 nodes), and specificity was
21% (3/14 nodes). In multivariate analysis, when controlling for
short-axis length, the finding of malignancy at lymphotropic nanoparticle-enhanced
MRI was an independent predictor of the presence of malignancy (odds
ratio, 61.0; 95% CI, 8.0 to infinity; p},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
of lymphotropic nanoparticle-enhanced MRI can improve the ability
to characterize lymph nodes as benign or malignant beyond size criteria
alone. MATERIALS AND METHODS: The cases of 42 consecutively registered
patients with a known primary malignant tumor of the genitourinary
tract who underwent both lymphotropic nanoparticle-enhanced MRI and
CT-guided biopsy of a lymph node at our institution from 2000 to
2005 were retrospectively identified. Lymphotropic nanoparticle-enhanced
MRI included T2(*)-weighted gradient-recalled echo imaging before
and 24-36 hours after i.v. administration of lymphotropic iron oxide
nanoparticles. Two positivity criteria for lymph node malignancy
were evaluated independently: lack of nanoparticle uptake at lymphotropic
nanoparticle-enhanced MRI and short-axis length of 1 cm or greater.
Sensitivity and specificity were calculated for each criterion with
biopsy results as the standard of reference. Logistic regression
analysis was used to determine the association (odds ratio) between
lymphotropic nanoparticle-enhanced MRI findings and the presence
of lymph node malignancy when controlling for short-axis length.
RESULTS: Metastatic lesions were detected at histologic examination
in 67% (28/42) of nodes. According to the lymphotropic nanoparticle-enhanced
MRI criterion, sensitivity for malignancy was 100% (28/28 nodes),
and specificity was 64% (9/14 nodes). According to the short-axis
criterion, sensitivity was 79% (22/28 nodes), and specificity was
21% (3/14 nodes). In multivariate analysis, when controlling for
short-axis length, the finding of malignancy at lymphotropic nanoparticle-enhanced
MRI was an independent predictor of the presence of malignancy (odds
ratio, 61.0; 95% CI, 8.0 to infinity; p
Geisler, Benjamin; Dam, R. M.; Gazelle, G. Scott; Goehler, Alexander
Risk of bias in meta-analysis on erythropoietin-stimulating agents in heart failure Journal Article
In: Heart, vol. 95, no. 15, pp. 1278-9; author reply, 2009, ISSN: 1468-201X (Electronic) 1355-6037, ().
@article{Geisler2009,
title = {Risk of bias in meta-analysis on erythropoietin-stimulating agents in heart failure},
author = {Benjamin Geisler and R. M. Dam and G. Scott Gazelle and Alexander Goehler},
url = {http://www.ncbi.nlm.nih.gov/pubmed/19605752},
issn = {1468-201X (Electronic) 1355-6037},
year = {2009},
date = {2009-08-01},
journal = {Heart},
volume = {95},
number = {15},
pages = {1278-9; author reply},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Kahlon, P.; McCullough, K.; Gazelle, G. Scott
Enhancing patient safety: standardization of CT contrast media practices Journal Article
In: J Am Coll Radiol, vol. 6, no. 8, pp. 562-6, 2009, ISSN: 1558-349X (Electronic) 1546-1440, ().
@article{Kahlon2009,
title = {Enhancing patient safety: standardization of CT contrast media practices},
author = {P. Kahlon and K. McCullough and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/19643384},
issn = {1558-349X (Electronic) 1546-1440},
year = {2009},
date = {2009-08-01},
urldate = {2009-08-01},
journal = {J Am Coll Radiol},
volume = {6},
number = {8},
pages = {562-6},
abstract = {Large health care systems with varied hospital cultures, environments,
and practices are continually challenged to provide safer and higher
quality patient care. The authors describe their experience implementing
uniform procedures for computed tomographic contrast media administration
and the impact that standardization of these practices had on patient
safety at a large integrated health care system.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
and practices are continually challenged to provide safer and higher
quality patient care. The authors describe their experience implementing
uniform procedures for computed tomographic contrast media administration
and the impact that standardization of these practices had on patient
safety at a large integrated health care system.
Pandharipande, Pari; Choy, G.; Carmen, M. G.; Gazelle, G. Scott; Russell, A. H.; Lee, S. I.
MRI and PET/CT for triaging stage IB clinically operable cervical cancer to appropriate therapy: decision analysis to assess patient outcomes Journal Article
In: AJR Am J Roentgenol, vol. 192, no. 3, pp. 802-14, 2009, ISSN: 1546-3141 (Electronic) 0361-803X, ().
@article{Pandharipande2009a,
title = {MRI and PET/CT for triaging stage IB clinically operable cervical
cancer to appropriate therapy: decision analysis to assess patient
outcomes},
author = {Pari Pandharipande and G. Choy and M. G. Carmen and G. Scott Gazelle and A. H. Russell and S. I. Lee},
url = {http://www.ncbi.nlm.nih.gov/pubmed/19234280},
issn = {1546-3141 (Electronic) 0361-803X},
year = {2009},
date = {2009-03-01},
journal = {AJR Am J Roentgenol},
volume = {192},
number = {3},
pages = {802-14},
abstract = {OBJECTIVE: We evaluated the ability of pretreatment MRI and PET/CT
to improve outcomes for patients with clinically staged International
Federation of Gynecology and Obstetrics (FIGO) IB cervical cancer.
MATERIALS AND METHODS: We developed a decision-analytic model to
predict outcomes for a hypothetical patient cohort with FIGO IB cervical
cancer who underwent pretreatment MRI, PET/CT, MRI and PET/CT, or
no further imaging (direct pursuance of surgery). The model incorporated
imaging performance, underlying parametrial extension and lymph node
involvement, surgery and chemoradiation treatment options, and survival
penalties from incorrect assessment of disease extent. Three outcomes
were compared: 5-year overall survival, percentage of patients receiving
correct primary therapy, and percentage of patients spared "trimodality
therapy" (surgery followed by chemoradiation). Sensitivity analysis
was performed to assess the effects of model uncertainty on outcomes.
RESULTS: The preferred imaging strategy depended on the outcome studied.
Five-year overall survival was comparable across strategies but was
highest with the no-imaging strategy (92.37%) and with PET/CT (92.36%)
and lowest with MRI (92.30%). Triage to correct primary therapy was
highest with PET/CT (89.27%) and lowest with MRI (68.21%). Avoidance
of trimodality therapy was highest with combined MRI and PET/CT (95.01%)
and lowest with the no-imaging strategy (82.32%). Results were somewhat
sensitive to imaging test performance characteristics but stable
across most parameter ranges tested. CONCLUSION: Pretreatment imaging
of FIGO IB cervical cancer patients can optimize triage to appropriate
therapy. Although imaging does not appear to improve survival, PET/CT
maximizes patient triage to correct therapy, and combined MRI and
PET/CT spares the most patients unnecessary trimodality therapy.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
to improve outcomes for patients with clinically staged International
Federation of Gynecology and Obstetrics (FIGO) IB cervical cancer.
MATERIALS AND METHODS: We developed a decision-analytic model to
predict outcomes for a hypothetical patient cohort with FIGO IB cervical
cancer who underwent pretreatment MRI, PET/CT, MRI and PET/CT, or
no further imaging (direct pursuance of surgery). The model incorporated
imaging performance, underlying parametrial extension and lymph node
involvement, surgery and chemoradiation treatment options, and survival
penalties from incorrect assessment of disease extent. Three outcomes
were compared: 5-year overall survival, percentage of patients receiving
correct primary therapy, and percentage of patients spared "trimodality
therapy" (surgery followed by chemoradiation). Sensitivity analysis
was performed to assess the effects of model uncertainty on outcomes.
RESULTS: The preferred imaging strategy depended on the outcome studied.
Five-year overall survival was comparable across strategies but was
highest with the no-imaging strategy (92.37%) and with PET/CT (92.36%)
and lowest with MRI (92.30%). Triage to correct primary therapy was
highest with PET/CT (89.27%) and lowest with MRI (68.21%). Avoidance
of trimodality therapy was highest with combined MRI and PET/CT (95.01%)
and lowest with the no-imaging strategy (82.32%). Results were somewhat
sensitive to imaging test performance characteristics but stable
across most parameter ranges tested. CONCLUSION: Pretreatment imaging
of FIGO IB cervical cancer patients can optimize triage to appropriate
therapy. Although imaging does not appear to improve survival, PET/CT
maximizes patient triage to correct therapy, and combined MRI and
PET/CT spares the most patients unnecessary trimodality therapy.
Stout, N. K.; Knudsen, Amy; Kong, Chung Yin; McMahon, Pamela M.; Gazelle, G. Scott
Calibration methods used in cancer simulation models and suggested reporting guidelines Journal Article
In: PharmacoEconomics, vol. 27, pp. 533-45, 2009, ().
@article{Stout2009,
title = {Calibration methods used in cancer simulation models and suggested
reporting guidelines},
author = {N. K. Stout and Amy Knudsen and Chung Yin Kong and Pamela M. McMahon and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/19663525},
year = {2009},
date = {2009-01-01},
journal = {PharmacoEconomics},
volume = {27},
pages = {533-45},
abstract = {Increasingly, computer simulation models are used for economic and
policy evaluation in cancer prevention and control. A model's predictions
of key outcomes, such as screening effectiveness, depend on the values
of unobservable natural history parameters. Calibration is the process
of determining the values of unobservable parameters by constraining
model output to replicate observed data. Because there are many approaches
for model calibration and little consensus on best practices, we
surveyed the literature to catalogue the use and reporting of these
methods in cancer simulation models. We conducted a MEDLINE search
(1980 through 2006) for articles on cancer-screening models and supplemented
search results with articles from our personal reference databases.
For each article, two authors independently abstracted pre-determined
items using a standard form. Data items included cancer site, model
type, methods used for determination of unobservable parameter values
and description of any calibration protocol. All authors reached
consensus on items of disagreement. Reviews and non-cancer models
were excluded. Articles describing analytical models, which estimate
parameters with statistical approaches (e.g. maximum likelihood)
were catalogued separately. Models that included unobservable parameters
were analysed and classified by whether calibration methods were
reported and if so, the methods used. The review process yielded
154 articles that met our inclusion criteria and, of these, we concluded
that 131 may have used calibration methods to determine model parameters.
Although the term 'calibration' was not always used, descriptions of calibration or 'model fitting' were found in 50% (n = 66) of the articles, with an additional 16% (n = 21) providing a reference to
methods. Calibration target data were identified in nearly all of
these articles. Other methodological details, such as the goodness-of-fit metric, were discussed in 54% (n = 47 of 87) of the articles reporting
calibration methods, while few details were provided on the algorithms
used to search the parameter space. Our review shows that the use
of cancer simulation modelling is increasing, although thorough descriptions
of calibration procedures are rare in the published literature for
these models. Calibration is a key component of model development
and is central to the validity and credibility of subsequent analyses
and inferences drawn from model predictions. To aid peer-review and
facilitate discussion of modelling methods, we propose a standardized
Calibration Reporting Checklist for model documentation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
policy evaluation in cancer prevention and control. A model's predictions
of key outcomes, such as screening effectiveness, depend on the values
of unobservable natural history parameters. Calibration is the process
of determining the values of unobservable parameters by constraining
model output to replicate observed data. Because there are many approaches
for model calibration and little consensus on best practices, we
surveyed the literature to catalogue the use and reporting of these
methods in cancer simulation models. We conducted a MEDLINE search
(1980 through 2006) for articles on cancer-screening models and supplemented
search results with articles from our personal reference databases.
For each article, two authors independently abstracted pre-determined
items using a standard form. Data items included cancer site, model
type, methods used for determination of unobservable parameter values
and description of any calibration protocol. All authors reached
consensus on items of disagreement. Reviews and non-cancer models
were excluded. Articles describing analytical models, which estimate
parameters with statistical approaches (e.g. maximum likelihood)
were catalogued separately. Models that included unobservable parameters
were analysed and classified by whether calibration methods were
reported and if so, the methods used. The review process yielded
154 articles that met our inclusion criteria and, of these, we concluded
that 131 may have used calibration methods to determine model parameters.
Although the term 'calibration' was not always used, descriptions of calibration or 'model fitting' were found in 50% (n = 66) of the articles, with an additional 16% (n = 21) providing a reference to
methods. Calibration target data were identified in nearly all of
these articles. Other methodological details, such as the goodness-of-fit metric, were discussed in 54% (n = 47 of 87) of the articles reporting
calibration methods, while few details were provided on the algorithms
used to search the parameter space. Our review shows that the use
of cancer simulation modelling is increasing, although thorough descriptions
of calibration procedures are rare in the published literature for
these models. Calibration is a key component of model development
and is central to the validity and credibility of subsequent analyses
and inferences drawn from model predictions. To aid peer-review and
facilitate discussion of modelling methods, we propose a standardized
Calibration Reporting Checklist for model documentation.
Kong, Chung Yin; McMahon, Pamela M.; Gazelle, G. Scott
Calibration of disease simulation model using an engineering approach Journal Article
In: Value Health, vol. 12, pp. 521-9, 2009, ().
@article{Kong2009,
title = {Calibration of disease simulation model using an engineering approach},
author = {Chung Yin Kong and Pamela M. McMahon and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/19900254},
year = {2009},
date = {2009-01-01},
journal = {Value Health},
volume = {12},
pages = {521-9},
abstract = {OBJECTIVES: Calibrating a disease simulation model's outputs to existing
clinical data is vital to generate confidence in the model's predictive
ability. Calibration involves two challenges: 1) defining a total
goodness-of-fit (GOF) score for multiple targets if simultaneous
fitting is required, and 2) searching for the optimal parameter set
that minimizes the total GOF score (i.e., yields the best fit). To
address these two prominent challenges, we have applied an engineering
approach to calibrate a microsimulation model, the Lung Cancer Policy
Model (LCPM). METHODS: First, 11 targets derived from clinical and
epidemiologic data were combined into a total GOF score by a weighted-sum
approach, accounting for the user-defined relative importance of
the calibration targets. Second, two automated parameter search algorithms,
simulated annealing (SA) and genetic algorithm (GA), were independently
applied to a simultaneous search of 28 natural history parameters
to minimize the total GOF score. Algorithm performance metrics were
defined for speed and model fit. RESULTS: Both search algorithms
obtained total GOF scores below 95 within 1000 search iterations.
Our results show that SA outperformed GA in locating a lower GOF.
After calibrating our LCPM, the predicted natural history of lung
cancer was consistent with other mathematical models of lung cancer
development. CONCLUSION: An engineering-based calibration method
was able to simultaneously fit LCPM output to multiple calibration
targets, with the benefits of fast computational speed and reduced
the need for human input and its potential bias.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
clinical data is vital to generate confidence in the model's predictive
ability. Calibration involves two challenges: 1) defining a total
goodness-of-fit (GOF) score for multiple targets if simultaneous
fitting is required, and 2) searching for the optimal parameter set
that minimizes the total GOF score (i.e., yields the best fit). To
address these two prominent challenges, we have applied an engineering
approach to calibrate a microsimulation model, the Lung Cancer Policy
Model (LCPM). METHODS: First, 11 targets derived from clinical and
epidemiologic data were combined into a total GOF score by a weighted-sum
approach, accounting for the user-defined relative importance of
the calibration targets. Second, two automated parameter search algorithms,
simulated annealing (SA) and genetic algorithm (GA), were independently
applied to a simultaneous search of 28 natural history parameters
to minimize the total GOF score. Algorithm performance metrics were
defined for speed and model fit. RESULTS: Both search algorithms
obtained total GOF scores below 95 within 1000 search iterations.
Our results show that SA outperformed GA in locating a lower GOF.
After calibrating our LCPM, the predicted natural history of lung
cancer was consistent with other mathematical models of lung cancer
development. CONCLUSION: An engineering-based calibration method
was able to simultaneously fit LCPM output to multiple calibration
targets, with the benefits of fast computational speed and reduced
the need for human input and its potential bias.
Cipriano, Lauren; Steinberg, M. L.; Gazelle, G. Scott; Gonzalez, R. G.
In: AJNR Am J Neuroradiol, vol. 30, pp. 703-9, 2009, ().
@article{Cipriano2009,
title = {Comparing and predicting the costs and outcomes of patients with
major and minor stroke using the Boston Acute Stroke Imaging Scale
neuroimaging classification system},
author = {Lauren Cipriano and M. L. Steinberg and G. Scott Gazelle and R. G. Gonzalez},
url = {http://www.ncbi.nlm.nih.gov/pubmed/19164436},
year = {2009},
date = {2009-01-01},
journal = {AJNR Am J Neuroradiol},
volume = {30},
pages = {703-9},
abstract = {BACKGROUND AND PURPOSE: A neuroimaging-based ischemic stroke classification
system that predicts costs and outcomes would be useful for clinical
prognostication and hospital resource planning. The Boston Acute
Stroke Imaging Scale (BASIS), a neuroimaging-based ischemic stroke
classification system, was tested to determine whether it was able
to predict the costs and clinical outcomes of patients with stroke
at an urban academic medical center. MATERIALS AND METHODS: Patients
with ischemic stroke who presented in the emergency department in
2000 (230 patients) and 2005 (250 patients) were classified by using
BASIS as having either a major or minor stroke. Compared outcomes
included death, length of hospitalization, discharge disposition,
use of imaging and intensive care unit (ICU) resources, and total
in-hospital cost. Continuous variables were compared by univariate
analysis by using the Student t test or the Satterthwaite test adjusted
for unequal variances. Categoric variables were tested with the chi(2)
test. Multiple regression analyses related total hospital cost (dependent
variable) to stroke severity (major versus minor), sex, age, presence
of comorbidities, and death during hospitalization. Logistic regression
analysis was applied to identify the significant predictive variables
indicating a greater likelihood of discharge home. RESULTS: In both
years, individuals with strokes classified as major had a significantly
longer length of stay, spent more days in the ICU, and had a higher
cost of hospitalization than patients with minor strokes (all outcomes,
P textless .0001). All deaths (8 in 2000, 26 in 2005) occurred in
patients with major stroke. Whereas 73% of patients with minor stroke
were discharged home, only 12.2% of patients with major stroke were
discharged home (P textless .0001); 61% of patients with major stroke
were discharged to a rehabilitation or skilled nursing facility.
Patients with major stroke cost 4.4 times and 3.0 times that of patients
with minor stroke in 2000 and 2005, respectively. Making up less
than one third of all patients, patients with major stroke accounted
for 60% of the total in-hospital cost of acute stroke care. CONCLUSIONS:
BASIS, a neuroimaging-based stroke classification system, is highly
effective at predicting in-hospital resource use, acute-hospitalization
cost, and outcome. Predictive ability was maintained across the years
studied.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
system that predicts costs and outcomes would be useful for clinical
prognostication and hospital resource planning. The Boston Acute
Stroke Imaging Scale (BASIS), a neuroimaging-based ischemic stroke
classification system, was tested to determine whether it was able
to predict the costs and clinical outcomes of patients with stroke
at an urban academic medical center. MATERIALS AND METHODS: Patients
with ischemic stroke who presented in the emergency department in
2000 (230 patients) and 2005 (250 patients) were classified by using
BASIS as having either a major or minor stroke. Compared outcomes
included death, length of hospitalization, discharge disposition,
use of imaging and intensive care unit (ICU) resources, and total
in-hospital cost. Continuous variables were compared by univariate
analysis by using the Student t test or the Satterthwaite test adjusted
for unequal variances. Categoric variables were tested with the chi(2)
test. Multiple regression analyses related total hospital cost (dependent
variable) to stroke severity (major versus minor), sex, age, presence
of comorbidities, and death during hospitalization. Logistic regression
analysis was applied to identify the significant predictive variables
indicating a greater likelihood of discharge home. RESULTS: In both
years, individuals with strokes classified as major had a significantly
longer length of stay, spent more days in the ICU, and had a higher
cost of hospitalization than patients with minor strokes (all outcomes,
P textless .0001). All deaths (8 in 2000, 26 in 2005) occurred in
patients with major stroke. Whereas 73% of patients with minor stroke
were discharged home, only 12.2% of patients with major stroke were
discharged home (P textless .0001); 61% of patients with major stroke
were discharged to a rehabilitation or skilled nursing facility.
Patients with major stroke cost 4.4 times and 3.0 times that of patients
with minor stroke in 2000 and 2005, respectively. Making up less
than one third of all patients, patients with major stroke accounted
for 60% of the total in-hospital cost of acute stroke care. CONCLUSIONS:
BASIS, a neuroimaging-based stroke classification system, is highly
effective at predicting in-hospital resource use, acute-hospitalization
cost, and outcome. Predictive ability was maintained across the years
studied.
Lee, Janie; Halpern, Elkan F.; Rafferty, E. A.; Gazelle, G. Scott
Evaluating the correlation between film mammography and MRI for screening women with increased breast cancer risk Journal Article
In: Acad Radiol, vol. 16, pp. 1323-8, 2009, ().
@article{Lee2009,
title = {Evaluating the correlation between film mammography and MRI for screening women with increased breast cancer risk},
author = {Janie Lee and Elkan F. Halpern and E. A. Rafferty and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/19632865},
year = {2009},
date = {2009-01-01},
urldate = {2009-01-01},
journal = {Acad Radiol},
volume = {16},
pages = {1323-8},
abstract = {RATIONALE AND OBJECTIVES: Breast magnetic resonance imaging (MRI)
is increasingly being added to mammography for screening asymptomatic
women at increased risk of breast cancer. Because the direction and
extent of correlation between mammography and MRI could potentially
result in over- or underestimation of the diagnostic gain related
to using MRI as an adjunct to mammographic screening, we performed
an analysis to evaluate the extent of correlation between mammography
and MRI. MATERIALS AND METHODS: We reviewed the published literature
to identify multimodality breast cancer screening studies reporting
the sensitivity of mammography and MRI, alone and in combination,
for breast cancer diagnosis. After calculating the expected sensitivity
of combined mammography and MRI under conditions of test independence
(no correlation), we compared the calculated and observed sensitivities
for combined mammography and MRI. We then calculated correlation
coefficients for mammography and MRI. RESULTS: Seven studies of multimodality
screening in women at increased risk of developing breast cancer
were included for analysis. Of these studies, the correlation between
film mammography and MRI was positive in three studies, negative
in two studies, and not identified in two studies. The calculated
correlation coefficients ranged from -0.38 to 0.18. In six of seven
studies, the 95% confidence interval for the correlation coefficient
included 0.0, indicating no significant correlation. CONCLUSIONS:
Evidence from published trials of multimodality breast cancer screening
identified no statistically significant correlation between film
mammography and MRI. Using both tests for breast cancer screening
is likely to improve the early detection of breast cancer in women
at increased risk.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
is increasingly being added to mammography for screening asymptomatic
women at increased risk of breast cancer. Because the direction and
extent of correlation between mammography and MRI could potentially
result in over- or underestimation of the diagnostic gain related
to using MRI as an adjunct to mammographic screening, we performed
an analysis to evaluate the extent of correlation between mammography
and MRI. MATERIALS AND METHODS: We reviewed the published literature
to identify multimodality breast cancer screening studies reporting
the sensitivity of mammography and MRI, alone and in combination,
for breast cancer diagnosis. After calculating the expected sensitivity
of combined mammography and MRI under conditions of test independence
(no correlation), we compared the calculated and observed sensitivities
for combined mammography and MRI. We then calculated correlation
coefficients for mammography and MRI. RESULTS: Seven studies of multimodality
screening in women at increased risk of developing breast cancer
were included for analysis. Of these studies, the correlation between
film mammography and MRI was positive in three studies, negative
in two studies, and not identified in two studies. The calculated
correlation coefficients ranged from -0.38 to 0.18. In six of seven
studies, the 95% confidence interval for the correlation coefficient
included 0.0, indicating no significant correlation. CONCLUSIONS:
Evidence from published trials of multimodality breast cancer screening
identified no statistically significant correlation between film
mammography and MRI. Using both tests for breast cancer screening
is likely to improve the early detection of breast cancer in women
at increased risk.
Ladapo, J. A.; Horwitz, J. R.; Weinstein, M. C.; Gazelle, G. Scott; Cutler, D. M.
Ädoption and spread of new imaging technology: a case study" Journal Article
In: Health Aff (Millwood), vol. 28, no. 6, pp. w1122-32, 2009, ISSN: 1544-5208 (Electronic) 0278-2715, ().
@article{Ladapo2009,
title = {\"{A}doption and spread of new imaging technology: a case study"},
author = {J. A. Ladapo and J. R. Horwitz and M. C. Weinstein and G. Scott Gazelle and D. M. Cutler},
url = {http://www.ncbi.nlm.nih.gov/pubmed/19828487},
issn = {1544-5208 (Electronic) 0278-2715},
year = {2009},
date = {2009-00-01},
journal = {Health Aff (Millwood)},
volume = {28},
number = {6},
pages = {w1122-32},
abstract = {Technology is a major driver of health care costs. Hospitals are rapidly
acquiring one new technology in particular: 64-slice computed tomography
(CT), which can be used to image coronary arteries in search of blockages.
We propose that it is more likely to be adopted by hospitals that
treat cardiac patients, function in competitive markets, are reimbursed
for the procedure, and have favorable operating margins. We find
that early adoption is related to cardiac patient volume but also
to operating margins. The paucity of evidence informing this technology's
role in cardiac care suggests that its adoption by cardiac-oriented
hospitals is premature. Further, adoption motivated by operating
margins reinforces concerns about haphazard technology acquisition.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
acquiring one new technology in particular: 64-slice computed tomography
(CT), which can be used to image coronary arteries in search of blockages.
We propose that it is more likely to be adopted by hospitals that
treat cardiac patients, function in competitive markets, are reimbursed
for the procedure, and have favorable operating margins. We find
that early adoption is related to cardiac patient volume but also
to operating margins. The paucity of evidence informing this technology's
role in cardiac care suggests that its adoption by cardiac-oriented
hospitals is premature. Further, adoption motivated by operating
margins reinforces concerns about haphazard technology acquisition.
Goehler, Alexander; Geisler, Benjamin; Manne, J. M.; Kosiborod, M.; Zhang, Z.; Weintraub, W. S.; Spertus, J. A.; Gazelle, G. Scott; Siebert, Uwe; Cohen, D. J.
In: Value Health, vol. 12, no. 1, pp. 185-7, 2009, ISSN: 1524-4733 (Electronic) 1098-3015, ().
@article{Gohler2009,
title = {\"{U}tility estimates for decision-analytic modeling in chronic heart
failure--health states based on New York {H}eart Association classes
and number of rehospitalizations"},
author = {Alexander Goehler and Benjamin Geisler and J. M. Manne and M. Kosiborod and Z. Zhang and W. S. Weintraub and J. A. Spertus and G. Scott Gazelle and Uwe Siebert and D. J. Cohen},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18647251},
issn = {1524-4733 (Electronic) 1098-3015},
year = {2009},
date = {2009-00-01},
journal = {Value Health},
volume = {12},
number = {1},
pages = {185-7},
abstract = {OBJECTIVES: For economic evaluations of chronic heart failure (CHF)
management strategies, utilities are not currently available for
disease proxies commonly used in Markov models. Our objective was
to estimate utilities for New York Heart Association (NYHA) classification
and number of cardiovascular rehospitalizations. METHODS: EuroQol
5D data from the Eplerenone Post-acute Myocardial Infarction Heart
Failure Efficacy and Survival Study trial were used to estimate utilities
as a function of NYHA classification and number of cardiovascular
rehospitalizations. RESULTS: In multivariate regression analyses
adjusted for age (60 years), female sex and absence of further comorbidities,
utilities for NYHA classes I-IV were 0.90, 0.83, 0.74, and 0.60 (P-value
\< 0.001 for trend). For cardiovascular rehospitalizations 0, 1, 2 and \>or=3, the associated utilities were 0.88, 0.85, 0.84, and 0.82
(P-value \< 0.001 for trend). CONCLUSIONS: NYHA class and number of
cardiovascular rehospitalizations are established proxies for CHF
progression and can be linked to utilities when used as health states
in a Markov model. NYHA class should be used when feasible.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
management strategies, utilities are not currently available for
disease proxies commonly used in Markov models. Our objective was
to estimate utilities for New York Heart Association (NYHA) classification
and number of cardiovascular rehospitalizations. METHODS: EuroQol
5D data from the Eplerenone Post-acute Myocardial Infarction Heart
Failure Efficacy and Survival Study trial were used to estimate utilities
as a function of NYHA classification and number of cardiovascular
rehospitalizations. RESULTS: In multivariate regression analyses
adjusted for age (60 years), female sex and absence of further comorbidities,
utilities for NYHA classes I-IV were 0.90, 0.83, 0.74, and 0.60 (P-value
< 0.001 for trend). For cardiovascular rehospitalizations 0, 1, 2 and >or=3, the associated utilities were 0.88, 0.85, 0.84, and 0.82
(P-value < 0.001 for trend). CONCLUSIONS: NYHA class and number of
cardiovascular rehospitalizations are established proxies for CHF
progression and can be linked to utilities when used as health states
in a Markov model. NYHA class should be used when feasible.
Geisler, Benjamin; Siebert, Uwe; Gazelle, G. Scott; Cohen, D. J.; Goehler, Alexander
Đeterministic sensitivity analysis for first-order Monte Carlo simulations: a technical note Journal Article
In: Value Health, vol. 12, no. 1, pp. 96-7, 2009, ISSN: 1524-4733 (Electronic) 1098-3015, ().
@article{Geisler2009a,
title = {{D}eterministic sensitivity analysis for first-order Monte Carlo simulations:
a technical note},
author = {Benjamin Geisler and Uwe Siebert and G. Scott Gazelle and D. J. Cohen and Alexander Goehler},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18647259},
issn = {1524-4733 (Electronic) 1098-3015},
year = {2009},
date = {2009-00-01},
journal = {Value Health},
volume = {12},
number = {1},
pages = {96-7},
abstract = {OBJECTIVES: Monte Carlo microsimulations have gained increasing popularity
in decision-analytic modeling because they can incorporate discrete
events. Although deterministic sensitivity analyses are essential
for interpretation of results, it remains difficult to combine these
alongside Monte Carlo simulations in standard modeling packages without
enormous time investment. Our purpose was to facilitate one-way deterministic
sensitivity analysis of TreeAge Markov state-transition models requiring
first-order Monte Carlo simulations. METHODS AND RESULTS: Using TreeAge
Pro Suite 2007 and Microsoft Visual Basic for EXCEL, we constructed
a generic script that enables one to perform automated deterministic
one-way sensitivity analyses in EXCEL employing microsimulation models.
In addition, we constructed a generic EXCEL-worksheet that allows
for use of the script with little programming knowledge. CONCLUSIONS:
Linking TreeAge Pro Suite 2007 and Visual Basic enables the performance
of deterministic sensitivity analyses of first-order Monte Carlo
simulations. There are other potentially interesting applications
for automated analysis.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
in decision-analytic modeling because they can incorporate discrete
events. Although deterministic sensitivity analyses are essential
for interpretation of results, it remains difficult to combine these
alongside Monte Carlo simulations in standard modeling packages without
enormous time investment. Our purpose was to facilitate one-way deterministic
sensitivity analysis of TreeAge Markov state-transition models requiring
first-order Monte Carlo simulations. METHODS AND RESULTS: Using TreeAge
Pro Suite 2007 and Microsoft Visual Basic for EXCEL, we constructed
a generic script that enables one to perform automated deterministic
one-way sensitivity analyses in EXCEL employing microsimulation models.
In addition, we constructed a generic EXCEL-worksheet that allows
for use of the script with little programming knowledge. CONCLUSIONS:
Linking TreeAge Pro Suite 2007 and Visual Basic enables the performance
of deterministic sensitivity analyses of first-order Monte Carlo
simulations. There are other potentially interesting applications
for automated analysis.
2008
McMahon, Pamela M.; Kong, Chung Yin; Weinstein, M. C.; Tramontano, Angela; Cipriano, Lauren; Johnson, B. E.; Weeks, J. C.; Gazelle, G. Scott
Adopting helical CT screening for lung cancer: potential health consequences during a 15-year period Journal Article
In: Cancer, vol. 113, no. 12, pp. 3440-9, 2008, ISSN: 0008-543X (Print) 0008-543X (Lin, ().
@article{McMahon2008,
title = {Adopting helical CT screening for lung cancer: potential health consequences during a 15-year period},
author = {Pamela M. McMahon and Chung Yin Kong and M. C. Weinstein and Angela Tramontano and Lauren Cipriano and B. E. Johnson and J. C. Weeks and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18988293},
issn = {0008-543X (Print) 0008-543X (Lin},
year = {2008},
date = {2008-12-01},
urldate = {2008-12-01},
journal = {Cancer},
volume = {113},
number = {12},
pages = {3440-9},
abstract = {BACKGROUND: Simulation modeling can synthesize data from single-arm
studies of lung cancer screening and tumor registries to investigate
computed tomography (CT) screening. This study estimated changes
in lung cancer outcomes through 2005, had chest CT screening been
introduced in 1990. METHODS: Hypothetical individuals with smoking
histories representative of 6 US cohorts (white males and females
aged 50, 60, and 70 years in 1990) were simulated in the Lung Cancer
Policy Model, a comprehensive patient-level simulation model of lung
cancer development, screening, and treatment. A no screening scenario
corresponded to observed outcomes. We simulated 3 screening scenarios in current or former smokers with textgreater or =20 pack-years as
follows: 1-time screen in 1990; and annual, and twice-annually screenings
beginning in 1990 and ending in 2005. Main outcomes were days of
life between 1990 and 2005 and life expectancy in 1990 (estimated
by simulating life histories past 2005). RESULTS: All screening scenarios
yielded reductions (compared with no screening) in lung cancer-specific
mortality by 2005, with larger reductions predicted for more frequent
screening. Compared with no screening, annual screening of ever-smokers
with at least 20 pack-years of cigarette exposure provided ever-smokers
with an additional 11 to 33 days of life by 2005, or an additional
3-10 weeks of (undiscounted) life expectancy. In sensitivity analyses,
the largest effects on gains from annual screening were due to reductions
in screening adherence and increased smoking cessation. CONCLUSIONS:
The adoption of CT screening, had it been available in 1990, might
have resulted in a modest gain in life expectancy.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
studies of lung cancer screening and tumor registries to investigate
computed tomography (CT) screening. This study estimated changes
in lung cancer outcomes through 2005, had chest CT screening been
introduced in 1990. METHODS: Hypothetical individuals with smoking
histories representative of 6 US cohorts (white males and females
aged 50, 60, and 70 years in 1990) were simulated in the Lung Cancer
Policy Model, a comprehensive patient-level simulation model of lung
cancer development, screening, and treatment. A no screening scenario
corresponded to observed outcomes. We simulated 3 screening scenarios in current or former smokers with textgreater or =20 pack-years as
follows: 1-time screen in 1990; and annual, and twice-annually screenings
beginning in 1990 and ending in 2005. Main outcomes were days of
life between 1990 and 2005 and life expectancy in 1990 (estimated
by simulating life histories past 2005). RESULTS: All screening scenarios
yielded reductions (compared with no screening) in lung cancer-specific
mortality by 2005, with larger reductions predicted for more frequent
screening. Compared with no screening, annual screening of ever-smokers
with at least 20 pack-years of cigarette exposure provided ever-smokers
with an additional 11 to 33 days of life by 2005, or an additional
3-10 weeks of (undiscounted) life expectancy. In sensitivity analyses,
the largest effects on gains from annual screening were due to reductions
in screening adherence and increased smoking cessation. CONCLUSIONS:
The adoption of CT screening, had it been available in 1990, might
have resulted in a modest gain in life expectancy.
Pandharipande, Pari; Harisinghani, M. G.; Ozanne, Elissa; Specht, M. C.; Hur, Chin; Lee, Janie; Gazelle, G. Scott
Staging MR lymphangiography of the axilla for early breast cancer: cost-effectiveness analysis Journal Article
In: AJR Am J Roentgenol, vol. 191, no. 5, pp. 1308-19, 2008, ISSN: 1546-3141 (Electronic) 0361-803X, ().
@article{Pandharipande2008,
title = {Staging MR lymphangiography of the axilla for early breast cancer:
cost-effectiveness analysis},
author = {Pari Pandharipande and M. G. Harisinghani and Elissa Ozanne and M. C. Specht and Chin Hur and Janie Lee and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18941062},
issn = {1546-3141 (Electronic) 0361-803X},
year = {2008},
date = {2008-11-01},
journal = {AJR Am J Roentgenol},
volume = {191},
number = {5},
pages = {1308-19},
abstract = {OBJECTIVE: The purpose of this study was to compare the cost-effectiveness
of MR lymphangiography-based strategies with that of sentinel lymph
node (SLN) biopsy alone in the axillary staging of early breast cancer.
MATERIALS AND METHODS: A decision-analytic Markov Model was developed
to estimate quality-adjusted life expectancy and lifetime costs among
61-year-old women with clinically node-negative early breast cancer.
Three axillary staging strategies were compared: MR lymphangiography
alone, combined MR lymphangiography-SLN biopsy, and SLN biopsy alone.
The model incorporated treatment decisions, outcome, and costs consequent
to axillary staging results. An incremental cost-effectiveness analysis
was performed to compare strategies. The effect of changes in key
parameters on results was addressed in sensitivity analysis. RESULTS:
In the base-case analysis, combined MR lymphangiography-SLN biopsy
was associated with the highest quality-adjusted life expectancy
(13.970 years) and cost ($63,582), followed by SLN biopsy alone (13.958
years, $62,462) and MR lymphangiography alone (13.957 years, $61,605).
MR lymphangiography-SLN biopsy and SLN biopsy both were associated
with higher life expectancy and cost relative to those of MR lymphangiography.
MR lymphangiography-SLN biopsy, however, was associated with greater
overall life expectancy and greater added life expectancy per dollar
than was SLN biopsy. SLN biopsy alone therefore was not considered
cost-effective, but MR lymphangiography and MR lymphangiography-SLN
biopsy remained competing choices. Preference of MR lymphangiography
strategies was most dependent on the sensitivity of MR lymphangiography
and SLN biopsy and on the quality-of-life consequences of SLN biopsy
and axillary lymph node dissection, but otherwise was stable across
most parameter ranges tested. CONCLUSION: From a cost-effectiveness
perspective, MR lymphangiography strategies for axillary staging
of early breast cancer are preferred over SLN biopsy alone. The sensitivity
of MR lymphangiography is a critical determinant of the cost-effectiveness
of MR lymphangiography strategies and merits further investigation
in the care of patients with early breast cancer.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
of MR lymphangiography-based strategies with that of sentinel lymph
node (SLN) biopsy alone in the axillary staging of early breast cancer.
MATERIALS AND METHODS: A decision-analytic Markov Model was developed
to estimate quality-adjusted life expectancy and lifetime costs among
61-year-old women with clinically node-negative early breast cancer.
Three axillary staging strategies were compared: MR lymphangiography
alone, combined MR lymphangiography-SLN biopsy, and SLN biopsy alone.
The model incorporated treatment decisions, outcome, and costs consequent
to axillary staging results. An incremental cost-effectiveness analysis
was performed to compare strategies. The effect of changes in key
parameters on results was addressed in sensitivity analysis. RESULTS:
In the base-case analysis, combined MR lymphangiography-SLN biopsy
was associated with the highest quality-adjusted life expectancy
(13.970 years) and cost ($63,582), followed by SLN biopsy alone (13.958
years, $62,462) and MR lymphangiography alone (13.957 years, $61,605).
MR lymphangiography-SLN biopsy and SLN biopsy both were associated
with higher life expectancy and cost relative to those of MR lymphangiography.
MR lymphangiography-SLN biopsy, however, was associated with greater
overall life expectancy and greater added life expectancy per dollar
than was SLN biopsy. SLN biopsy alone therefore was not considered
cost-effective, but MR lymphangiography and MR lymphangiography-SLN
biopsy remained competing choices. Preference of MR lymphangiography
strategies was most dependent on the sensitivity of MR lymphangiography
and SLN biopsy and on the quality-of-life consequences of SLN biopsy
and axillary lymph node dissection, but otherwise was stable across
most parameter ranges tested. CONCLUSION: From a cost-effectiveness
perspective, MR lymphangiography strategies for axillary staging
of early breast cancer are preferred over SLN biopsy alone. The sensitivity
of MR lymphangiography is a critical determinant of the cost-effectiveness
of MR lymphangiography strategies and merits further investigation
in the care of patients with early breast cancer.
Hur, Chin; Broughton, D. E.; Ozanne, Elissa; Yachimski, P.; Nishioka, N. S.; Gazelle, G. Scott
Patient preferences for the chemoprevention of esophageal adenocarcinoma in Barrett's esophagus Journal Article
In: Am J Gastroenterol, vol. 103, no. 10, pp. 2432-42, 2008, ISSN: 1572-0241 (Electronic) 0002-9270, ().
@article{Hur2008a,
title = {Patient preferences for the chemoprevention of esophageal adenocarcinoma
in Barrett's esophagus},
author = {Chin Hur and D. E. Broughton and Elissa Ozanne and P. Yachimski and N. S. Nishioka and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18775019},
issn = {1572-0241 (Electronic) 0002-9270},
year = {2008},
date = {2008-10-01},
journal = {Am J Gastroenterol},
volume = {103},
number = {10},
pages = {2432-42},
abstract = {OBJECTIVES: Although evidence suggests that aspirin and celecoxib
may reduce the risk of esophageal adenocarcinoma (EAC) in patients
with Barrett's esophagus (BE), these drugs can also cause harmful
side effects. Our aim was to determine and characterize preferences
for these two drugs in patients with BE. METHODS: Preferences data
were collected from recruited BE patients using a customized questionnaire,
which incorporated standard risk communication techniques. Summary
profiles outlined the benefits and harms of celecoxib and aspirin
presented anonymously. Both drugs were portrayed as reducing the
risk of EAC and increasing the risk of GI events. However, celecoxib
increased the risk of myocardial infarction (MI) while aspirin reduced
the risk. Factors influencing patient acceptance of each drug were
analyzed. RESULTS: One hundred of 109 (92%) subjects completed the
study. Under base case conditions, 15% stated that they would take
celecoxib and 76% aspirin (P \< 0.0001). Patients identified the greater
risk of MI as the primary reason for their unwillingness to take
celecoxib and the lower risk of EAC for aspirin. Even in scenarios
in which the benefits of celecoxib were improved and the harms reduced,
a majority continued to find it unacceptable. CONCLUSIONS: A majority
of those surveyed stated that they would take aspirin but would not
take celecoxib. Most patients are interested in EAC chemoprevention,
but the amount of protection and the side effect profile of a drug
determine its acceptability. These data can inform physicians regarding
the tradeoffs patients are willing to consider for chemoprevention.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
may reduce the risk of esophageal adenocarcinoma (EAC) in patients
with Barrett's esophagus (BE), these drugs can also cause harmful
side effects. Our aim was to determine and characterize preferences
for these two drugs in patients with BE. METHODS: Preferences data
were collected from recruited BE patients using a customized questionnaire,
which incorporated standard risk communication techniques. Summary
profiles outlined the benefits and harms of celecoxib and aspirin
presented anonymously. Both drugs were portrayed as reducing the
risk of EAC and increasing the risk of GI events. However, celecoxib
increased the risk of myocardial infarction (MI) while aspirin reduced
the risk. Factors influencing patient acceptance of each drug were
analyzed. RESULTS: One hundred of 109 (92%) subjects completed the
study. Under base case conditions, 15% stated that they would take
celecoxib and 76% aspirin (P < 0.0001). Patients identified the greater
risk of MI as the primary reason for their unwillingness to take
celecoxib and the lower risk of EAC for aspirin. Even in scenarios
in which the benefits of celecoxib were improved and the harms reduced,
a majority continued to find it unacceptable. CONCLUSIONS: A majority
of those surveyed stated that they would take aspirin but would not
take celecoxib. Most patients are interested in EAC chemoprevention,
but the amount of protection and the side effect profile of a drug
determine its acceptability. These data can inform physicians regarding
the tradeoffs patients are willing to consider for chemoprevention.
Goehler, Alexander; Conrads-Frank, Annette; Worrell, S. S.; Geisler, Benjamin; Halpern, Elkan F.; Dietz, R.; Anker, S. D.; Gazelle, G. Scott; Siebert, Uwe
Decision-analytic evaluation of the clinical effectiveness and cost-effectiveness of management programmes in chronic heart failure Journal Article
In: Eur J Heart Fail, vol. 10, no. 10, pp. 1026-32, 2008, ISSN: 1388-9842 (Print) 1388-9842 (Lin, ().
@article{Gohler2008,
title = {Decision-analytic evaluation of the clinical effectiveness and cost-effectiveness of management programmes in chronic heart failure},
author = {Alexander Goehler and Annette Conrads-Frank and S. S. Worrell and Benjamin Geisler and Elkan F. Halpern and R. Dietz and S. D. Anker and G. Scott Gazelle and Uwe Siebert},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18760666},
issn = {1388-9842 (Print) 1388-9842 (Lin},
year = {2008},
date = {2008-10-01},
urldate = {2008-10-01},
journal = {Eur J Heart Fail},
volume = {10},
number = {10},
pages = {1026-32},
abstract = {BACKGROUND AND AIMS: While management programmes (MPs) for chronic
heart failure (CHF) are clinically effective, their cost-effectiveness
remains uncertain. Thus, this study sought to determine the cost-effectiveness
of MPs. METHODS AND RESULTS: We developed a Markov model to estimate
life expectancy, quality-adjusted life expectancy, lifetime costs,
and the incremental cost-effectiveness of MPs as compared to standard
care. Standard care was defined by the EuroHeart Failure Survey for
Germany, MP efficacy was derived from our recent meta-analysis and
cost estimates were based on the German healthcare system. For a
population with a mean age 67 years (35% female) at onset of CHF,
our model predicted an average quality-adjusted life expectancy of
2.64 years for standard care and 2.83 years for MP. MP yielded additional
lifetime costs of euro1700 resulting in an incremental cost-utility
ratio (ICUR) of euro8900 (95% CI: dominant to 177,100) per quality-adjusted
life year (QALY) gained. Sensitivity analyses demonstrated that the
ICUR was sensitive to age and sex. CONCLUSION: MPs increase life
expectancy in patients with CHF by an average of 84 days and increase
lifetime cost of care by approximately euro1700. MPs improve outcomes
in a cost-effective manner, although they are not cost-saving on
a lifetime horizon.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
heart failure (CHF) are clinically effective, their cost-effectiveness
remains uncertain. Thus, this study sought to determine the cost-effectiveness
of MPs. METHODS AND RESULTS: We developed a Markov model to estimate
life expectancy, quality-adjusted life expectancy, lifetime costs,
and the incremental cost-effectiveness of MPs as compared to standard
care. Standard care was defined by the EuroHeart Failure Survey for
Germany, MP efficacy was derived from our recent meta-analysis and
cost estimates were based on the German healthcare system. For a
population with a mean age 67 years (35% female) at onset of CHF,
our model predicted an average quality-adjusted life expectancy of
2.64 years for standard care and 2.83 years for MP. MP yielded additional
lifetime costs of euro1700 resulting in an incremental cost-utility
ratio (ICUR) of euro8900 (95% CI: dominant to 177,100) per quality-adjusted
life year (QALY) gained. Sensitivity analyses demonstrated that the
ICUR was sensitive to age and sex. CONCLUSION: MPs increase life
expectancy in patients with CHF by an average of 84 days and increase
lifetime cost of care by approximately euro1700. MPs improve outcomes
in a cost-effective manner, although they are not cost-saving on
a lifetime horizon.
Ladapo, J. A.; Hoffmann, Udo; Bamberg, F.; Nagurney, J. T.; Cutler, D. M.; Weinstein, M. C.; Gazelle, G. Scott
Cost-effectiveness of coronary MDCT in the triage of patients with acute chest pain Journal Article
In: AJR Am J Roentgenol, vol. 191, no. 2, pp. 455-63, 2008, ISSN: 1546-3141 (Electronic) 0361-803X, ().
@article{Ladapo2008,
title = {Cost-effectiveness of coronary MDCT in the triage of patients with
acute chest pain},
author = {J. A. Ladapo and Udo Hoffmann and F. Bamberg and J. T. Nagurney and D. M. Cutler and M. C. Weinstein and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18647917},
issn = {1546-3141 (Electronic) 0361-803X},
year = {2008},
date = {2008-08-01},
journal = {AJR Am J Roentgenol},
volume = {191},
number = {2},
pages = {455-63},
abstract = {OBJECTIVE: Patients at low risk for acute coronary syndrome (ACS)
who present to the emergency department complaining of acute chest
pain place a substantial economic burden on the U.S. health care
system. Noninvasive 64-MDCT coronary angiography may facilitate their
triage, and we evaluated its cost-effectiveness. MATERIALS AND METHODS:
A microsimulation model was developed to compare costs and health
effects of performing CT coronary angiography and either discharging,
stress testing, or referring emergency department patients for invasive
coronary angiography, depending on their severity of atherosclerosis,
compared with a standard-of-care (SOC) algorithm that based management
on biomarkers and stress tests alone. RESULTS: Using CT coronary
angiography to triage 55-year-old men with acute chest pain increased
emergency department and hospital costs by $110 and raised total
health care costs by $200. In 55-year-old women, the technology was
cost-saving; emergency department and hospital costs decreased by
$410, and total health care costs decreased by $380. Compared with
the SOC, CT coronary angiography-based triage extended life expectancy
by 10 days in men and by 6 days in women. This translated into corresponding
improvements of 0.03 quality-adjusted life years (QALYs) and 0.01
QALYs, respectively. The incremental cost-effectiveness ratio for
CT coronary angiography was $6,400 per QALY in men; in women, CT
coronary angiography was cost-saving. Cost-effectiveness ratios were
sensitive to several parameters but generally remained in the range
of what is typically considered cost-effective. CONCLUSION: CT coronary
angiography-based triage for patients with low-risk chest pain is
modestly more effective than the SOC. It is also cost-saving in women
and associated with low cost-effectiveness ratios in men.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
who present to the emergency department complaining of acute chest
pain place a substantial economic burden on the U.S. health care
system. Noninvasive 64-MDCT coronary angiography may facilitate their
triage, and we evaluated its cost-effectiveness. MATERIALS AND METHODS:
A microsimulation model was developed to compare costs and health
effects of performing CT coronary angiography and either discharging,
stress testing, or referring emergency department patients for invasive
coronary angiography, depending on their severity of atherosclerosis,
compared with a standard-of-care (SOC) algorithm that based management
on biomarkers and stress tests alone. RESULTS: Using CT coronary
angiography to triage 55-year-old men with acute chest pain increased
emergency department and hospital costs by $110 and raised total
health care costs by $200. In 55-year-old women, the technology was
cost-saving; emergency department and hospital costs decreased by
$410, and total health care costs decreased by $380. Compared with
the SOC, CT coronary angiography-based triage extended life expectancy
by 10 days in men and by 6 days in women. This translated into corresponding
improvements of 0.03 quality-adjusted life years (QALYs) and 0.01
QALYs, respectively. The incremental cost-effectiveness ratio for
CT coronary angiography was $6,400 per QALY in men; in women, CT
coronary angiography was cost-saving. Cost-effectiveness ratios were
sensitive to several parameters but generally remained in the range
of what is typically considered cost-effective. CONCLUSION: CT coronary
angiography-based triage for patients with low-risk chest pain is
modestly more effective than the SOC. It is also cost-saving in women
and associated with low cost-effectiveness ratios in men.
Lee, Janie; Georgian-Smith, D.; Gazelle, G. Scott; Halpern, Elkan F.; Rafferty, E. A.; Moore, R. H.; Yeh, E. D.; D'Alessandro, H. A.; Hitt, R. A.; Kopans, D. B.
In: Radiology, vol. 248, no. 2, pp. 398-405, 2008, ISSN: 1527-1315 (Electronic) 0033-8419, ().
@article{Lee2008a,
title = {Detecting nonpalpable recurrent breast cancer: the role of routine mammographic screening of transverse rectus abdominis myocutaneous flap reconstructions},
author = {Janie Lee and D. Georgian-Smith and G. Scott Gazelle and Elkan F. Halpern and E. A. Rafferty and R. H. Moore and E. D. Yeh and H. A. D'Alessandro and R. A. Hitt and D. B. Kopans},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18539887},
issn = {1527-1315 (Electronic) 0033-8419},
year = {2008},
date = {2008-08-01},
urldate = {2008-08-01},
journal = {Radiology},
volume = {248},
number = {2},
pages = {398-405},
abstract = {PURPOSE: To perform a retrospective cohort study to determine the
rates of recall and cancer detection and then to develop a decision
analytic model to evaluate the effectiveness of routine screening
of transverse rectus abdominis myocutaneous (TRAM) flap reconstructions.
MATERIALS AND METHODS: This study was approved by the institutional
review board, and the methods comply with HIPAA regulations. A retrospective
search of the institutional mammographic results database was done
to identify bilateral screening mammographic examinations obtained
from January 1, 1999, through July 15, 2005. The search included
the term TRAM; the recall and cancer detetion rates were then detected.
Subsequently, a decision analytic model was constructed to evaluate
a hypothetical cohort of women with TRAM flap reconstructions. RESULTS:
Of 554 mammograms (265 TRAM flap reconstructions), 546 (98.6%) had
negative results (Breast Imaging Reporting and Data System category
1 or 2). Eight (1.4%) had positive test results (Breast Imaging Reporting
and Data System category 0, 3, 4, or 5). All suspicious lesions underwent
biopsy and had benign pathologic results. No interval breast cancers
were identified. The detection rate for nonpalpable recurrent breast
cancer was 0% (exact 95% confidence interval: 0.0%, 1.4%). According
to decision analysis, screening would help detect an estimated 12
additional recurrent cancers per 1000 women screened, providing an
additional 1.6 days of life expectancy for the screened cohort. Under
base-case conditions, screening of TRAM flap reconstructions is less
effective than screening asymptomatic women in their 40s. Sensitivity
analysis revealed that a benefit equivalent to that of screening
asymptomatic women in their 40s was achievable under conditions related
to estimates of screening effectiveness and cancer detection rate.
CONCLUSION: Routine screening mammography of TRAM flap reconstructions
has a very low detection rate for nonpalpable recurrent breast cancer.
Decision analysis indicates that screening such women is less effective
than screening asymptomatic women in their 40s for primary breast
cancer.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
rates of recall and cancer detection and then to develop a decision
analytic model to evaluate the effectiveness of routine screening
of transverse rectus abdominis myocutaneous (TRAM) flap reconstructions.
MATERIALS AND METHODS: This study was approved by the institutional
review board, and the methods comply with HIPAA regulations. A retrospective
search of the institutional mammographic results database was done
to identify bilateral screening mammographic examinations obtained
from January 1, 1999, through July 15, 2005. The search included
the term TRAM; the recall and cancer detetion rates were then detected.
Subsequently, a decision analytic model was constructed to evaluate
a hypothetical cohort of women with TRAM flap reconstructions. RESULTS:
Of 554 mammograms (265 TRAM flap reconstructions), 546 (98.6%) had
negative results (Breast Imaging Reporting and Data System category
1 or 2). Eight (1.4%) had positive test results (Breast Imaging Reporting
and Data System category 0, 3, 4, or 5). All suspicious lesions underwent
biopsy and had benign pathologic results. No interval breast cancers
were identified. The detection rate for nonpalpable recurrent breast
cancer was 0% (exact 95% confidence interval: 0.0%, 1.4%). According
to decision analysis, screening would help detect an estimated 12
additional recurrent cancers per 1000 women screened, providing an
additional 1.6 days of life expectancy for the screened cohort. Under
base-case conditions, screening of TRAM flap reconstructions is less
effective than screening asymptomatic women in their 40s. Sensitivity
analysis revealed that a benefit equivalent to that of screening
asymptomatic women in their 40s was achievable under conditions related
to estimates of screening effectiveness and cancer detection rate.
CONCLUSION: Routine screening mammography of TRAM flap reconstructions
has a very low detection rate for nonpalpable recurrent breast cancer.
Decision analysis indicates that screening such women is less effective
than screening asymptomatic women in their 40s for primary breast
cancer.
Pandharipande, Pari; Gervais, D. A.; Mueller, P. R.; Hur, Chin; Gazelle, G. Scott
Radiofrequency ablation versus nephron-sparing surgery for small unilateral renal cell carcinoma: cost-effectiveness analysis Journal Article
In: Radiology, vol. 248, no. 1, pp. 169-78, 2008, ISSN: 1527-1315 (Electronic) 0033-8419, ().
@article{Pandharipande2008a,
title = {Radiofrequency ablation versus nephron-sparing surgery for small
unilateral renal cell carcinoma: cost-effectiveness analysis},
author = {Pari Pandharipande and D. A. Gervais and P. R. Mueller and Chin Hur and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18458248},
issn = {1527-1315 (Electronic) 0033-8419},
year = {2008},
date = {2008-07-01},
journal = {Radiology},
volume = {248},
number = {1},
pages = {169-78},
abstract = {PURPOSE: To evaluate the relative cost-effectiveness of percutaneous
radiofrequency (RF) ablation versus nephron-sparing surgery (NSS) in patients with small (\<or=4-cm) renal cell carcinoma (RCC), given
a commonly accepted level of societal willingness to pay. MATERIALS
AND METHODS: A decision-analytic Markov model was developed to estimate
life expectancy and lifetime costs for 65-year-old patients with
a small RCC treated with RF ablation or NSS. The model incorporated
RCC presence, treatment effectiveness and costs, and short- and long-term
outcomes. An incremental cost-effectiveness analysis was performed
to identify treatment preference under an assumed $75,000 per quality-adjusted
life-year (QALY) societal willingness-to-pay threshold level, within
proposed ranges for guiding implementation of new health care interventions.
The effect of changes in key parameters on strategy preference was
addressed in sensitivity analysis. RESULTS: By using base-case assumptions,
NSS yielded a minimally greater average quality-adjusted life expectancy
than did RF ablation (2.5 days) but was more expensive. NSS had an
incremental cost-effectiveness ratio of $1,152,529 per QALY relative
to RF ablation, greatly exceeding $75,000 per QALY. Therefore, RF
ablation was considered preferred and remained so if the annual probability
of post-RF ablation local recurrence was up to 48% higher relative
to that post-NSS. NSS preference required an estimated NSS cost reduction
of $7500 or RF ablation cost increase of $6229. Results were robust
to changes in most model parameters, but treatment preference was
dependent on the relative probabilities of local recurrence after
RF ablation and NSS, the short-term costs of both, and quality of
life after NSS. CONCLUSION: RF ablation was preferred over NSS for
small RCC treatment at a societal willingness-to-pay threshold level
of $75,000 per QALY. This result was robust to changes in most model
parameters, but somewhat dependent on the relative probabilities
of post-RF ablation and post-NSS local recurrence, NSS and RF ablation
short-term costs, and post-NSS quality of life, factors which merit
further primary investigation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
radiofrequency (RF) ablation versus nephron-sparing surgery (NSS) in patients with small (<or=4-cm) renal cell carcinoma (RCC), given
a commonly accepted level of societal willingness to pay. MATERIALS
AND METHODS: A decision-analytic Markov model was developed to estimate
life expectancy and lifetime costs for 65-year-old patients with
a small RCC treated with RF ablation or NSS. The model incorporated
RCC presence, treatment effectiveness and costs, and short- and long-term
outcomes. An incremental cost-effectiveness analysis was performed
to identify treatment preference under an assumed $75,000 per quality-adjusted
life-year (QALY) societal willingness-to-pay threshold level, within
proposed ranges for guiding implementation of new health care interventions.
The effect of changes in key parameters on strategy preference was
addressed in sensitivity analysis. RESULTS: By using base-case assumptions,
NSS yielded a minimally greater average quality-adjusted life expectancy
than did RF ablation (2.5 days) but was more expensive. NSS had an
incremental cost-effectiveness ratio of $1,152,529 per QALY relative
to RF ablation, greatly exceeding $75,000 per QALY. Therefore, RF
ablation was considered preferred and remained so if the annual probability
of post-RF ablation local recurrence was up to 48% higher relative
to that post-NSS. NSS preference required an estimated NSS cost reduction
of $7500 or RF ablation cost increase of $6229. Results were robust
to changes in most model parameters, but treatment preference was
dependent on the relative probabilities of local recurrence after
RF ablation and NSS, the short-term costs of both, and quality of
life after NSS. CONCLUSION: RF ablation was preferred over NSS for
small RCC treatment at a societal willingness-to-pay threshold level
of $75,000 per QALY. This result was robust to changes in most model
parameters, but somewhat dependent on the relative probabilities
of post-RF ablation and post-NSS local recurrence, NSS and RF ablation
short-term costs, and post-NSS quality of life, factors which merit
further primary investigation.
McMahon, Pamela M.; Kong, Chung Yin; Johnson, B. E.; Weinstein, M. C.; Weeks, J. C.; Kuntz, K. M.; Shepard, J. A.; Swensen, S. J.; Gazelle, G. Scott
Estimating long-term effectiveness of lung cancer screening in the Mayo CT screening study Journal Article
In: Radiology, vol. 248, no. 1, pp. 278-87, 2008, ISSN: 1527-1315 (Electronic) 0033-8419, ().
@article{McMahon2008a,
title = {Estimating long-term effectiveness of lung cancer screening in the Mayo CT screening study},
author = {Pamela M. McMahon and Chung Yin Kong and B. E. Johnson and M. C. Weinstein and J. C. Weeks and K. M. Kuntz and J. A. Shepard and S. J. Swensen and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18458247},
issn = {1527-1315 (Electronic) 0033-8419},
year = {2008},
date = {2008-07-01},
urldate = {2008-07-01},
journal = {Radiology},
volume = {248},
number = {1},
pages = {278-87},
abstract = {PURPOSE: To use individual-level data provided from the single-arm
study of helical computed tomographic (CT) screening at the Mayo
Clinic (Rochester, Minn) to estimate the long-term effectiveness
of screening in Mayo study participants and to compare estimates
from an existing lung cancer simulation model with estimates from
a different modeling approach that used the same data. MATERIALS
AND METHODS: The study was approved by institutional review boards
and was HIPAA compliant. Deidentified individual-level data from
participants (1520 current or former smokers aged 50-85 years) in
the Mayo Clinic helical CT screening study were used to populate
the Lung Cancer Policy Model, a comprehensive microsimulation model
of lung cancer development, screening findings, treatment results,
and long-term outcomes. The model predicted diagnosed cases of lung
cancer and deaths per simulated study arm (five annual screening
examinations vs no screening). Main outcome measures were predicted
changes in lung cancer-specific and all-cause mortality as functions
of follow-up time after simulated enrollment and randomization. RESULTS:
At 6-year follow-up, the screening arm had an estimated 37% relative
increase in lung cancer detection, compared with the control arm.
At 15-year follow-up, five annual screening examinations yielded
a 9% relative increase in lung cancer detection. The relative reduction
in cumulative lung cancer-specific mortality from five annual screening
examinations was 28% at 6-year follow-up (15% at 15 years). The relative
reduction in cumulative all-cause mortality from five annual screening
examinations was 4% at 6-year follow-up (2% at 15 years). CONCLUSION:
Screening may reduce lung cancer-specific mortality but may offer
a smaller reduction in overall mortality because of increased competing
mortality risks associated with smoking.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
study of helical computed tomographic (CT) screening at the Mayo
Clinic (Rochester, Minn) to estimate the long-term effectiveness
of screening in Mayo study participants and to compare estimates
from an existing lung cancer simulation model with estimates from
a different modeling approach that used the same data. MATERIALS
AND METHODS: The study was approved by institutional review boards
and was HIPAA compliant. Deidentified individual-level data from
participants (1520 current or former smokers aged 50-85 years) in
the Mayo Clinic helical CT screening study were used to populate
the Lung Cancer Policy Model, a comprehensive microsimulation model
of lung cancer development, screening findings, treatment results,
and long-term outcomes. The model predicted diagnosed cases of lung
cancer and deaths per simulated study arm (five annual screening
examinations vs no screening). Main outcome measures were predicted
changes in lung cancer-specific and all-cause mortality as functions
of follow-up time after simulated enrollment and randomization. RESULTS:
At 6-year follow-up, the screening arm had an estimated 37% relative
increase in lung cancer detection, compared with the control arm.
At 15-year follow-up, five annual screening examinations yielded
a 9% relative increase in lung cancer detection. The relative reduction
in cumulative lung cancer-specific mortality from five annual screening
examinations was 28% at 6-year follow-up (15% at 15 years). The relative
reduction in cumulative all-cause mortality from five annual screening
examinations was 4% at 6-year follow-up (2% at 15 years). CONCLUSION:
Screening may reduce lung cancer-specific mortality but may offer
a smaller reduction in overall mortality because of increased competing
mortality risks associated with smoking.
Lee, Janie; Kopans, D. B.; McMahon, Pamela M.; Halpern, Elkan F.; Ryan, P. D.; Weinstein, M. C.; Gazelle, G. Scott
Breast cancer screening in BRCA1 mutation carriers: effectiveness of MR imaging--Markov Monte Carlo decision analysis Journal Article
In: Radiology, vol. 246, pp. 763-71, 2008, ().
@article{Lee2008,
title = {Breast cancer screening in BRCA1 mutation carriers: effectiveness
of MR imaging--Markov Monte Carlo decision analysis},
author = {Janie Lee and D. B. Kopans and Pamela M. McMahon and Elkan F. Halpern and P. D. Ryan and M. C. Weinstein and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18309013},
year = {2008},
date = {2008-01-01},
journal = {Radiology},
volume = {246},
pages = {763-71},
abstract = {PURPOSE: To project intermediate and long-term clinical outcomes of
magnetic resonance (MR) imaging screening for breast cancer in women
with BRCA1 gene mutations. MATERIALS AND METHODS: A microsimulation
model was developed to compare three annual screening strategies
versus clinical surveillance: (a) mammography, (b) MR imaging, and
(c) combined MR imaging and mammography. Input parameters were obtained
from the published medical literature, existing databases, and expert
opinion. The model was calibrated to targets from the Surveillance
Epidemiology and End Results database (1975-1980) compiled during
a period prior to the onset of widespread mammographic screening.
Sensitivity analysis was performed to evaluate the effect of uncertainty
in parameter estimates. RESULTS: With clinical surveillance, the
estimated median diameter of invasive breast cancers at presentation
was 2.6 cm. Average life expectancy was 71.15 years. With annual
screening with mammography, MR imaging, or combined mammography and
MR imaging, median invasive tumor diameters at diagnosis decreased
to 1.9, 1.3, and 1.1 cm, respectively. Annual screening with mammography,
MR imaging, or combined mammography and MR imaging increased average
life expectancy by 0.80 year, 1.10 years, and 1.38 years, respectively,
and decreased relative mortality from breast cancer (16.8 17.2 and
22.0 respectively). Program sensitivity was greater than 50% only
with MR imaging screening strategies. The majority of women undergoing
screening had one or more false-positive screening examinations (53.8
80.2 and 84.0% for mammography, MR imaging, and combined mammography
and MR imaging, respectively). Many women also underwent one or more
biopsies for benign disease (11.3 26.3 and 30.3 respectively). Results
were sensitive to BRCA1 penetrance estimates and to MR imaging sensitivity
in the detection of ductal carcinoma in situ. CONCLUSION: Annual
screening with combined mammography and MR imaging provides BRCA1
mutation carriers with the greatest life expectancy gain and breast
cancer mortality reduction. However, an important trade-off of this
strategy is an increased rate of false-positive screening results
and biopsies performed for benign disease.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
magnetic resonance (MR) imaging screening for breast cancer in women
with BRCA1 gene mutations. MATERIALS AND METHODS: A microsimulation
model was developed to compare three annual screening strategies
versus clinical surveillance: (a) mammography, (b) MR imaging, and
(c) combined MR imaging and mammography. Input parameters were obtained
from the published medical literature, existing databases, and expert
opinion. The model was calibrated to targets from the Surveillance
Epidemiology and End Results database (1975-1980) compiled during
a period prior to the onset of widespread mammographic screening.
Sensitivity analysis was performed to evaluate the effect of uncertainty
in parameter estimates. RESULTS: With clinical surveillance, the
estimated median diameter of invasive breast cancers at presentation
was 2.6 cm. Average life expectancy was 71.15 years. With annual
screening with mammography, MR imaging, or combined mammography and
MR imaging, median invasive tumor diameters at diagnosis decreased
to 1.9, 1.3, and 1.1 cm, respectively. Annual screening with mammography,
MR imaging, or combined mammography and MR imaging increased average
life expectancy by 0.80 year, 1.10 years, and 1.38 years, respectively,
and decreased relative mortality from breast cancer (16.8 17.2 and
22.0 respectively). Program sensitivity was greater than 50% only
with MR imaging screening strategies. The majority of women undergoing
screening had one or more false-positive screening examinations (53.8
80.2 and 84.0% for mammography, MR imaging, and combined mammography
and MR imaging, respectively). Many women also underwent one or more
biopsies for benign disease (11.3 26.3 and 30.3 respectively). Results
were sensitive to BRCA1 penetrance estimates and to MR imaging sensitivity
in the detection of ductal carcinoma in situ. CONCLUSION: Annual
screening with combined mammography and MR imaging provides BRCA1
mutation carriers with the greatest life expectancy gain and breast
cancer mortality reduction. However, an important trade-off of this
strategy is an increased rate of false-positive screening results
and biopsies performed for benign disease.
Pearson, Steven; Knudsen, Amy; Scherer, R. W.; Weissberg, J.; Gazelle, G. Scott
Assessing the comparative effectiveness of a diagnostic technology: CT colonography Journal Article
In: Health Aff (Millwood), vol. 27, no. 6, pp. 1503-14, 2008, ISSN: 1544-5208 (Electronic) 0278-2715, ().
@article{Pearson2008a,
title = {Assessing the comparative effectiveness of a diagnostic technology: CT colonography},
author = {Steven Pearson and Amy Knudsen and R. W. Scherer and J. Weissberg and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18997205},
issn = {1544-5208 (Electronic) 0278-2715},
year = {2008},
date = {2008-00-01},
urldate = {2008-00-01},
journal = {Health Aff (Millwood)},
volume = {27},
number = {6},
pages = {1503-14},
abstract = {Medical imaging is a prime example of an innovation that has brought
important advances to medical care while triggering concerns about
potential overuse and excessive costs. Many hopes are riding on comparative
effectiveness research to help guide better decision making to improve
quality and value. But the dynamic nature of medical imaging poses
challenges for the traditional paradigms of evidentiary review and
analysis at the heart of comparative effectiveness. This paper discusses
these challenges and presents policy lessons for manufacturers, evidence
reviewers, and decisionmakers, illustrated by an assessment of a
prominent emerging imaging technique: computed tomography (CT) colonography.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
important advances to medical care while triggering concerns about
potential overuse and excessive costs. Many hopes are riding on comparative
effectiveness research to help guide better decision making to improve
quality and value. But the dynamic nature of medical imaging poses
challenges for the traditional paradigms of evidentiary review and
analysis at the heart of comparative effectiveness. This paper discusses
these challenges and presents policy lessons for manufacturers, evidence
reviewers, and decisionmakers, illustrated by an assessment of a
prominent emerging imaging technique: computed tomography (CT) colonography.
2007
Gazelle, G. Scott; Halpern, Elkan F.; Ryan, H. S.; Tramontano, Angela
Utilization of diagnostic medical imaging: comparison of radiologist referral versus same-specialty referral Journal Article
In: Radiology, vol. 245, no. 2, pp. 517-22, 2007, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Gazelle2007,
title = {Utilization of diagnostic medical imaging: comparison of radiologist referral versus same-specialty referral},
author = {G. Scott Gazelle and Elkan F. Halpern and H. S. Ryan and Angela Tramontano},
url = {http://www.ncbi.nlm.nih.gov/pubmed/17940306},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2007},
date = {2007-11-01},
urldate = {2007-11-01},
journal = {Radiology},
volume = {245},
number = {2},
pages = {517-22},
abstract = {PURPOSE: To retrospectively compare the frequency with which patients
underwent diagnostic medical imaging procedures during episodes of
outpatient medical care according to whether their physicians referred
patients for imaging to themselves and/or physicians in their same
specialty or to radiologists. MATERIALS AND METHODS: Institutional
review board approval was not necessary for this HIPAA-compliant
study. An insurance claims database from a large national employer-based
health plan was obtained. Claims data from 1999-2003 were grouped
into episodes of care for six conditions: cardiopulmonary disease,
coronary and/or cardiac disease, extremity fracture, knee pain, intraabdominal
malignancy, and stroke. For each condition, each referring physician's
behavior was categorized as either "same-specialty referral" or "radiologist
referral" on the basis of that physician's entire history of imaging
referrals for the condition. The frequency with which patients underwent
diagnostic medical imaging procedures during episodes of care was
compared according to whether their physicians referred patients
for imaging to themselves and/or same-specialty physicians or to
radiologists. Rates were compared by using chi(2) tests, and logistic
regression was used to compare utilization rates, with patient age
and number of comorbidities as covariates. RESULTS: For the conditions
evaluated, physicians who referred patients to themselves or to other
same-specialty physicians for diagnostic imaging used imaging between
1.12 and 2.29 times as often, per episode of care, as physicians
who referred patients to radiologists (P \< .005 for all comparisons).
Adjusting for patient age and comorbidity, the likelihood of imaging
was 1.196-3.228 times greater for patients cared forby same-specialty-referring
physicians. CONCLUSION: Same-specialty-referring physicians tend
to utilize imaging more frequently than do physicians who refer their
patients to radiologists. These results cannot be explained by differences
in case mix (because analyses were performed within six specific
conditions of interest), patient age, or comorbidity.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
underwent diagnostic medical imaging procedures during episodes of
outpatient medical care according to whether their physicians referred
patients for imaging to themselves and/or physicians in their same
specialty or to radiologists. MATERIALS AND METHODS: Institutional
review board approval was not necessary for this HIPAA-compliant
study. An insurance claims database from a large national employer-based
health plan was obtained. Claims data from 1999-2003 were grouped
into episodes of care for six conditions: cardiopulmonary disease,
coronary and/or cardiac disease, extremity fracture, knee pain, intraabdominal
malignancy, and stroke. For each condition, each referring physician's
behavior was categorized as either "same-specialty referral" or "radiologist
referral" on the basis of that physician's entire history of imaging
referrals for the condition. The frequency with which patients underwent
diagnostic medical imaging procedures during episodes of care was
compared according to whether their physicians referred patients
for imaging to themselves and/or same-specialty physicians or to
radiologists. Rates were compared by using chi(2) tests, and logistic
regression was used to compare utilization rates, with patient age
and number of comorbidities as covariates. RESULTS: For the conditions
evaluated, physicians who referred patients to themselves or to other
same-specialty physicians for diagnostic imaging used imaging between
1.12 and 2.29 times as often, per episode of care, as physicians
who referred patients to radiologists (P < .005 for all comparisons).
Adjusting for patient age and comorbidity, the likelihood of imaging
was 1.196-3.228 times greater for patients cared forby same-specialty-referring
physicians. CONCLUSION: Same-specialty-referring physicians tend
to utilize imaging more frequently than do physicians who refer their
patients to radiologists. These results cannot be explained by differences
in case mix (because analyses were performed within six specific
conditions of interest), patient age, or comorbidity.
Stahl, James; Goldman, J. M.; Rattner, D. W.; Gazelle, G. Scott
Adapting to a new system of surgical technologies and perioperative processes among clinicians Journal Article
In: J Surg Res, vol. 139, pp. 61-7, 2007, ().
@article{Stahl2007a,
title = {Adapting to a new system of surgical technologies and perioperative processes among clinicians},
author = {James Stahl and J. M. Goldman and D. W. Rattner and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/17275033},
year = {2007},
date = {2007-01-01},
urldate = {2007-01-01},
journal = {J Surg Res},
volume = {139},
pages = {61-7},
abstract = {PURPOSE: To understand learning and adaptation to a new system of
surgical technologies and perioperative processes. METHODS: Patient
wait time, flow time, and surgery procedure time were recorded in
the experimental ("Operating room of the future" or ORF) and control
ORs over the first year of the ORF's operation. Regression methods
were used to examine factors hypothesized to influence performance.
RESULTS: Flow time, wait time, and surgery procedure time for each
case decreased significantly in the ORF. The ORF performance demonstrated
an initial overshoot followed by oscillation with 30-40 d period
around the group mean. Similar behavior was observed for surgeons if they had textgreateror=2-week hiatus from operating and had an
average caseload more than 2.1 cases/week. Regression models using hypothesized learning factors predicted flow time (R(2)=0.33) and wait time (R(2)=0.36); adding procedure type to these models raised
R(2) to 0.7 and 0.57, respectively. CONCLUSIONS: Objective observation
of system performance in which a new technology is introduced can
provide insights into adaptation and may have significant implications
for OR scheduling, training, and cost-effectiveness evaluations.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
surgical technologies and perioperative processes. METHODS: Patient
wait time, flow time, and surgery procedure time were recorded in
the experimental ("Operating room of the future" or ORF) and control
ORs over the first year of the ORF's operation. Regression methods
were used to examine factors hypothesized to influence performance.
RESULTS: Flow time, wait time, and surgery procedure time for each
case decreased significantly in the ORF. The ORF performance demonstrated
an initial overshoot followed by oscillation with 30-40 d period
around the group mean. Similar behavior was observed for surgeons if they had textgreateror=2-week hiatus from operating and had an
average caseload more than 2.1 cases/week. Regression models using hypothesized learning factors predicted flow time (R(2)=0.33) and wait time (R(2)=0.36); adding procedure type to these models raised
R(2) to 0.7 and 0.57, respectively. CONCLUSIONS: Objective observation
of system performance in which a new technology is introduced can
provide insights into adaptation and may have significant implications
for OR scheduling, training, and cost-effectiveness evaluations.
Stahl, James; Vacanti, J. P.; Gazelle, G. Scott
Assessing emerging technologies--the case of organ replacement technologies: volume, durability, cost Journal Article
In: Int J Technol Assess Health Care, vol. 23, pp. 331-6, 2007, ().
@article{Stahl2007,
title = {Assessing emerging technologies--the case of organ replacement technologies: volume, durability, cost},
author = {James Stahl and J. P. Vacanti and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/17579935},
year = {2007},
date = {2007-01-01},
urldate = {2007-01-01},
journal = {Int J Technol Assess Health Care},
volume = {23},
pages = {331-6},
abstract = {OBJECTIVES: The aim of this study was to estimate thresholds for production
volume, durability, and cost of care for the cost-effective adoption
of liver organ replacement technologies (ORTs). METHODS: We constructed
a discrete-event simulation model of the liver allocation system
in the United States. The model was calibrated against UNOS data
(1994-2000). Into this model, we introduced ORTs with varying durability
(time to failure), cost of care, and production volume. Primary outputs
of interest were time to 5 percent reduction in the waiting list
and time to 5 percent increase in expected transplant volume. RESULTS:
Model output for both calibration and validation phases closely matched
published data: waiting list length (+/-2 percent), number of transplants
(+/-2 percent), deaths while waiting (+/-5 percent), and time to
transplant (+/-11 percent). Reducing the waiting list was dependent
on both ORT durability and production volume. The longer the durability,
the less production volume needed to reduce the waiting list and
vice versa. However, below 250 ORT/year, durability needed to be
textgreater2 years for any significant change to be seen in the waiting
list. For base-case costs, all ORT production volume and durability
scenarios result in more transplants per year at less total cost
of care/patient than the current system. ORTs remain cost saving
until manufacturing costs are textgreater5 times base-case costs,
production is less 500 ORT/year, and durability textless6 months.
CONCLUSIONS: Although there remain many technical challenges to overcome,
as long as ORTs can meet these threshold criteria, they have the
potential of transforming the world of end-stage liver disease.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
volume, durability, and cost of care for the cost-effective adoption
of liver organ replacement technologies (ORTs). METHODS: We constructed
a discrete-event simulation model of the liver allocation system
in the United States. The model was calibrated against UNOS data
(1994-2000). Into this model, we introduced ORTs with varying durability
(time to failure), cost of care, and production volume. Primary outputs
of interest were time to 5 percent reduction in the waiting list
and time to 5 percent increase in expected transplant volume. RESULTS:
Model output for both calibration and validation phases closely matched
published data: waiting list length (+/-2 percent), number of transplants
(+/-2 percent), deaths while waiting (+/-5 percent), and time to
transplant (+/-11 percent). Reducing the waiting list was dependent
on both ORT durability and production volume. The longer the durability,
the less production volume needed to reduce the waiting list and
vice versa. However, below 250 ORT/year, durability needed to be
textgreater2 years for any significant change to be seen in the waiting
list. For base-case costs, all ORT production volume and durability
scenarios result in more transplants per year at less total cost
of care/patient than the current system. ORTs remain cost saving
until manufacturing costs are textgreater5 times base-case costs,
production is less 500 ORT/year, and durability textless6 months.
CONCLUSIONS: Although there remain many technical challenges to overcome,
as long as ORTs can meet these threshold criteria, they have the
potential of transforming the world of end-stage liver disease.
Hur, Chin; Chung, D. C.; Schoen, R. E.; Gazelle, G. Scott
The management of small polyps found by virtual colonoscopy: results of a decision analysis Journal Article
In: Clin Gastroenterol Hepatol, vol. 5, pp. 237-44, 2007, ().
@article{Hur2007,
title = {The management of small polyps found by virtual colonoscopy: results of a decision analysis},
author = {Chin Hur and D. C. Chung and R. E. Schoen and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/17296532},
year = {2007},
date = {2007-01-01},
urldate = {2007-01-01},
journal = {Clin Gastroenterol Hepatol},
volume = {5},
pages = {237-44},
abstract = {BACKGROUND \& AIMS: There is a firm consensus that larger (textgreater or =10 mm) colonic polyps should be removed; however, the importance
of removing smaller polyps (textless10 mm) is more controversial.
If computed tomographic colonography (CTC) is used for colorectal
cancer screening, the majority of polypoid lesions identified will
be less than 10 mm in size. Decision-analytic techniques were used
to compare the outcomes of 2 management strategies for smaller (6-9
mm) polyps discovered by CTC. METHODS: Hypothetic average-risk patients
who had undergone a CTC examination and found to have a small (6-9
mm) polyp were simulated to either: (1) undergo immediate colonoscopy
for polypectomy (COLO), or (2) wait 3 years for a repeat CTC examination
(WAIT). A Markov model was constructed to analyze outcomes including
the number of deaths and cancers after a 3-year follow-up period
or time horizon. Values for the model parameters were derived from
the published literature and from Surveillance Epidemiology and End
Results data, and an extensive sensitivity analysis was performed.
RESULTS: The COLO strategy resulted in 14 total deaths per 100,000
patients compared with 79 total deaths in the WAIT strategy, for
a difference of 65 deaths. The COLO strategy resulted in 39 cancers
per 100,000 patients vs 773 in the WAIT strategy, for a difference
of 734 cancers. Sensitivity analysis found that model findings were
robust and only sensitive at extreme parameter values. CONCLUSIONS:
Managing smaller polyps detected on a screening CTC with another
CTC examination 3 years later likely will result in more deaths and
cancers than immediate colonoscopy and polypectomy.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
of removing smaller polyps (textless10 mm) is more controversial.
If computed tomographic colonography (CTC) is used for colorectal
cancer screening, the majority of polypoid lesions identified will
be less than 10 mm in size. Decision-analytic techniques were used
to compare the outcomes of 2 management strategies for smaller (6-9
mm) polyps discovered by CTC. METHODS: Hypothetic average-risk patients
who had undergone a CTC examination and found to have a small (6-9
mm) polyp were simulated to either: (1) undergo immediate colonoscopy
for polypectomy (COLO), or (2) wait 3 years for a repeat CTC examination
(WAIT). A Markov model was constructed to analyze outcomes including
the number of deaths and cancers after a 3-year follow-up period
or time horizon. Values for the model parameters were derived from
the published literature and from Surveillance Epidemiology and End
Results data, and an extensive sensitivity analysis was performed.
RESULTS: The COLO strategy resulted in 14 total deaths per 100,000
patients compared with 79 total deaths in the WAIT strategy, for
a difference of 65 deaths. The COLO strategy resulted in 39 cancers
per 100,000 patients vs 773 in the WAIT strategy, for a difference
of 734 cancers. Sensitivity analysis found that model findings were
robust and only sensitive at extreme parameter values. CONCLUSIONS:
Managing smaller polyps detected on a screening CTC with another
CTC examination 3 years later likely will result in more deaths and
cancers than immediate colonoscopy and polypectomy.
Knudsen, Amy; McMahon, Pamela M.; Gazelle, G. Scott
Use of modeling to evaluate the cost-effectiveness of cancer screening programs Journal Article
In: J Clin Oncol, vol. 25, pp. 203-8, 2007, ().
@article{Knudsen2007,
title = {Use of modeling to evaluate the cost-effectiveness of cancer screening programs},
author = {Amy Knudsen and Pamela M. McMahon and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/17210941},
year = {2007},
date = {2007-01-01},
urldate = {2007-01-01},
journal = {J Clin Oncol},
volume = {25},
pages = {203-8},
abstract = {Cost-effectiveness analysis (CEA) is an analytic tool that provides
a framework for comparing the health benefits and resource expenditures
associated with competing medical and public health interventions,
thereby allowing decision makers to identify interventions that yield
the greatest amount of health, given their resource constraints.
Models are important components of most, if not all, CEAs, and they
play a key role in evaluating the cost-effectiveness of cancer screening
programs, in particular. In this article, we describe the basic types
of models used to evaluate cancer screening programs and provide
examples of the use of models in CEAs and to guide cancer screening
policy. Finally, we offer some suggestions for important concepts
to consider when interpreting model results.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
a framework for comparing the health benefits and resource expenditures
associated with competing medical and public health interventions,
thereby allowing decision makers to identify interventions that yield
the greatest amount of health, given their resource constraints.
Models are important components of most, if not all, CEAs, and they
play a key role in evaluating the cost-effectiveness of cancer screening
programs, in particular. In this article, we describe the basic types
of models used to evaluate cancer screening programs and provide
examples of the use of models in CEAs and to guide cancer screening
policy. Finally, we offer some suggestions for important concepts
to consider when interpreting model results.
2006
Goehler, Alexander; Januzzi, J. L.; Worrell, S. S.; Osterziel, K. J.; Gazelle, G. Scott; Dietz, R.; Siebert, Uwe
A systematic meta-analysis of the efficacy and heterogeneity of disease management programs in congestive heart failure Journal Article
In: J Card Fail, vol. 12, no. 7, pp. 554-67, 2006, ISSN: 1532-8414 (Electronic) 1071-9164, ().
@article{Gohler2006,
title = {A systematic meta-analysis of the efficacy and heterogeneity of disease management programs in congestive heart failure},
author = {Alexander Goehler and J. L. Januzzi and S. S. Worrell and K. J. Osterziel and G. Scott Gazelle and R. Dietz and Uwe Siebert},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16952790},
issn = {1532-8414 (Electronic) 1071-9164},
year = {2006},
date = {2006-09-01},
urldate = {2006-09-01},
journal = {J Card Fail},
volume = {12},
number = {7},
pages = {554-67},
abstract = {BACKGROUND: We sought to systematically combine the evidence on efficacy
of disease management programs (DMPs) in the treatment of congestive
heart failure (CHF), to identify and explain heterogeneity of results
from prior studies of DMPs, and to assess potential publication bias
from these studies. METHODS AND RESULTS: We conducted a systematic
literature search on randomized clinical trials investigating the
effect of DMPs on CHF outcomes and performed meta-analyses and meta-regressions
comparing DMPs and standard care for mortality and rehospitalization.
We included 36 studies from 13 different countries (with data from
8341 patients). Our meta-analysis yielded a pooled risk difference
of 3% (95% confidence interval [CI] 1-6%, P \< .01) for mortality
and of 8% (95% CI 5-11%, P \< .0001) for rehospitalization, both favoring
DMP. Factors explaining heterogeneity between studies included severity
of disease, proportion of beta-blocker at baseline, country, duration
of follow-up, and mode of postdischarge contact. No statistically
significant publication bias was detected. CONCLUSION: DMPs have
the potential to reduce morbidity and mortality for patients with
CHF. The benefit of the intervention depends on age, severity of
disease, guideline-based treatment at baseline, and DMP modalities.
Future studies should directly compare the effect of different aspects
of disease management programs for different populations.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
of disease management programs (DMPs) in the treatment of congestive
heart failure (CHF), to identify and explain heterogeneity of results
from prior studies of DMPs, and to assess potential publication bias
from these studies. METHODS AND RESULTS: We conducted a systematic
literature search on randomized clinical trials investigating the
effect of DMPs on CHF outcomes and performed meta-analyses and meta-regressions
comparing DMPs and standard care for mortality and rehospitalization.
We included 36 studies from 13 different countries (with data from
8341 patients). Our meta-analysis yielded a pooled risk difference
of 3% (95% confidence interval [CI] 1-6%, P < .01) for mortality
and of 8% (95% CI 5-11%, P < .0001) for rehospitalization, both favoring
DMP. Factors explaining heterogeneity between studies included severity
of disease, proportion of beta-blocker at baseline, country, duration
of follow-up, and mode of postdischarge contact. No statistically
significant publication bias was detected. CONCLUSION: DMPs have
the potential to reduce morbidity and mortality for patients with
CHF. The benefit of the intervention depends on age, severity of
disease, guideline-based treatment at baseline, and DMP modalities.
Future studies should directly compare the effect of different aspects
of disease management programs for different populations.
Siegel, C. A.; Hur, Chin; Korzenik, J. R.; Gazelle, G. Scott; Sands, B. E.
Risks and benefits of infliximab for the treatment of Crohn's disease Journal Article
In: Clin Gastroenterol Hepatol, vol. 4, no. 8, pp. 1017-24; quiz 976, 2006, ISSN: 1542-3565 (Print) 1542-3565 (Lin, ().
@article{Siegel2006,
title = {Risks and benefits of infliximab for the treatment of Crohn's disease},
author = {C. A. Siegel and Chin Hur and J. R. Korzenik and G. Scott Gazelle and B. E. Sands},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16843733},
issn = {1542-3565 (Print) 1542-3565 (Lin},
year = {2006},
date = {2006-08-01},
journal = {Clin Gastroenterol Hepatol},
volume = {4},
number = {8},
pages = {1017-24; quiz 976},
abstract = {BACKGROUND \& AIMS: Infliximab is effective for the treatment of active
Crohn's disease. However, rare but serious complications related
to infliximab therapy including lymphoma, sepsis, and death have
been reported. The purpose of this study was to analyze the risks
and benefits of infliximab for the treatment of Crohn's disease with
the goal of providing data to aid both physicians and patients in
the process of making a decision about treatment. METHODS: A decision
analytic model was constructed to determine the risks and benefits
of infliximab when compared with standard therapy. The analysis simulated
2 cohorts of 100,000 patients each, with one arm receiving infliximab
while the other remained on standard therapy. RESULTS: Model results
showed that in 100,000 patients at 1 year, infliximab will lead to
12,216 more patients in remission, 4255 fewer surgeries, and 33 fewer
deaths from flares of disease. This is at the cost of 201 more lymphomas
and 249 more deaths related to complications from infliximab. Overall,
the infliximab strategy resulted in more quality-adjusted life years
(QALYs/patient) than the standard therapy strategy (.77 QALYs/patient
vs .75 QALYs/patient). CONCLUSIONS: Despite an increased risk of
lymphoma and death associated with use of infliximab, the substantial
clinical improvement and fewer surgeries as a result of infliximab
result in an increase in QALYs. In properly selected patients, the
benefits of infliximab could outweigh its risks. These data should
help guide decision making and the informed consent process when
considering the use of infliximab for the treatment of Crohn's disease.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Crohn's disease. However, rare but serious complications related
to infliximab therapy including lymphoma, sepsis, and death have
been reported. The purpose of this study was to analyze the risks
and benefits of infliximab for the treatment of Crohn's disease with
the goal of providing data to aid both physicians and patients in
the process of making a decision about treatment. METHODS: A decision
analytic model was constructed to determine the risks and benefits
of infliximab when compared with standard therapy. The analysis simulated
2 cohorts of 100,000 patients each, with one arm receiving infliximab
while the other remained on standard therapy. RESULTS: Model results
showed that in 100,000 patients at 1 year, infliximab will lead to
12,216 more patients in remission, 4255 fewer surgeries, and 33 fewer
deaths from flares of disease. This is at the cost of 201 more lymphomas
and 249 more deaths related to complications from infliximab. Overall,
the infliximab strategy resulted in more quality-adjusted life years
(QALYs/patient) than the standard therapy strategy (.77 QALYs/patient
vs .75 QALYs/patient). CONCLUSIONS: Despite an increased risk of
lymphoma and death associated with use of infliximab, the substantial
clinical improvement and fewer surgeries as a result of infliximab
result in an increase in QALYs. In properly selected patients, the
benefits of infliximab could outweigh its risks. These data should
help guide decision making and the informed consent process when
considering the use of infliximab for the treatment of Crohn's disease.
Stahl, James; Sandberg, W. S.; Daily, B.; Wiklund, R.; Egan, M. T.; Goldman, J. M.; Isaacson, K. B.; Gazelle, G. Scott; Rattner, D. W.
Reorganizing patient care and workflow in the operating room: a cost-effectiveness study Journal Article
In: Surgery, vol. 139, no. 6, pp. 717-28, 2006, ISSN: 0039-6060 (Print) 0039-6060 (Lin, ().
@article{Stahl2006,
title = {Reorganizing patient care and workflow in the operating room: a cost-effectiveness study},
author = {James Stahl and W. S. Sandberg and B. Daily and R. Wiklund and M. T. Egan and J. M. Goldman and K. B. Isaacson and G. Scott Gazelle and D. W. Rattner},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16782425},
issn = {0039-6060 (Print) 0039-6060 (Lin},
year = {2006},
date = {2006-06-01},
journal = {Surgery},
volume = {139},
number = {6},
pages = {717-28},
abstract = {BACKGROUND: Many surgeons believe that long turnover times between
cases are a major impediment to their productivity. We hypothesized
that redesigning the operating room (OR) and perioperative-staffing
system to take advantage of parallel processing would improve throughput
and lower the cost of care. METHODS: A state of the art high tech
OR suite equipped with augmented data collection systems served as
a living laboratory to evaluate both new devices and perioperative
systems of care. The OR suite and all the experimental studies carried
out in this setting were designated as the OR of the Future Project
(ORF). Before constructing the ORF, modeling studies were conducted
to inform the architectural and staffing design and estimate their
benefit. In phase I a small prospective trial tested the main hypothesized
benefits of the ORF: reduced patient intra-operative flow-time, wait-time
and operative procedure time. In phase II a larger retrospective
study was conducted to explore factors influencing these effects.
A modified process costing method was used to estimate costs based
on nationally derived data. Cost-effectiveness was evaluated using
standard methods. RESULTS: There were 385 cases matched by surgeon
and procedure type in the retrospective dataset (182 ORF, 193 standard
operating room [SOR]). The median Wait Time (12.5 m ORF vs 23.8 m
SOR), Operative Procedure Time (56.1 m ORF vs 70.5 m SOR), Emergence
Time (10.9 m ORF vs 14.5 m SOR) and Total Patient OR Flowtime (79.5
m ORF vs 108.9 m SOR) were all shorter in the ORF (P},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
cases are a major impediment to their productivity. We hypothesized
that redesigning the operating room (OR) and perioperative-staffing
system to take advantage of parallel processing would improve throughput
and lower the cost of care. METHODS: A state of the art high tech
OR suite equipped with augmented data collection systems served as
a living laboratory to evaluate both new devices and perioperative
systems of care. The OR suite and all the experimental studies carried
out in this setting were designated as the OR of the Future Project
(ORF). Before constructing the ORF, modeling studies were conducted
to inform the architectural and staffing design and estimate their
benefit. In phase I a small prospective trial tested the main hypothesized
benefits of the ORF: reduced patient intra-operative flow-time, wait-time
and operative procedure time. In phase II a larger retrospective
study was conducted to explore factors influencing these effects.
A modified process costing method was used to estimate costs based
on nationally derived data. Cost-effectiveness was evaluated using
standard methods. RESULTS: There were 385 cases matched by surgeon
and procedure type in the retrospective dataset (182 ORF, 193 standard
operating room [SOR]). The median Wait Time (12.5 m ORF vs 23.8 m
SOR), Operative Procedure Time (56.1 m ORF vs 70.5 m SOR), Emergence
Time (10.9 m ORF vs 14.5 m SOR) and Total Patient OR Flowtime (79.5
m ORF vs 108.9 m SOR) were all shorter in the ORF (P
Hur, Chin; Chan, A. T.; Tramontano, Angela; Gazelle, G. Scott
Coxibs versus combination NSAID and PPI therapy for chronic pain: an exploration of the risks, benefits, and costs Journal Article
In: Ann Pharmacother, vol. 40, no. 6, pp. 1052-63, 2006, ISSN: 1060-0280 (Print) 1060-0280 (Lin, ().
@article{Hur2006a,
title = {Coxibs versus combination NSAID and PPI therapy for chronic pain:
an exploration of the risks, benefits, and costs},
author = {Chin Hur and A. T. Chan and Angela Tramontano and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16720709},
issn = {1060-0280 (Print) 1060-0280 (Lin},
year = {2006},
date = {2006-06-01},
journal = {Ann Pharmacother},
volume = {40},
number = {6},
pages = {1052-63},
abstract = {OBJECTIVE: To systematically review studies qualitatively to compare
the risks (gastrointestinal [GI] and cardiovascular) and benefits
(pain control) of cyclooxygenase-2 inhibitors (coxibs) relative to
an alternative therapy of a nonselective nonsteroidal antiinflammatory
drug (NSAID) combined with a proton-pump inhibitor (PPI) and explore
circumstances when coxibs may be appropriate. METHODS: Relevant studies
were identified through a search of MEDLINE (Ovid Technologies, 1985-November
2005; English language, clinical trial), PubMed (1985-November 2005;
English language, clinical trial, humans), and the Cochrane Collaboration
using the terms selective COX-2 inhibitors and coxibs, as well as
the various chemical names for specific coxib agents. Studies that
compared a coxib with a nonselective NSAID and provided data concerning
our outcomes of interest were included and categorized by the outcome
variable, as well as by the specific coxib studied. RESULTS: The
majority of the numerous studies that evaluated pain as an endpoint
showed no difference between coxib and nonselective NSAID therapy.
However, while limited, preliminary safety data regarding the effects
of both classes on the upper and lower GI tract suggest coxib superiority.
Although coxibs are associated with an increased risk of cardiovascular
adverse events (CVEs) compared with placebo, this effect has not
been conclusively shown compared with nonselective NSAIDs. Currently,
coxib therapy is more expensive than combination therapy using a
nonselective NSAID plus a PPI. CONCLUSIONS: Compared with combination
therapy including a nonselective NSAID and PPI, coxibs provide equivalent
pain control and may have a lower GI tract complication profile,
but at an unknown increased risk of CVEs and a greater financial
cost. Coxib therapy may be an appropriate treatment for chronic pain
in select patients with higher risks of GI complications, lower risk
of CVEs, and in whom greater cost is not a restraint.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
the risks (gastrointestinal [GI] and cardiovascular) and benefits
(pain control) of cyclooxygenase-2 inhibitors (coxibs) relative to
an alternative therapy of a nonselective nonsteroidal antiinflammatory
drug (NSAID) combined with a proton-pump inhibitor (PPI) and explore
circumstances when coxibs may be appropriate. METHODS: Relevant studies
were identified through a search of MEDLINE (Ovid Technologies, 1985-November
2005; English language, clinical trial), PubMed (1985-November 2005;
English language, clinical trial, humans), and the Cochrane Collaboration
using the terms selective COX-2 inhibitors and coxibs, as well as
the various chemical names for specific coxib agents. Studies that
compared a coxib with a nonselective NSAID and provided data concerning
our outcomes of interest were included and categorized by the outcome
variable, as well as by the specific coxib studied. RESULTS: The
majority of the numerous studies that evaluated pain as an endpoint
showed no difference between coxib and nonselective NSAID therapy.
However, while limited, preliminary safety data regarding the effects
of both classes on the upper and lower GI tract suggest coxib superiority.
Although coxibs are associated with an increased risk of cardiovascular
adverse events (CVEs) compared with placebo, this effect has not
been conclusively shown compared with nonselective NSAIDs. Currently,
coxib therapy is more expensive than combination therapy using a
nonselective NSAID plus a PPI. CONCLUSIONS: Compared with combination
therapy including a nonselective NSAID and PPI, coxibs provide equivalent
pain control and may have a lower GI tract complication profile,
but at an unknown increased risk of CVEs and a greater financial
cost. Coxib therapy may be an appropriate treatment for chronic pain
in select patients with higher risks of GI complications, lower risk
of CVEs, and in whom greater cost is not a restraint.
Rodriguez, J. R.; Germes, S. S.; Pandharipande, Pari; Gazelle, G. Scott; Thayer, S. P.; Warshaw, A. L.; Castillo, C. Fernandez-del
Implications and cost of pancreatic leak following distal pancreatic resection Journal Article
In: Arch Surg, vol. 141, no. 4, pp. 361-5; discussion 36, 2006, ISSN: 0004-0010 (Print) 0004-0010 (Lin, ().
@article{Rodriguez2006,
title = {Implications and cost of pancreatic leak following distal pancreatic resection},
author = {J. R. Rodriguez and S. S. Germes and Pari Pandharipande and G. Scott Gazelle and S. P. Thayer and A. L. Warshaw and C. Fernandez-del Castillo},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16618893},
issn = {0004-0010 (Print) 0004-0010 (Lin},
year = {2006},
date = {2006-04-01},
urldate = {2006-04-01},
journal = {Arch Surg},
volume = {141},
number = {4},
pages = {361-5; discussion 36},
abstract = {OBJECTIVES: Pancreatic stump leak (PL) after elective distal pancreatic
resection significantly impacts cost and increases subsequent health
care resource utilization. We sought to provide an economic framework
for potential interventions aimed at reducing its occurrence. DESIGN:
Retrospective case series and economic evaluation. SETTING: University-affiliated,
tertiary care referral center. PATIENTS: Sixty-six patients undergoing
elective distal pancreatectomy. MAIN OUTCOME MEASURES: Postoperative
complications; hospital and professional costs. RESULTS: Overall
postoperative morbidity occurred in 34 patients (52%) with no deaths.
The total number of patients with complications directly related
to PL was 22 (33%). The mean +/- SD number of total hospital days
for the no-PL group was 5.2 +/- 1.7 days (range, 3-12 days) vs 16.6 +/- 14.6 days (range, 4-49 days) for the PL group (P = .001). The
average patient with PL-related problems incurred a total cost that
was 2.01 times greater than the average patient in the no-PL group.
A decision analytic model developed to evaluate threshold costs showed
that a hypothetical intervention designed to reduce the complication
rate of distal pancreatectomy by one third would be financially justifiable
up to a cost of $1418 per patient. CONCLUSIONS: Complications derived
from PL following distal pancreatectomy double the cost and dramatically
increase health care resource utilization. There is an urgent need
to develop strategies that reduce the incidence of this common complication.
Interventions aimed at decreasing the incidence of PL should take
into account this cost differential. We provide an economic model
to serve as a guide for developing these technologies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
resection significantly impacts cost and increases subsequent health
care resource utilization. We sought to provide an economic framework
for potential interventions aimed at reducing its occurrence. DESIGN:
Retrospective case series and economic evaluation. SETTING: University-affiliated,
tertiary care referral center. PATIENTS: Sixty-six patients undergoing
elective distal pancreatectomy. MAIN OUTCOME MEASURES: Postoperative
complications; hospital and professional costs. RESULTS: Overall
postoperative morbidity occurred in 34 patients (52%) with no deaths.
The total number of patients with complications directly related
to PL was 22 (33%). The mean +/- SD number of total hospital days
for the no-PL group was 5.2 +/- 1.7 days (range, 3-12 days) vs 16.6 +/- 14.6 days (range, 4-49 days) for the PL group (P = .001). The
average patient with PL-related problems incurred a total cost that
was 2.01 times greater than the average patient in the no-PL group.
A decision analytic model developed to evaluate threshold costs showed
that a hypothetical intervention designed to reduce the complication
rate of distal pancreatectomy by one third would be financially justifiable
up to a cost of $1418 per patient. CONCLUSIONS: Complications derived
from PL following distal pancreatectomy double the cost and dramatically
increase health care resource utilization. There is an urgent need
to develop strategies that reduce the incidence of this common complication.
Interventions aimed at decreasing the incidence of PL should take
into account this cost differential. We provide an economic model
to serve as a guide for developing these technologies.
Hendee, W. R.; Gazelle, G. Scott
Biomedical Imaging Research Opportunities Workshop III: a white paper Journal Article
In: Ann Biomed Eng, vol. 34, no. 2, pp. 188-98, 2006, ISSN: 0090-6964 (Print) 0090-6964 (Lin, ().
@article{Hendee2006,
title = {Biomedical Imaging Research Opportunities Workshop III: a white paper},
author = {W. R. Hendee and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16482416},
issn = {0090-6964 (Print) 0090-6964 (Lin},
year = {2006},
date = {2006-02-01},
journal = {Ann Biomed Eng},
volume = {34},
number = {2},
pages = {188-98},
abstract = {The third Biomedical Imaging Research Opportunities Workshop (BIROW
III) was held on March 11-12, 2005, in Bethesda, MD. The workshop
addressed four areas of imaging that present opportunities for research
and development: Multimodality Image-Guided Therapy, Imaging Informatics,
Imaging Cell Trafficking, and Technology Improvement and Commercialization.
The first three areas were individually addressed in their own plenary
sessions, followed by audience discussions that explored research
opportunities and challenges. This paper synthesizes these discussions
into a strategy for future research directions in biomedical imaging.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
III) was held on March 11-12, 2005, in Bethesda, MD. The workshop
addressed four areas of imaging that present opportunities for research
and development: Multimodality Image-Guided Therapy, Imaging Informatics,
Imaging Cell Trafficking, and Technology Improvement and Commercialization.
The first three areas were individually addressed in their own plenary
sessions, followed by audience discussions that explored research
opportunities and challenges. This paper synthesizes these discussions
into a strategy for future research directions in biomedical imaging.
Siebert, Uwe; Januzzi, J. L.; Beinfeld, M. T.; Cameron, R.; Gazelle, G. Scott
In: Am J Cardiol, vol. 98, pp. 800-5, 2006, ().
@article{Siebert2006a,
title = {Cost-effectiveness of using N-terminal pro-brain natriuretic peptide
to guide the diagnostic assessment and management of dyspneic patients
in the emergency department},
author = {Uwe Siebert and J. L. Januzzi and M. T. Beinfeld and R. Cameron and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16950189},
year = {2006},
date = {2006-01-01},
journal = {Am J Cardiol},
volume = {98},
pages = {800-5},
abstract = {The cost-effectiveness of N-terminal pro-brain natriuretic peptide
(NT-pro-BNP) in dyspneic patients in emergency departments (EDs)
is unknown. The objective of this study was to assess the cost-effectiveness
of NT-pro-BNP testing for the evaluation and initial management of
patients with dyspnea in the ED setting. A decision model was developed
to evaluate the cost-effectiveness of diagnostic assessment and patient
management guided by NT-pro-BNP, compared with standard clinical
assessment. The model includes the diagnostic accuracy of the 2 strategies
for congestive heart failure and resulting events at 60-day follow-up.
Clinical data were obtained from a prospective blinded study of 599
patients presenting to the ED with dyspnea. Costs were based on the
Massachusetts General Hospital cost accounting database. The model
predicted serious adverse events during follow-up (i.e., urgent care
visits, repeat ED presentations, rehospitalizations) and direct medical
costs for echocardiograms and hospitalizations. NT-pro-BNP-guided
assessment was associated with a 1.6% relative reduction of serious
adverse event risk and a 9.4% reduction in costs, translating into
savings of 474 per patient, compared with standard clinical assessment.
In a sensitivity analysis considering mortality, NT-pro-BNP testing
was associated with a 1.0% relative reduction in post-discharge mortality.
The optimal use of NT-pro-BNP guidance could reduce the use of echocardiography
by up to 58 prevent 13% of initial hospitalizations, and reduce hospital
days by 12 In conclusion, on the basis of this model, the use of
NT-pro-BNP in the diagnostic assessment and subsequent management
of patients with dyspnea in the ED setting could lead to improved
patient care while providing substantial cost savings to the health
care system.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
(NT-pro-BNP) in dyspneic patients in emergency departments (EDs)
is unknown. The objective of this study was to assess the cost-effectiveness
of NT-pro-BNP testing for the evaluation and initial management of
patients with dyspnea in the ED setting. A decision model was developed
to evaluate the cost-effectiveness of diagnostic assessment and patient
management guided by NT-pro-BNP, compared with standard clinical
assessment. The model includes the diagnostic accuracy of the 2 strategies
for congestive heart failure and resulting events at 60-day follow-up.
Clinical data were obtained from a prospective blinded study of 599
patients presenting to the ED with dyspnea. Costs were based on the
Massachusetts General Hospital cost accounting database. The model
predicted serious adverse events during follow-up (i.e., urgent care
visits, repeat ED presentations, rehospitalizations) and direct medical
costs for echocardiograms and hospitalizations. NT-pro-BNP-guided
assessment was associated with a 1.6% relative reduction of serious
adverse event risk and a 9.4% reduction in costs, translating into
savings of 474 per patient, compared with standard clinical assessment.
In a sensitivity analysis considering mortality, NT-pro-BNP testing
was associated with a 1.0% relative reduction in post-discharge mortality.
The optimal use of NT-pro-BNP guidance could reduce the use of echocardiography
by up to 58 prevent 13% of initial hospitalizations, and reduce hospital
days by 12 In conclusion, on the basis of this model, the use of
NT-pro-BNP in the diagnostic assessment and subsequent management
of patients with dyspnea in the ED setting could lead to improved
patient care while providing substantial cost savings to the health
care system.
Hur, Chin; Wittenberg, Eve; Nishioka, N. S.; Gazelle, G. Scott
Quality of life in patients with various Barrett's esophagus associated health states Journal Article
In: Health Qual Life Outcomes, vol. 4, pp. 45, 2006, ().
@article{Hur2006,
title = {Quality of life in patients with various Barrett's esophagus associated
health states},
author = {Chin Hur and Eve Wittenberg and N. S. Nishioka and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16884539},
year = {2006},
date = {2006-01-01},
journal = {Health Qual Life Outcomes},
volume = {4},
pages = {45},
abstract = {BACKGROUND: The management of Barrett's esophagus (BE), particularly
high grade dysplasia (HGD), is an area of much debate and controversy.
Surgical esophagectomy, intensive endoscopic surveillance and mucosal
ablative techniques, especially photodynamic therapy (PDT), have
been proposed as possible management strategies. The purpose of this
study was to determine the health related quality of life associated
with Barrett's esophagus and many of the pivotal health states associated
with Barrett's HGD management. METHODS: 20 patients with Barrett's
esophagus were enrolled in a pilot survey study at a large urban
hospital. The utility of Barrett's esophagus without dysplasia (current
health state) as well as various health states associated with HGD
management (hypothetical states as the subject did not have HGD)
were measured using a validated health utility instrument (Paper
Standard Gamble). These specific health states were chosen for the
study because they are considered pivotal in Barrett's HGD decision
making. Information regarding Barrett's HGD was presented to the
subject in a standardized format that was designed to be easily comprehendible. RESULTS: The average utility scores (0-1 with 0 = death and 1 = perfect
health) for the various Barrett's esophagus associated states were:
BE without dysplasia-0.95; Post-esophagectomy for HGD with dysphagia-0.92;
Post-PDT for HGD with recurrence uncertainty-0.93; Post-PDT for HGD
with recurrence uncertainty and dysphagia-0.91; Intensive endoscopic
surveillance for HGD-0.90. CONCLUSION: We present the scores for
utilities associated with Barrett's esophagus as well as various
states associated with the management of HGD. The results of our
study may be useful in advising patients and providers regarding
expected outcomes of the various HGD management strategies as well
as providing utility scores for future cost-effectiveness analyses.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
high grade dysplasia (HGD), is an area of much debate and controversy.
Surgical esophagectomy, intensive endoscopic surveillance and mucosal
ablative techniques, especially photodynamic therapy (PDT), have
been proposed as possible management strategies. The purpose of this
study was to determine the health related quality of life associated
with Barrett's esophagus and many of the pivotal health states associated
with Barrett's HGD management. METHODS: 20 patients with Barrett's
esophagus were enrolled in a pilot survey study at a large urban
hospital. The utility of Barrett's esophagus without dysplasia (current
health state) as well as various health states associated with HGD
management (hypothetical states as the subject did not have HGD)
were measured using a validated health utility instrument (Paper
Standard Gamble). These specific health states were chosen for the
study because they are considered pivotal in Barrett's HGD decision
making. Information regarding Barrett's HGD was presented to the
subject in a standardized format that was designed to be easily comprehendible. RESULTS: The average utility scores (0-1 with 0 = death and 1 = perfect
health) for the various Barrett's esophagus associated states were:
BE without dysplasia-0.95; Post-esophagectomy for HGD with dysphagia-0.92;
Post-PDT for HGD with recurrence uncertainty-0.93; Post-PDT for HGD
with recurrence uncertainty and dysphagia-0.91; Intensive endoscopic
surveillance for HGD-0.90. CONCLUSION: We present the scores for
utilities associated with Barrett's esophagus as well as various
states associated with the management of HGD. The results of our
study may be useful in advising patients and providers regarding
expected outcomes of the various HGD management strategies as well
as providing utility scores for future cost-effectiveness analyses.
McMahon, Pamela M.; Zaslavsky, A. M.; Weinstein, M. C.; Kuntz, K. M.; Weeks, J. C.; Gazelle, G. Scott
Estimation of mortality rates for disease simulation models using Bayesian evidence synthesis Journal Article
In: Med Decis Making, vol. 26, pp. 497-511, 2006, ().
@article{McMahon2006,
title = {Estimation of mortality rates for disease simulation models using Bayesian evidence synthesis},
author = {Pamela M. McMahon and A. M. Zaslavsky and M. C. Weinstein and K. M. Kuntz and J. C. Weeks and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16997927},
year = {2006},
date = {2006-01-01},
urldate = {2006-01-01},
journal = {Med Decis Making},
volume = {26},
pages = {497-511},
abstract = {PURPOSE: The authors propose a Bayesian approach for estimating competing
risks for inputs to disease simulation models. This approach is suggested
when modeling a disease that causes a large proportion of all-cause
mortality, particularly when mortality from the disease of interest
and other-cause mortality are both affected by the same risk factor.
METHODS: The authors demonstrate a Bayesian evidence synthesis by
estimating other-cause mortality, stratified by smoking status, for
use in a simulation model of lung cancer. National (US) survey data
linked to death registries (National Health Interview Survey [NHIS]--Multiple
Cause of Death files) were used to fit cause-specific hazard models
for 3 causes of death (lung cancer, heart disease, and all other
causes), controlling for age, sex, race, and smoking status. Synthesis
of NHIS data with national vital statistics data on numbers and causes
of deaths was performed in WinBUGS (version 1.4.1, MRC Biostatistics
Unit, UK). Correction for inconsistencies between the NHIS and vital
statistics data is described. A published cohort study was a source
of prior information for smoking-related mortality. RESULTS: Marginal
posterior densities of annual mortality rates for lung cancer and
other-cause death (further divided into heart disease and all other
causes), stratified by 5-year age interval, race (white and black),
gender, and smoking status (current, former, never), were estimated,
specific to a time period (1987-1995). Overall, black current smokers
experienced the highest mortality rates. CONCLUSIONS: Bayesian evidence
synthesis is an effective method for estimation of cause-specific
mortality rates, stratified by demographic factors.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
risks for inputs to disease simulation models. This approach is suggested
when modeling a disease that causes a large proportion of all-cause
mortality, particularly when mortality from the disease of interest
and other-cause mortality are both affected by the same risk factor.
METHODS: The authors demonstrate a Bayesian evidence synthesis by
estimating other-cause mortality, stratified by smoking status, for
use in a simulation model of lung cancer. National (US) survey data
linked to death registries (National Health Interview Survey [NHIS]--Multiple
Cause of Death files) were used to fit cause-specific hazard models
for 3 causes of death (lung cancer, heart disease, and all other
causes), controlling for age, sex, race, and smoking status. Synthesis
of NHIS data with national vital statistics data on numbers and causes
of deaths was performed in WinBUGS (version 1.4.1, MRC Biostatistics
Unit, UK). Correction for inconsistencies between the NHIS and vital
statistics data is described. A published cohort study was a source
of prior information for smoking-related mortality. RESULTS: Marginal
posterior densities of annual mortality rates for lung cancer and
other-cause death (further divided into heart disease and all other
causes), stratified by 5-year age interval, race (white and black),
gender, and smoking status (current, former, never), were estimated,
specific to a time period (1987-1995). Overall, black current smokers
experienced the highest mortality rates. CONCLUSIONS: Bayesian evidence
synthesis is an effective method for estimation of cause-specific
mortality rates, stratified by demographic factors.
Blanchfield, Bonnie B.; Grant, Richard W.; Estey, G. A.; Chueh, H. C.; Gazelle, G. Scott; Meigs, James
Cost of an informatics-based diabetes management program Journal Article
In: Int J Technol Assess Health Care, vol. 22, no. 2, pp. 249-54, 2006, ISSN: 0266-4623 (Print) 0266-4623 (Lin, ().
@article{Blanchfield2006,
title = {Cost of an informatics-based diabetes management program},
author = {Bonnie B. Blanchfield and Richard W. Grant and G. A. Estey and H. C. Chueh and G. Scott Gazelle and James Meigs},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16571201},
issn = {0266-4623 (Print) 0266-4623 (Lin},
year = {2006},
date = {2006-00-01},
journal = {Int J Technol Assess Health Care},
volume = {22},
number = {2},
pages = {249-54},
abstract = {OBJECTIVES: The relatively high cost of information technology systems
may be a barrier to hospitals thinking of adopting this technology.
The experiences of early adopters may facilitate decision making
for hospitals less able to risk their limited resources. This study
identifies the costs to design, develop, implement, and operate an
innovative informatics-based registry and disease management system
(POPMAN) to manage type 2 diabetes in a primary care setting. METHODS:
The various cost components of POPMAN were systematically identified
and collected.Results: POPMAN cost 450,000 dollars to develop and
operate over 3.5 years (1999-2003). Approximately 250,000 dollars
of these costs are one-time expenditures or sunk costs. Annual operating
costs are expected to range from 90,000 dollars to 110,000 dollars
translating to approximately 90 dollars per patient for a 1,200 patient
registry. CONCLUSIONS: The cost of POPMAN is comparable to the costs
of other quality-improving interventions for patients with diabetes.
Modifications to POPMAN for adaptation to other chronic diseases
or to interface with new electronic medical record systems will require
additional investment but should not be as high as initial development
costs. POPMAN provides a means of tracking progress against negotiated
quality targets, allowing hospitals to negotiate pay for performance
incentives with insurers that may exceed the annual operating cost
of POPMAN. As a result, the quality of care of patients with diabetes
through use of POPMAN could be improved at a minimal net cost to
hospitals.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
may be a barrier to hospitals thinking of adopting this technology.
The experiences of early adopters may facilitate decision making
for hospitals less able to risk their limited resources. This study
identifies the costs to design, develop, implement, and operate an
innovative informatics-based registry and disease management system
(POPMAN) to manage type 2 diabetes in a primary care setting. METHODS:
The various cost components of POPMAN were systematically identified
and collected.Results: POPMAN cost 450,000 dollars to develop and
operate over 3.5 years (1999-2003). Approximately 250,000 dollars
of these costs are one-time expenditures or sunk costs. Annual operating
costs are expected to range from 90,000 dollars to 110,000 dollars
translating to approximately 90 dollars per patient for a 1,200 patient
registry. CONCLUSIONS: The cost of POPMAN is comparable to the costs
of other quality-improving interventions for patients with diabetes.
Modifications to POPMAN for adaptation to other chronic diseases
or to interface with new electronic medical record systems will require
additional investment but should not be as high as initial development
costs. POPMAN provides a means of tracking progress against negotiated
quality targets, allowing hospitals to negotiate pay for performance
incentives with insurers that may exceed the annual operating cost
of POPMAN. As a result, the quality of care of patients with diabetes
through use of POPMAN could be improved at a minimal net cost to
hospitals.
2005
Mathes, D. W.; Solari, M. G.; Randolph, M. A.; Gazelle, G. Scott; Yamada, K.; Huang, C. A.; Sachs, D. H.; Lee, W. P.
Long-term acceptance of renal allografts following prenatal inoculation with adult bone marrow Journal Article
In: Transplantation, vol. 80, no. 9, pp. 1300-8, 2005, ISSN: 0041-1337 (Print) 0041-1337 (Lin, ().
@article{Mathes2005,
title = {Long-term acceptance of renal allografts following prenatal inoculation
with adult bone marrow},
author = {D. W. Mathes and M. G. Solari and M. A. Randolph and G. Scott Gazelle and K. Yamada and C. A. Huang and D. H. Sachs and W. P. Lee},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16314799},
issn = {0041-1337 (Print) 0041-1337 (Lin},
year = {2005},
date = {2005-11-01},
journal = {Transplantation},
volume = {80},
number = {9},
pages = {1300-8},
abstract = {BACKGROUND: The aim was to investigate if intravascular in utero injection
of adult bone marrow into swine fetuses could lead to macrochimerism
and tolerance to the donor. METHODS: Outbred Yorkshire sows and boars
screening negative for MHC allele SLA of MGH miniature swine were
bred. A laparotomy was performed on the sows at 50 days gestation
to expose the uterus. Bone marrow harvested from SLA miniature swine
was T-cell depleted and injected intravascularly into seventeen fetuses.
Flow cytometry was performed to detect donor cells (chimerism) in
the peripheral blood after birth. Mixed lymphocyte reactions (MLR)
and cell-mediated lympholysis (CML) assays were used to assess the
response to donor MHC. Previously frozen skin grafts from the bone
marrow donor were placed on the offspring from the first litter.
Donor-matched renal transplant from SLA donors were performed on
chimeric swine, with and without a short 12-day course of cyclosporine,
and one nonchimeric littermate. RESULTS: Nine inoculated offspring
demonstrated donor cell chimerism in the peripheral blood and lymphohematopoietic
tissues. All animals with detectable chimerism within the first three
weeks were consistently nonreactive to donor MHC in vitro. Animals
challenged with donor skin grafts displayed prolonged graft survival
without producing antidonor antibodies. All chimeric animals accepted
donor-matched kidney allografts, even one without cyclosporine. The
kidney in the nonchimeric littermate rejected by day 21. CONCLUSIONS:
Transplantation of allogeneic adult bone marrow into immunocompetent
fetal recipients resulted in chimerism. In utero inoculation led
to operational tolerance to the donor's major histocompatibility
antigens and long-term acceptance to organ allografts.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
of adult bone marrow into swine fetuses could lead to macrochimerism
and tolerance to the donor. METHODS: Outbred Yorkshire sows and boars
screening negative for MHC allele SLA of MGH miniature swine were
bred. A laparotomy was performed on the sows at 50 days gestation
to expose the uterus. Bone marrow harvested from SLA miniature swine
was T-cell depleted and injected intravascularly into seventeen fetuses.
Flow cytometry was performed to detect donor cells (chimerism) in
the peripheral blood after birth. Mixed lymphocyte reactions (MLR)
and cell-mediated lympholysis (CML) assays were used to assess the
response to donor MHC. Previously frozen skin grafts from the bone
marrow donor were placed on the offspring from the first litter.
Donor-matched renal transplant from SLA donors were performed on
chimeric swine, with and without a short 12-day course of cyclosporine,
and one nonchimeric littermate. RESULTS: Nine inoculated offspring
demonstrated donor cell chimerism in the peripheral blood and lymphohematopoietic
tissues. All animals with detectable chimerism within the first three
weeks were consistently nonreactive to donor MHC in vitro. Animals
challenged with donor skin grafts displayed prolonged graft survival
without producing antidonor antibodies. All chimeric animals accepted
donor-matched kidney allografts, even one without cyclosporine. The
kidney in the nonchimeric littermate rejected by day 21. CONCLUSIONS:
Transplantation of allogeneic adult bone marrow into immunocompetent
fetal recipients resulted in chimerism. In utero inoculation led
to operational tolerance to the donor's major histocompatibility
antigens and long-term acceptance to organ allografts.
Hur, Chin; Gazelle, G. Scott; Hsu, E. H.; Halpern, Elkan F.; Podolsky, D. K.
The effect of prior colonic imaging on endoscopic productivity: potential impact of computed tomographic colonography Journal Article
In: Clin Gastroenterol Hepatol, vol. 3, no. 11, pp. 1124-7, 2005, ISSN: 1542-3565 (Print) 1542-3565 (Lin, ().
@article{Hur2005b,
title = {The effect of prior colonic imaging on endoscopic productivity: potential impact of computed tomographic colonography},
author = {Chin Hur and G. Scott Gazelle and E. H. Hsu and Elkan F. Halpern and D. K. Podolsky},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16271344},
issn = {1542-3565 (Print) 1542-3565 (Lin},
year = {2005},
date = {2005-11-01},
urldate = {2005-11-01},
journal = {Clin Gastroenterol Hepatol},
volume = {3},
number = {11},
pages = {1124-7},
abstract = {BACKGROUND \& AIMS: If computed tomographic colonography (CTC) is used
for primary colorectal cancer (CRC) screening with a small polyp
size threshold to define a CTC study as positive, a substantial portion
of all colonoscopies performed annually will be to follow up positive
CTC examinations. Moreover, the majority of positive CTC examinations
would be false positives (FP). This case-control study was undertaken
to test the hypothesis that colonoscopy examinations resulting from
FP CTC studies would take longer to complete than negative screening
colonoscopies. METHODS: Endoscopic records of a large, urban hospital
were reviewed to identify all patients who had either a positive
barium enema (BE) study or flexible sigmoidoscopy (FS) and a negative
follow-up colonoscopy examination (these patients were used as surrogates
for CTC FP cases). For each of the 28 FP patients or cases identified,
2 screening colonoscopies performed by the same endoscopist within
the same time period were identified and used as matched controls.
A two-way analysis of variance test was performed to assess for differences
in time to complete colonoscopies between these 2 groups, controlling
for the individual endoscopist. RESULTS: FP colonoscopies took an
average of 24.0 minutes to complete, whereas negative screening colonoscopies
took 14.9 minutes; FP colonoscopies required 61% more active time
to complete. This highly statistically significant difference (P
\< .0001) persisted with subset analyses that only included BE or
FS cases and when fellow or surgeon cases were excluded. CONCLUSIONS:
FP colonoscopies take longer to perform than negative screening colonoscopies.
If CTC is implemented as the primary modality for CRC screening,
these FP examinations could comprise a substantial percentage of
the colonoscopies performed, potentially leading to a significant
decrease in endoscopic productivity.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
for primary colorectal cancer (CRC) screening with a small polyp
size threshold to define a CTC study as positive, a substantial portion
of all colonoscopies performed annually will be to follow up positive
CTC examinations. Moreover, the majority of positive CTC examinations
would be false positives (FP). This case-control study was undertaken
to test the hypothesis that colonoscopy examinations resulting from
FP CTC studies would take longer to complete than negative screening
colonoscopies. METHODS: Endoscopic records of a large, urban hospital
were reviewed to identify all patients who had either a positive
barium enema (BE) study or flexible sigmoidoscopy (FS) and a negative
follow-up colonoscopy examination (these patients were used as surrogates
for CTC FP cases). For each of the 28 FP patients or cases identified,
2 screening colonoscopies performed by the same endoscopist within
the same time period were identified and used as matched controls.
A two-way analysis of variance test was performed to assess for differences
in time to complete colonoscopies between these 2 groups, controlling
for the individual endoscopist. RESULTS: FP colonoscopies took an
average of 24.0 minutes to complete, whereas negative screening colonoscopies
took 14.9 minutes; FP colonoscopies required 61% more active time
to complete. This highly statistically significant difference (P
< .0001) persisted with subset analyses that only included BE or
FS cases and when fellow or surgeon cases were excluded. CONCLUSIONS:
FP colonoscopies take longer to perform than negative screening colonoscopies.
If CTC is implemented as the primary modality for CRC screening,
these FP examinations could comprise a substantial percentage of
the colonoscopies performed, potentially leading to a significant
decrease in endoscopic productivity.
Bosch, Johanna; Beinfeld, M. T.; Muller, J. E.; Brady, T.; Gazelle, G. Scott
In: J Interv Cardiol, vol. 18, no. 5, pp. 339-49, 2005, ISSN: 0896-4327 (Print) 0896-4327 (Lin, ().
@article{Bosch2005,
title = {A cost-effectiveness analysis of a hypothetical catheter-based strategy for the detection and treatment of vulnerable coronary plaques with drug-eluting stents},
author = {Johanna Bosch and M. T. Beinfeld and J. E. Muller and T. Brady and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16202108},
issn = {0896-4327 (Print) 0896-4327 (Lin},
year = {2005},
date = {2005-10-01},
urldate = {2005-10-01},
journal = {J Interv Cardiol},
volume = {18},
number = {5},
pages = {339-49},
abstract = {AIM: Extensive efforts are underway to develop methods for the detection
and treatment of vulnerable/high-risk coronary artery plaques. We
utilized decision analysis to evaluate the hypothetical clinical
benefits and cost-effectiveness of a catheter-based strategy. METHODS
AND RESULTS: Currently, stenotic coronary plaques are treated without
regard to vulnerability. In a new strategy, vulnerable coronary plaques
are detected with a catheter-based test and treated with a drug-eluting
stent, regardless of degree of stenosis. A Markov-decision model
was developed to compare the new strategy with current practice.
Monte Carlo simulations were performed from a societal perspective,
costs were converted to year 2003 U.S. dollars, and future costs
and outcomes were discounted at 3%. Sensitivity analyses were performed
to evaluate the effect of assumptions on variables such as the prevalence
of vulnerable plaques and treatment effect. In 60-year-old male patients
with coronary stenoses the new strategy would be less expensive and
more effective than current practice (37,045 dollars vs 38,257 dollars
and 10.23 vs 9.86 quality-adjusted life years (QALYs), respectively).
The benefits of the new strategy were robust in sensitivity analyses
(e.g., if the prevalence of vulnerable plaques in this patient group
was 50% or more and the sensitivity and specificity of the new test
were at least 0.80). CONCLUSION: In selected patients with coronary
artery stenosis, the detection of vulnerable plaques with a catheter-based
test followed by their treatment with a drug-eluting stent could
be a less expensive and more effective strategy than current practice.
If applied to 1 million such patients in the United States undergoing
catheterization, the new strategy would add 370,000 QALYs and save
1.2 billion dollars per year.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
and treatment of vulnerable/high-risk coronary artery plaques. We
utilized decision analysis to evaluate the hypothetical clinical
benefits and cost-effectiveness of a catheter-based strategy. METHODS
AND RESULTS: Currently, stenotic coronary plaques are treated without
regard to vulnerability. In a new strategy, vulnerable coronary plaques
are detected with a catheter-based test and treated with a drug-eluting
stent, regardless of degree of stenosis. A Markov-decision model
was developed to compare the new strategy with current practice.
Monte Carlo simulations were performed from a societal perspective,
costs were converted to year 2003 U.S. dollars, and future costs
and outcomes were discounted at 3%. Sensitivity analyses were performed
to evaluate the effect of assumptions on variables such as the prevalence
of vulnerable plaques and treatment effect. In 60-year-old male patients
with coronary stenoses the new strategy would be less expensive and
more effective than current practice (37,045 dollars vs 38,257 dollars
and 10.23 vs 9.86 quality-adjusted life years (QALYs), respectively).
The benefits of the new strategy were robust in sensitivity analyses
(e.g., if the prevalence of vulnerable plaques in this patient group
was 50% or more and the sensitivity and specificity of the new test
were at least 0.80). CONCLUSION: In selected patients with coronary
artery stenosis, the detection of vulnerable plaques with a catheter-based
test followed by their treatment with a drug-eluting stent could
be a less expensive and more effective strategy than current practice.
If applied to 1 million such patients in the United States undergoing
catheterization, the new strategy would add 370,000 QALYs and save
1.2 billion dollars per year.
Partain, C. L.; Chan, H. P.; Gelovani, J. G.; Giger, M. L.; Izatt, J. A.; Jolesz, F. A.; Kandarpa, K.; Li, K. C.; McNitt-Gray, M.; Napel, S.; Summers, R. M.; Gazelle, G. Scott
Biomedical Imaging Research Opportunities Workshop II: report and recommendations Journal Article
In: Radiology, vol. 236, no. 2, pp. 389-403, 2005, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Partain2005,
title = {Biomedical Imaging Research Opportunities Workshop II: report and
recommendations},
author = {C. L. Partain and H. P. Chan and J. G. Gelovani and M. L. Giger and J. A. Izatt and F. A. Jolesz and K. Kandarpa and K. C. Li and M. McNitt-Gray and S. Napel and R. M. Summers and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16040898},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2005},
date = {2005-08-01},
journal = {Radiology},
volume = {236},
number = {2},
pages = {389-403},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Beinfeld, M. T.; Wittenberg, Eve; Gazelle, G. Scott
Cost-effectiveness of whole-body CT screening Journal Article
In: Radiology, vol. 234, no. 2, pp. 415-22, 2005, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Beinfeld2005,
title = {Cost-effectiveness of whole-body CT screening},
author = {M. T. Beinfeld and Eve Wittenberg and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15670999},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2005},
date = {2005-02-01},
journal = {Radiology},
volume = {234},
number = {2},
pages = {415-22},
abstract = {PURPOSE: To make preliminary estimates of the effectiveness (in life-years)
and cost-effectiveness (in costs per life-year) of whole-body computed
tomographic (CT) screening. MATERIALS AND METHODS: Costs and effectiveness
(in life-years) of onetime whole-body CT screening relative to those
of no screening were calculated by using a decision-analytic model.
It was assumed that any benefits from screening were due to earlier
detection of disease and improvement in survival relative to survival
with routine care. Eight conditions were included in the model: ovarian,
pancreatic, lung, liver, kidney, and colon cancer; abdominal aortic
aneurysm; and coronary artery disease. Costs of the screening examination,
follow-up tests, and patient care were estimated. The base-case analysis
was performed for a hypothetical cohort of 500 000 self-referred
asymptomatic 50-year-old men. For sensitivity analyses, the age and
sex of the cohort were varied. Results were expressed in 2001 U.S.
dollars per life-year gained. RESULTS: Compared with routine care,
whole-body CT screening provided minimal gains in life expectancy
(0.016 6 years or 6 days) at an average additional cost of 2513 dollars
per patient, or an incremental cost-effectiveness ratio of 151 000
dollars per life-year gained. Most patients (90.8%) had at least
one positive finding, but only 2.0% had disease; work-up in patients
with a false-positive result of screening accounted for 32.3% of
total costs (1720 dollars of 5332 dollars). Results were sensitive
to the prevalence of disease, the effect of screening on stage of
disease at diagnosis, the specificity of screening, and the costs
of follow-up for false-positive findings. CONCLUSION: Even with assumptions
favorable to whole-body CT, implementation of onetime screening would
not be cost-effective compared with currently funded medical interventions;
follow-up for false-positive findings would add a substantial financial
burden to the health care system.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
and cost-effectiveness (in costs per life-year) of whole-body computed
tomographic (CT) screening. MATERIALS AND METHODS: Costs and effectiveness
(in life-years) of onetime whole-body CT screening relative to those
of no screening were calculated by using a decision-analytic model.
It was assumed that any benefits from screening were due to earlier
detection of disease and improvement in survival relative to survival
with routine care. Eight conditions were included in the model: ovarian,
pancreatic, lung, liver, kidney, and colon cancer; abdominal aortic
aneurysm; and coronary artery disease. Costs of the screening examination,
follow-up tests, and patient care were estimated. The base-case analysis
was performed for a hypothetical cohort of 500 000 self-referred
asymptomatic 50-year-old men. For sensitivity analyses, the age and
sex of the cohort were varied. Results were expressed in 2001 U.S.
dollars per life-year gained. RESULTS: Compared with routine care,
whole-body CT screening provided minimal gains in life expectancy
(0.016 6 years or 6 days) at an average additional cost of 2513 dollars
per patient, or an incremental cost-effectiveness ratio of 151 000
dollars per life-year gained. Most patients (90.8%) had at least
one positive finding, but only 2.0% had disease; work-up in patients
with a false-positive result of screening accounted for 32.3% of
total costs (1720 dollars of 5332 dollars). Results were sensitive
to the prevalence of disease, the effect of screening on stage of
disease at diagnosis, the specificity of screening, and the costs
of follow-up for false-positive findings. CONCLUSION: Even with assumptions
favorable to whole-body CT, implementation of onetime screening would
not be cost-effective compared with currently funded medical interventions;
follow-up for false-positive findings would add a substantial financial
burden to the health care system.
Stahl, James; Egan, M. T.; Goldman, J. M.; Tenney, D.; Wiklund, R. A.; Sandberg, W. S.; Gazelle, G. Scott; Rattner, D. W.
Ïntroducing new technology into the operating room: measuring the impact on job performance and satisfaction" Journal Article
In: Surgery, vol. 137, pp. 518-26, 2005, ().
@article{Stahl2005a,
title = {\"{I}ntroducing new technology into the operating room: measuring the impact on job performance and satisfaction"},
author = {James Stahl and M. T. Egan and J. M. Goldman and D. Tenney and R. A. Wiklund and W. S. Sandberg and G. Scott Gazelle and D. W. Rattner},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15855924},
year = {2005},
date = {2005-01-01},
journal = {Surgery},
volume = {137},
pages = {518-26},
abstract = {BACKGROUND: The Massachusetts General Hospital (MGH) Operating Room
of the Future (ORF) project is a test site for evaluating new surgical
technologies and processes. Here we evaluate the effect on staff
satisfaction and burnout of introducing a set of new technologies.
METHODS: Staff satisfaction and burnout were measured via sequential
surveys based on the Maslach Burnout Inventory during the introduction
of a new technology system. Functional behavior of the OR was measured
in terms of flow time (time to transit the OR) and wait time (time
to access the OR). These data were gathered using time-motion analysis
methods. RESULTS: Significant functional improvements were found
in the ORF (more than 35% reduction in flow time and wait time, P
textless .05). During the same period, more exposure to the ORF resulted
in greater sense of personal accomplishment among surgeons, a worse
sense of personal accomplishment among nurses, more emotional exhaustion
among surgeons, and less emotional exhaustion among nurses. However,
the responses for emotional exhaustion were reversed the greater
the time from exposure to the ORF. Staff with 6 to 10 years' experience
were at highest risk for burnout across all categories. General surgeons
experienced more emotional exhaustion than other physicians. CONCLUSIONS:
Tracking the response of all users and identifying groups at high
risk for burnout when exposed to new systems should be a central
part of any new technology project.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
of the Future (ORF) project is a test site for evaluating new surgical
technologies and processes. Here we evaluate the effect on staff
satisfaction and burnout of introducing a set of new technologies.
METHODS: Staff satisfaction and burnout were measured via sequential
surveys based on the Maslach Burnout Inventory during the introduction
of a new technology system. Functional behavior of the OR was measured
in terms of flow time (time to transit the OR) and wait time (time
to access the OR). These data were gathered using time-motion analysis
methods. RESULTS: Significant functional improvements were found
in the ORF (more than 35% reduction in flow time and wait time, P
textless .05). During the same period, more exposure to the ORF resulted
in greater sense of personal accomplishment among surgeons, a worse
sense of personal accomplishment among nurses, more emotional exhaustion
among surgeons, and less emotional exhaustion among nurses. However,
the responses for emotional exhaustion were reversed the greater
the time from exposure to the ORF. Staff with 6 to 10 years' experience
were at highest risk for burnout across all categories. General surgeons
experienced more emotional exhaustion than other physicians. CONCLUSIONS:
Tracking the response of all users and identifying groups at high
risk for burnout when exposed to new systems should be a central
part of any new technology project.
Hur, Chin; Simon, L. S.; Gazelle, G. Scott
Änalysis of aspirin-associated risks in healthy individuals" Journal Article
In: Ann Pharmacother, vol. 39, no. 1, pp. 51-7, 2005, ISSN: 1060-0280 (Print) 1060-0280 (Lin, ().
@article{Hur2005a,
title = {\"{A}nalysis of aspirin-associated risks in healthy individuals"},
author = {Chin Hur and L. S. Simon and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15590881},
issn = {1060-0280 (Print) 1060-0280 (Lin},
year = {2005},
date = {2005-01-01},
journal = {Ann Pharmacother},
volume = {39},
number = {1},
pages = {51-7},
abstract = {BACKGROUND: Aspirin therapy is widely accepted for patients with documented
cardiovascular disease, but there is a growing trend among healthy
individuals to use aspirin as primary prevention for both cardiovascular
disease and cancer. OBJECTIVE: To determine the impact of the complications
of aspirin therapy on quality-adjusted life-years (QALYs) in healthy
individuals. METHODS: A computer-based decision-analytic model was
constructed. In this model, healthy individuals taking aspirin were
assumed to receive no advantages from the aspirin, but were at risk
of developing its associated complications. Individuals took 325
mg of enteric-coated aspirin every day until death, discontinuing
therapy only if an aspirin-induced complication occurred. The analysis
was performed from a societal perspective, starting at age 50 years.
Extensive sensitivity analyses were performed. RESULTS: In the absence
of any beneficial effect, aspirin reduced QALYs by 0.03 per individual.
Unadjusted life expectancy was decreased by 0.04 years (2 wk). Lifetime
aspirin use cost an average of $460/healthy person. The total complication
rate over a lifetime of aspirin therapy was 6.79%, with a mortality
rate of 0.18%. Alternatively stated, there was one complication for
every 15 individuals treated and one death for every 556 individuals
treated. Extensive sensitivity analysis showed the range of results
possible when varying age, gender, length of follow-up, and other
key parameters. CONCLUSIONS: Assuming no benefits, aspirin therapy
in healthy individuals leads to a small reduction in QALYs at an
overall low cost per person. However, approximately 1 in 15 individuals
will experience an aspirin-induced complication and 1 in 556 individuals
will die.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
cardiovascular disease, but there is a growing trend among healthy
individuals to use aspirin as primary prevention for both cardiovascular
disease and cancer. OBJECTIVE: To determine the impact of the complications
of aspirin therapy on quality-adjusted life-years (QALYs) in healthy
individuals. METHODS: A computer-based decision-analytic model was
constructed. In this model, healthy individuals taking aspirin were
assumed to receive no advantages from the aspirin, but were at risk
of developing its associated complications. Individuals took 325
mg of enteric-coated aspirin every day until death, discontinuing
therapy only if an aspirin-induced complication occurred. The analysis
was performed from a societal perspective, starting at age 50 years.
Extensive sensitivity analyses were performed. RESULTS: In the absence
of any beneficial effect, aspirin reduced QALYs by 0.03 per individual.
Unadjusted life expectancy was decreased by 0.04 years (2 wk). Lifetime
aspirin use cost an average of $460/healthy person. The total complication
rate over a lifetime of aspirin therapy was 6.79%, with a mortality
rate of 0.18%. Alternatively stated, there was one complication for
every 15 individuals treated and one death for every 556 individuals
treated. Extensive sensitivity analysis showed the range of results
possible when varying age, gender, length of follow-up, and other
key parameters. CONCLUSIONS: Assuming no benefits, aspirin therapy
in healthy individuals leads to a small reduction in QALYs at an
overall low cost per person. However, approximately 1 in 15 individuals
will experience an aspirin-induced complication and 1 in 556 individuals
will die.
Beinfeld, Molly T.; Gazelle, G. Scott
Điagnostic imaging costs: are they driving up the costs of hospital care? Journal Article
In: Radiology, vol. 235, pp. 934-9, 2005, ().
@article{Beinfeld2005a,
title = {{D}iagnostic imaging costs: are they driving up the costs of hospital
care?},
author = {Molly T. Beinfeld and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15833988},
year = {2005},
date = {2005-01-01},
journal = {Radiology},
volume = {235},
pages = {934-9},
abstract = {To retrospectively determine how changes in utilization of computed
tomography (CT), magnetic resonance (MR) imaging, and other imaging
technologies between 1996 and 2002 influenced costs of inpatient
hospital care at one large academic medical center.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
tomography (CT), magnetic resonance (MR) imaging, and other imaging
technologies between 1996 and 2002 influenced costs of inpatient
hospital care at one large academic medical center.
Neumann, P. J.; Divi, N.; Beinfeld, M. T.; Levine, B. S.; Keenan, P. S.; Halpern, Elkan F.; Gazelle, G. Scott
Medicare's national coverage decisions, 1999-2003: quality of evidence and review times Journal Article
In: Health Aff (Millwood), vol. 24, no. 1, pp. 243-54, 2005, ISSN: 0278-2715 (Print) 0278-2715 (Lin, ().
@article{Neumann2005,
title = {Medicare's national coverage decisions, 1999-2003: quality of evidence
and review times},
author = {P. J. Neumann and N. Divi and M. T. Beinfeld and B. S. Levine and P. S. Keenan and Elkan F. Halpern and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15647237},
issn = {0278-2715 (Print) 0278-2715 (Lin},
year = {2005},
date = {2005-00-01},
journal = {Health Aff (Millwood)},
volume = {24},
number = {1},
pages = {243-54},
abstract = {In 1998 Medicare amended its procedures for making national coverage
decisions for new technologies in an attempt to make the process
more transparent and evidence based. We examined the quality of evidence
for sixty-nine technologies reviewed by Medicare since then. Determinations
by the Centers for Medicare and Medicaid Services (CMS) have generally
been consistent with the strength of evidence. Good clinical evidence
from rigorous studies is usually lacking for the technologies Medicare
considers, although in most cases the CMS covers with conditions
if there is at least fair evidence that benefits outweigh harms.
Decisions referred to the external Medicare Coverage Advisory Committee
(MCAC) have averaged eight months longer than non-MCAC decisions.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
decisions for new technologies in an attempt to make the process
more transparent and evidence based. We examined the quality of evidence
for sixty-nine technologies reviewed by Medicare since then. Determinations
by the Centers for Medicare and Medicaid Services (CMS) have generally
been consistent with the strength of evidence. Good clinical evidence
from rigorous studies is usually lacking for the technologies Medicare
considers, although in most cases the CMS covers with conditions
if there is at least fair evidence that benefits outweigh harms.
Decisions referred to the external Medicare Coverage Advisory Committee
(MCAC) have averaged eight months longer than non-MCAC decisions.
2004
Earle, C. C.; Kwok, A.; Gazelle, G. Scott; Fuchs, C. S.
Two schedules of second-line irinotecan for metastatic colon carcinoma Journal Article
In: Cancer, vol. 101, no. 11, pp. 2533-9, 2004, ISSN: 0008-543X (Print) 0008-543X (Lin, ().
@article{Earle2004,
title = {Two schedules of second-line irinotecan for metastatic colon carcinoma},
author = {C. C. Earle and A. Kwok and G. Scott Gazelle and C. S. Fuchs},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15503310},
issn = {0008-543X (Print) 0008-543X (Lin},
year = {2004},
date = {2004-12-01},
urldate = {2004-12-01},
journal = {Cancer},
volume = {101},
number = {11},
pages = {2533-9},
abstract = {BACKGROUND: In a recently reported, randomized trial, it was found
that a regimen of irinotecan once every 3 weeks for patients with
advanced colorectal carcinoma was associated with a lower incidence
of severe diarrhea compared with weekly treatment, and both regimens
had similar efficacy. METHODS: Resource utilization was captured
prospectively for all 291 patients who were included in the trial.
Utilities were estimated by transformation of the global quality-of-life
(QOL) item on the Eastern Organization for Research and Treatment
of Cancer QLQ-C30 instrument. RESULTS: Patients in the every-3-week
arm incurred an average incremental cost of $1362, because they received
higher average weekly doses and because the every-3-week regimen
resulted in less toxicity, allowing delivery of 97% of the planned
doses compared with delivery of only 75% of the planned doses in
the weekly arm. This lower toxicity also resulted in offsetting savings
from decreased hospitalization and less requirement for supportive
medications. Non-chemotherapy-related treatment administration costs
also were lower, because the every-3-week regimen could be delivered
with half the number of infusions. Utility declined less in the every-3-week
arm, resulting in a saving of 6.3 quality-adjusted days. The base-case
cost:utility ratio was $78,627 per quality-adjusted life year for
patients on the every-3-week schedule. However, that ratio was very
sensitive to the cost of irinotecan. CONCLUSIONS: The schedule of
irinotecan once every 3 weeks schedule was more costly but achieved
lower toxicity, resulting in modestly improved utility. The cost-per-utility
ratio was comparable to other commonly accepted contemporary treatments.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
that a regimen of irinotecan once every 3 weeks for patients with
advanced colorectal carcinoma was associated with a lower incidence
of severe diarrhea compared with weekly treatment, and both regimens
had similar efficacy. METHODS: Resource utilization was captured
prospectively for all 291 patients who were included in the trial.
Utilities were estimated by transformation of the global quality-of-life
(QOL) item on the Eastern Organization for Research and Treatment
of Cancer QLQ-C30 instrument. RESULTS: Patients in the every-3-week
arm incurred an average incremental cost of $1362, because they received
higher average weekly doses and because the every-3-week regimen
resulted in less toxicity, allowing delivery of 97% of the planned
doses compared with delivery of only 75% of the planned doses in
the weekly arm. This lower toxicity also resulted in offsetting savings
from decreased hospitalization and less requirement for supportive
medications. Non-chemotherapy-related treatment administration costs
also were lower, because the every-3-week regimen could be delivered
with half the number of infusions. Utility declined less in the every-3-week
arm, resulting in a saving of 6.3 quality-adjusted days. The base-case
cost:utility ratio was $78,627 per quality-adjusted life year for
patients on the every-3-week schedule. However, that ratio was very
sensitive to the cost of irinotecan. CONCLUSIONS: The schedule of
irinotecan once every 3 weeks schedule was more costly but achieved
lower toxicity, resulting in modestly improved utility. The cost-per-utility
ratio was comparable to other commonly accepted contemporary treatments.
Hur, Chin; Gazelle, G. Scott; Zalis, M. E.; Podolsky, D. K.
An analysis of the potential impact of computed tomographic colonography (virtual colonoscopy) on colonoscopy demand Journal Article
In: Gastroenterology, vol. 127, no. 5, pp. 1312-21, 2004, ISSN: 0016-5085 (Print) 0016-5085 (Lin, ().
@article{Hur2004b,
title = {An analysis of the potential impact of computed tomographic colonography (virtual colonoscopy) on colonoscopy demand},
author = {Chin Hur and G. Scott Gazelle and M. E. Zalis and D. K. Podolsky},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15521000},
issn = {0016-5085 (Print) 0016-5085 (Lin},
year = {2004},
date = {2004-11-01},
urldate = {2004-11-01},
journal = {Gastroenterology},
volume = {127},
number = {5},
pages = {1312-21},
abstract = {BACKGROUND AND AIMS: There has been much speculation about the potential
impact on the use of conventional colonoscopy if "virtual" computed
tomographic colonography (CTC) became a widely accepted modality
for colorectal cancer (CRC) screening. However, no formal analysis
of the impact of CTC on colonoscopy demand has been reported. METHODS:
A mathematical model to predict colonoscopy demand based on several
relevant input parameters was constructed. Current national colonoscopy
practice, estimated using various published reports, was used as
the foundation to project colonoscopy demand if CTC were implemented
as the primary CRC screening modality. RESULTS: In the base-case
analysis, if CTC were used as the primary modality for CRC screening,
1.78 million colonoscopies could be eliminated from the total 6.47
million in 2003. Depending on the polyp size threshold used to define
a CTC study as positive (6 or 10 mm), this loss would be partially
offset by 1.21 million (6 mm) or .34 million (10 mm) follow-up colonoscopies
for CTC examinations with positive findings, resulting in a net loss
of .57 million (8.8% decrease) (6 mm) or 1.44 million (22.3% decrease)
(10 mm). Extensive sensitivity analyses showed that the findings
of this model were robust and insensitive to most parameters tested
but were sensitive to a few parameters, including the percentage
of CTC examinations with positive findings. CONCLUSIONS: Wide-scale
implementation of CTC for CRC screening would likely lead to a decrease
in use of conventional colonoscopy. The percentage of CTC studies
with positive findings seemed to be a pivotal variable, which would
be determined in large part by the polyp size ultimately established
to define a positive finding.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
impact on the use of conventional colonoscopy if "virtual" computed
tomographic colonography (CTC) became a widely accepted modality
for colorectal cancer (CRC) screening. However, no formal analysis
of the impact of CTC on colonoscopy demand has been reported. METHODS:
A mathematical model to predict colonoscopy demand based on several
relevant input parameters was constructed. Current national colonoscopy
practice, estimated using various published reports, was used as
the foundation to project colonoscopy demand if CTC were implemented
as the primary CRC screening modality. RESULTS: In the base-case
analysis, if CTC were used as the primary modality for CRC screening,
1.78 million colonoscopies could be eliminated from the total 6.47
million in 2003. Depending on the polyp size threshold used to define
a CTC study as positive (6 or 10 mm), this loss would be partially
offset by 1.21 million (6 mm) or .34 million (10 mm) follow-up colonoscopies
for CTC examinations with positive findings, resulting in a net loss
of .57 million (8.8% decrease) (6 mm) or 1.44 million (22.3% decrease)
(10 mm). Extensive sensitivity analyses showed that the findings
of this model were robust and insensitive to most parameters tested
but were sensitive to a few parameters, including the percentage
of CTC examinations with positive findings. CONCLUSIONS: Wide-scale
implementation of CTC for CRC screening would likely lead to a decrease
in use of conventional colonoscopy. The percentage of CTC studies
with positive findings seemed to be a pivotal variable, which would
be determined in large part by the polyp size ultimately established
to define a positive finding.
Hur, Chin; Simon, L. S.; Gazelle, G. Scott
The cost-effectiveness of aspirin versus cyclooxygenase-2-selective inhibitors for colorectal carcinoma chemoprevention in healthy individuals Journal Article
In: Cancer, vol. 101, no. 1, pp. 189-97, 2004, ISSN: 0008-543X (Print) 0008-543X (Lin, ().
@article{Hur2004,
title = {The cost-effectiveness of aspirin versus cyclooxygenase-2-selective inhibitors for colorectal carcinoma chemoprevention in healthy individuals},
author = {Chin Hur and L. S. Simon and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15222006},
issn = {0008-543X (Print) 0008-543X (Lin},
year = {2004},
date = {2004-07-01},
urldate = {2004-07-01},
journal = {Cancer},
volume = {101},
number = {1},
pages = {189-97},
abstract = {BACKGROUND: Aspirin therapy is accepted widely for secondary prevention
in patients with documented cardiovascular disease, but there is
a growing trend among healthy individuals to use aspirin as primary
chemoprevention for both cardiovascular and oncologic diseases. Accruing
evidence suggests that cyclooxygenase-2-selective inhibitors (coxibs)
may be effective for colorectal carcinoma (CRC) chemoprevention but
would not provide the primary cardiac benefit of aspirin. METHODS:
A computer-based Markov model simulated hypothetical cohorts of healthy
men age 50 years who took either 325 mg of enteric-coated aspirin
daily or celecoxib at a dose of 400 mg twice a day. Patients in both
cohorts could develop drug-related complications that would lead
to its discontinuation. The aspirin group also was modeled to have
a decreased rate of coronary ischemic events; however, decreased
CRC mortality was not modeled in either group based on the assumption
that the two treatments were effective equally in this regard. Data
sources included published literature and the Centers for Medicare
and Medicaid Services. Endpoints used to compare the two strategies
included quality-adjusted life years (QALYs), mortality and complication
rates, and cost. The analysis was from a societal perspective with
a time horizon of 10 years from age 50 years. Extensive sensitivity
analyses were performed. RESULTS: Aspirin therapy resulted in 0.03
more QALYs and cost $23,000 less than coxib therapy over a 10-year
period. Compared with the aspirin group, the coxib group had 3.877%
more complications and 0.17% more deaths. Alternatively stated, coxib
therapy resulted in 1 patient complication or death for every 26
or 588 patients treated with coxibs, respectively. CONCLUSIONS: Assuming
equal efficacy in CRC prevention over a 10-year period, aspirin was
both more effective and less costly than coxib therapy when used
for primary chemoprevention of CRC.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
in patients with documented cardiovascular disease, but there is
a growing trend among healthy individuals to use aspirin as primary
chemoprevention for both cardiovascular and oncologic diseases. Accruing
evidence suggests that cyclooxygenase-2-selective inhibitors (coxibs)
may be effective for colorectal carcinoma (CRC) chemoprevention but
would not provide the primary cardiac benefit of aspirin. METHODS:
A computer-based Markov model simulated hypothetical cohorts of healthy
men age 50 years who took either 325 mg of enteric-coated aspirin
daily or celecoxib at a dose of 400 mg twice a day. Patients in both
cohorts could develop drug-related complications that would lead
to its discontinuation. The aspirin group also was modeled to have
a decreased rate of coronary ischemic events; however, decreased
CRC mortality was not modeled in either group based on the assumption
that the two treatments were effective equally in this regard. Data
sources included published literature and the Centers for Medicare
and Medicaid Services. Endpoints used to compare the two strategies
included quality-adjusted life years (QALYs), mortality and complication
rates, and cost. The analysis was from a societal perspective with
a time horizon of 10 years from age 50 years. Extensive sensitivity
analyses were performed. RESULTS: Aspirin therapy resulted in 0.03
more QALYs and cost $23,000 less than coxib therapy over a 10-year
period. Compared with the aspirin group, the coxib group had 3.877%
more complications and 0.17% more deaths. Alternatively stated, coxib
therapy resulted in 1 patient complication or death for every 26
or 588 patients treated with coxibs, respectively. CONCLUSIONS: Assuming
equal efficacy in CRC prevention over a 10-year period, aspirin was
both more effective and less costly than coxib therapy when used
for primary chemoprevention of CRC.
Horkan, C.; Ahmed, M.; Liu, Z.; Gazelle, G. Scott; Solazzo, S. A.; Kruskal, J. B.; Goldberg, S. N.
Radiofrequency ablation: Effect of pharmacologic modulation of hepatic and renal blood flow on coagulation diameter in a VX2 tumor model Journal Article
In: J Vasc Interv Radiol, vol. 15, no. 3, pp. 269-74, 2004, ISSN: 1051-0443 (Print) 1051-0443 (Lin, ().
@article{Horkan2004,
title = {Radiofrequency ablation: Effect of pharmacologic modulation of hepatic
and renal blood flow on coagulation diameter in a VX2 tumor model},
author = {C. Horkan and M. Ahmed and Z. Liu and G. Scott Gazelle and S. A. Solazzo and J. B. Kruskal and S. N. Goldberg},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15028812},
issn = {1051-0443 (Print) 1051-0443 (Lin},
year = {2004},
date = {2004-03-01},
journal = {J Vasc Interv Radiol},
volume = {15},
number = {3},
pages = {269-74},
abstract = {PURPOSE: To determine whether pharmacologic agents can be used to
modulate blood flow in hepatic and renal tumors sufficiently to alter
the extent of radiofrequency (RF)-induced coagulation. MATERIALS
AND METHODS: VX2 tumors (8-15 mm) were implanted in the liver (n = 25) or kidney (n = 8) of 33 New Zealand White rabbits. RF was applied
to tumors for 6 minutes with use of conventional electrodes (125
mA +/- 35; 90 degrees C +/- 2 degrees C tip temperature). In the
hepatic model, blood flow was modulated with use of halothane, epinephrine,
or arsenic trioxide (2-6 mg/kg). Laser Doppler flowmetry was used
to quantify changes in hepatic blood flow. Correlation of blood flow
with induced coagulation diameter was performed. RF ablation was
then performed in a renal model with and without arsenic trioxide.
RESULTS: For liver tumors, halothane and arsenic trioxide reduced
blood flow to 40.3% +/- 17.8% and 29% +/- 15% of normal, respectively,
whereas epinephrine increased blood flow to 207.8% +/- 97.9%. Correlation of blood flow to coagulation diameter was demonstrated (R(2) = 0.40).
Coagulation measured 7 mm +/- 1 with epinephrine, 10 mm +/- 1 with
normal blood flow, 12 mm +/- 3 with halothane, and 13 mm +/- 3 with
arsenic trioxide (P \<.04 compared with controls). In the renal model,
arsenic trioxide decreased blood flow (44% +/- 16%) and increased
coagulation diameter (10.9 mm +/- 1) compared with controls (84%
+/- 11% and 7.6 mm +/- 1; P \<.01, both comparisons). CONCLUSIONS:
RF-induced coagulation necrosis in rabbit hepatic and renal tumors
is affected by tumor blood flow. Pharmacologic modulation of tumor
blood flow may provide a noninvasive way to decrease blood flow during
thermally mediated ablation therapy, potentially enabling the creation
of larger zones of coagulation necrosis.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
modulate blood flow in hepatic and renal tumors sufficiently to alter
the extent of radiofrequency (RF)-induced coagulation. MATERIALS
AND METHODS: VX2 tumors (8-15 mm) were implanted in the liver (n = 25) or kidney (n = 8) of 33 New Zealand White rabbits. RF was applied
to tumors for 6 minutes with use of conventional electrodes (125
mA +/- 35; 90 degrees C +/- 2 degrees C tip temperature). In the
hepatic model, blood flow was modulated with use of halothane, epinephrine,
or arsenic trioxide (2-6 mg/kg). Laser Doppler flowmetry was used
to quantify changes in hepatic blood flow. Correlation of blood flow
with induced coagulation diameter was performed. RF ablation was
then performed in a renal model with and without arsenic trioxide.
RESULTS: For liver tumors, halothane and arsenic trioxide reduced
blood flow to 40.3% +/- 17.8% and 29% +/- 15% of normal, respectively,
whereas epinephrine increased blood flow to 207.8% +/- 97.9%. Correlation of blood flow to coagulation diameter was demonstrated (R(2) = 0.40).
Coagulation measured 7 mm +/- 1 with epinephrine, 10 mm +/- 1 with
normal blood flow, 12 mm +/- 3 with halothane, and 13 mm +/- 3 with
arsenic trioxide (P <.04 compared with controls). In the renal model,
arsenic trioxide decreased blood flow (44% +/- 16%) and increased
coagulation diameter (10.9 mm +/- 1) compared with controls (84%
+/- 11% and 7.6 mm +/- 1; P <.01, both comparisons). CONCLUSIONS:
RF-induced coagulation necrosis in rabbit hepatic and renal tumors
is affected by tumor blood flow. Pharmacologic modulation of tumor
blood flow may provide a noninvasive way to decrease blood flow during
thermally mediated ablation therapy, potentially enabling the creation
of larger zones of coagulation necrosis.
Hur, Chin; Nishioka, N. S.; Gazelle, G. Scott
Cost-effectiveness of aspirin chemoprevention for Barrett's esophagus Journal Article
In: J Natl Cancer Inst, vol. 96, no. 4, pp. 316-25, 2004, ISSN: 1460-2105 (Electronic) 0027-8874, ().
@article{Hur2004a,
title = {Cost-effectiveness of aspirin chemoprevention for Barrett's esophagus},
author = {Chin Hur and N. S. Nishioka and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/14970280},
issn = {1460-2105 (Electronic) 0027-8874},
year = {2004},
date = {2004-02-01},
journal = {J Natl Cancer Inst},
volume = {96},
number = {4},
pages = {316-25},
abstract = {BACKGROUND: Recent data suggest that nonsteroidal anti-inflammatory
drugs, including aspirin, may prevent the progression of Barrett's
esophagus to adenocarcinoma. However, use of aspirin is associated
with numerous potential complications, including gastrointestinal
bleeding and hemorrhagic strokes. We used a modeling approach to
determine and compare the effectiveness and cost-effectiveness of
aspirin with and without endoscopic surveillance to prevent esophageal
adenocarcinoma. METHODS: A Markov Monte Carlo decision model was
constructed to compare four strategies for management of Barrett's
esophagus: aspirin therapy, endoscopic surveillance with biopsies,
both, or neither. Patients who took a daily enteric-coated aspirin
were modeled to have a 50% reduction in the incidence of esophageal
adenocarcinoma but could have complications related to therapy, at
which point the aspirin was discontinued. Potential cardiac benefits
of aspirin and its role in the chemoprevention of other cancers were
not included in the analysis. The analysis was from a societal perspective
from age 55 years until death. Sensitivity analyses were performed
to investigate the effects of changes in model parameters on estimated
costs and effectiveness outcomes across a wide range of assumptions.
RESULTS: Aspirin therapy was more effective and less costly than
no therapy, resulting in 0.19 more quality-adjusted life years (QALYs).
The combination of aspirin and endoscopic surveillance produced 0.27
more QALYs than no therapy at a cost of 13,400 U.S. dollars more,
for an associated incremental cost-effectiveness ratio of 49,600
U.S. dollars/QALY. Aspirin use in combination with endoscopic surveillance
dominated endoscopic surveillance alone, resulting in 0.06 more QALYs
and 11,400 U.S. dollars less cost. The model's results were sensitive
to increasing age and to decreased benefit or delay in aspirin's
chemopreventive efficacy. CONCLUSION: Using published values of parameters,
regardless of whether a patient undergoes endoscopic surveillance,
aspirin use in the management of Barrett's esophagus appears to be
a cost-effective strategy to prevent esophageal adenocarcinoma.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
drugs, including aspirin, may prevent the progression of Barrett's
esophagus to adenocarcinoma. However, use of aspirin is associated
with numerous potential complications, including gastrointestinal
bleeding and hemorrhagic strokes. We used a modeling approach to
determine and compare the effectiveness and cost-effectiveness of
aspirin with and without endoscopic surveillance to prevent esophageal
adenocarcinoma. METHODS: A Markov Monte Carlo decision model was
constructed to compare four strategies for management of Barrett's
esophagus: aspirin therapy, endoscopic surveillance with biopsies,
both, or neither. Patients who took a daily enteric-coated aspirin
were modeled to have a 50% reduction in the incidence of esophageal
adenocarcinoma but could have complications related to therapy, at
which point the aspirin was discontinued. Potential cardiac benefits
of aspirin and its role in the chemoprevention of other cancers were
not included in the analysis. The analysis was from a societal perspective
from age 55 years until death. Sensitivity analyses were performed
to investigate the effects of changes in model parameters on estimated
costs and effectiveness outcomes across a wide range of assumptions.
RESULTS: Aspirin therapy was more effective and less costly than
no therapy, resulting in 0.19 more quality-adjusted life years (QALYs).
The combination of aspirin and endoscopic surveillance produced 0.27
more QALYs than no therapy at a cost of 13,400 U.S. dollars more,
for an associated incremental cost-effectiveness ratio of 49,600
U.S. dollars/QALY. Aspirin use in combination with endoscopic surveillance
dominated endoscopic surveillance alone, resulting in 0.06 more QALYs
and 11,400 U.S. dollars less cost. The model's results were sensitive
to increasing age and to decreased benefit or delay in aspirin's
chemopreventive efficacy. CONCLUSION: Using published values of parameters,
regardless of whether a patient undergoes endoscopic surveillance,
aspirin use in the management of Barrett's esophagus appears to be
a cost-effective strategy to prevent esophageal adenocarcinoma.
Gazelle, G. Scott; McMahon, Pamela M.; Beinfeld, M. T.; Halpern, Elkan F.; Weinstein, M. C.
Metastatic colorectal carcinoma: cost-effectiveness of percutaneous radiofrequency ablation versus that of hepatic resection Journal Article
In: Radiology, vol. 233, pp. 729-39, 2004, ().
@article{Gazelle2004,
title = {Metastatic colorectal carcinoma: cost-effectiveness of percutaneous
radiofrequency ablation versus that of hepatic resection},
author = {G. Scott Gazelle and Pamela M. McMahon and M. T. Beinfeld and Elkan F. Halpern and M. C. Weinstein},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15564408},
year = {2004},
date = {2004-01-01},
journal = {Radiology},
volume = {233},
pages = {729-39},
abstract = {PURPOSE: To evaluate the relative cost-effectiveness of radiofrequency
(RF) ablation and hepatic resection in patients with metachronous
liver metastases from colorectal carcinoma (CRC) and compare the
outcomes, cost, and cost-effectiveness of a variety of treatment
and follow-up strategies. MATERIALS AND METHODS: A state-transition
decision model for evaluating the (societal) cost-effectiveness of
RF ablation and hepatic resection in patients with CRC liver metastases
was developed. The model tracks the presence, number, size, location,
growth, detection, and removal of up to 15 individual metastases
in each patient. Survival, quality of life, and cost are predicted
on the basis of disease extent. Imaging, ablation, and resection
affect outcomes through detection and elimination of individual metastases.
Several patient care strategies were developed and compared on the
basis of cost, effectiveness, and incremental cost-effectiveness
(expressed as dollars per quality-adjusted life-year [QALY]). Extensive
sensitivity analysis was performed to evaluate the impact of alternative
scenarios and assumptions on results. RESULTS: A strategy permitting
ablation of up to five metastases with computed tomographic (CT)
follow-up every 4 months resulted in a gain of 0.65 QALYs relative
to a no-treat strategy, at an incremental cost of 2400 per QALY.
Compared with this ablation strategy, a strategy permitting resection
of up to four metastases, one repeat resection, and CT follow-up
every 6 months resulted in an additional gain of 0.76 QALYs at an
incremental cost of 24 300 per QALY. Across a range of model assumptions,
more aggressive treatment strategies (ie, ablation or resection of
more metastases, treatment of recurrent metastases, more frequent
follow-up imaging) were superior to less aggressive strategies and
had incremental cost-effectiveness ratios of less than 35 000 per
QALY. Findings were insensitive to changes in most model parameters;
however, results were somewhat sensitive to changes in size thresholds
for RF ablation, the number of metastases present, and surgery and
treatment costs. CONCLUSION: RF ablation is a cost-effective treatment
option for patients with CRC liver metastases. However, in most scenarios,
hepatic resection is more effective (in terms of QALYs gained) than
RF ablation and has an incremental cost-effectiveness ratio of less
than 35 000 per QALY.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
(RF) ablation and hepatic resection in patients with metachronous
liver metastases from colorectal carcinoma (CRC) and compare the
outcomes, cost, and cost-effectiveness of a variety of treatment
and follow-up strategies. MATERIALS AND METHODS: A state-transition
decision model for evaluating the (societal) cost-effectiveness of
RF ablation and hepatic resection in patients with CRC liver metastases
was developed. The model tracks the presence, number, size, location,
growth, detection, and removal of up to 15 individual metastases
in each patient. Survival, quality of life, and cost are predicted
on the basis of disease extent. Imaging, ablation, and resection
affect outcomes through detection and elimination of individual metastases.
Several patient care strategies were developed and compared on the
basis of cost, effectiveness, and incremental cost-effectiveness
(expressed as dollars per quality-adjusted life-year [QALY]). Extensive
sensitivity analysis was performed to evaluate the impact of alternative
scenarios and assumptions on results. RESULTS: A strategy permitting
ablation of up to five metastases with computed tomographic (CT)
follow-up every 4 months resulted in a gain of 0.65 QALYs relative
to a no-treat strategy, at an incremental cost of 2400 per QALY.
Compared with this ablation strategy, a strategy permitting resection
of up to four metastases, one repeat resection, and CT follow-up
every 6 months resulted in an additional gain of 0.76 QALYs at an
incremental cost of 24 300 per QALY. Across a range of model assumptions,
more aggressive treatment strategies (ie, ablation or resection of
more metastases, treatment of recurrent metastases, more frequent
follow-up imaging) were superior to less aggressive strategies and
had incremental cost-effectiveness ratios of less than 35 000 per
QALY. Findings were insensitive to changes in most model parameters;
however, results were somewhat sensitive to changes in size thresholds
for RF ablation, the number of metastases present, and surgery and
treatment costs. CONCLUSION: RF ablation is a cost-effective treatment
option for patients with CRC liver metastases. However, in most scenarios,
hepatic resection is more effective (in terms of QALYs gained) than
RF ablation and has an incremental cost-effectiveness ratio of less
than 35 000 per QALY.
Beinfeld, M. T.; Bosch, Johanna; Isaacson, K. B.; Gazelle, G. Scott
Cost-effectiveness of uterine artery embolization and hysterectomy for uterine fibroids Journal Article
In: Radiology, vol. 230, no. 1, pp. 207-13, 2004, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Beinfeld2004,
title = {Cost-effectiveness of uterine artery embolization and hysterectomy
for uterine fibroids},
author = {M. T. Beinfeld and Johanna Bosch and K. B. Isaacson and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/14695395},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2004},
date = {2004-01-01},
journal = {Radiology},
volume = {230},
number = {1},
pages = {207-13},
abstract = {PURPOSE: To compare the cost-effectiveness of uterine artery embolization
(UAE) with that of hysterectomy for women with symptomatic uterine
fibroids. MATERIALS AND METHODS: The authors developed a decision
model to compare the costs and effectiveness of UAE and hysterectomy.
In the model, a cohort of women aged 40 years with a diagnosis of
uterine fibroids and no desire for future pregnancy was followed
up until menopause. The analysis was performed from a societal perspective,
including all costs and effects, regardless of who incurs them. Transition
probability and quality-of-life estimates were obtained from the
literature and a gynecologist, whereas costs (in 1999 U.S. dollars)
were estimated by using rates of Medicare reimbursement for hospital
costs and physician fees. Sensitivity analyses of key estimates were
performed. Results were expressed in costs per quality-adjusted life-year
(QALY). RESULTS: UAE was more effective (8.29 vs 8.18 QALYs) and
less expensive (US dollars 6916 vs US dollars 7847) than hysterectomy.
Cost-effectiveness results, with the exception of quality-of-life
data, were robust to changes in most model assumptions. When the
quality-of-life adjustment was eliminated, the two procedures were
equally effective. CONCLUSION: UAE is a cost-effective alternative
to hysterectomy across a wide range of assumptions about the costs
and effectiveness of the two procedures. However, the study results
were sensitive to changes in quality-of-life values.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
(UAE) with that of hysterectomy for women with symptomatic uterine
fibroids. MATERIALS AND METHODS: The authors developed a decision
model to compare the costs and effectiveness of UAE and hysterectomy.
In the model, a cohort of women aged 40 years with a diagnosis of
uterine fibroids and no desire for future pregnancy was followed
up until menopause. The analysis was performed from a societal perspective,
including all costs and effects, regardless of who incurs them. Transition
probability and quality-of-life estimates were obtained from the
literature and a gynecologist, whereas costs (in 1999 U.S. dollars)
were estimated by using rates of Medicare reimbursement for hospital
costs and physician fees. Sensitivity analyses of key estimates were
performed. Results were expressed in costs per quality-adjusted life-year
(QALY). RESULTS: UAE was more effective (8.29 vs 8.18 QALYs) and
less expensive (US dollars 6916 vs US dollars 7847) than hysterectomy.
Cost-effectiveness results, with the exception of quality-of-life
data, were robust to changes in most model assumptions. When the
quality-of-life adjustment was eliminated, the two procedures were
equally effective. CONCLUSION: UAE is a cost-effective alternative
to hysterectomy across a wide range of assumptions about the costs
and effectiveness of the two procedures. However, the study results
were sensitive to changes in quality-of-life values.
2003
Stahl, James; Furie, K. L.; Gleason, S.; Gazelle, G. Scott
Stroke: Effect of implementing an evaluation and treatment protocol compliant with NINDS recommendations Journal Article
In: Radiology, vol. 228, no. 3, pp. 659-68, 2003, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Stahl2003a,
title = {Stroke: Effect of implementing an evaluation and treatment protocol
compliant with NINDS recommendations},
author = {James Stahl and K. L. Furie and S. Gleason and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12954888},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2003},
date = {2003-09-01},
journal = {Radiology},
volume = {228},
number = {3},
pages = {659-68},
abstract = {PURPOSE: To evaluate--relative to routine clinical practice--the potential
cost-effectiveness of implementing a strategy compliant with National
Institute of Neurological Disorders and Stroke (NINDS) recommendations
for care of patients presenting with signs and symptoms of acute
ischemic stroke. MATERIALS AND METHODS: A discrete-event simulation
model of the process of stroke care from symptom onset through administration
of tissue plasminogen activator (tPA) was constructed. A literature
review was performed to determine process times, performance of computed
tomography (CT), health outcomes, and cost estimates. The following
were compared: (a) a "base-case" strategy determined on the basis
of findings in the literature and (b) a NINDS-compliant strategy
(ie, evaluation by emergency physician in less than 10 minutes, interpretation
of CT scans within 45 minutes, and administration of tPA within 1
hour after presentation). Strategies were compared with regard to
cost and effectiveness. Sensitivity analyses were performed for all
relevant cost, timing, and resource parameters. Outcomes of concern
were quality-adjusted life years and number of patients treated within
a 3-hour therapeutic window. RESULTS: The NINDS-compliant strategy
resulted in an average quality-adjusted life years value of 3.64,
versus 3.63 for the base case, at an approximate cost of 434 US dollars
per patient. The NINDS-compliant strategy increased the proportion
of treatable patients from 1.4% to 3.7% and remained cost-effective
for expenditures of up to 450 US dollars per patient. Assuming base-case
parameters are used, increasing the number of CT scanners from two
to eight raised the proportion of treatable patients to 1.5%. Increasing
the number of available neurologists from four to eight raised the
proportion to 1.44%. Reducing the time from stroke onset to emergency
department arrival by 30 minutes raised the proportion to up to 7.7%.
CONCLUSION: Applying NINDS recommendations is potentially cost-effective,
although reducing the time from stroke onset to emergency department
arrival may be even more so.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
cost-effectiveness of implementing a strategy compliant with National
Institute of Neurological Disorders and Stroke (NINDS) recommendations
for care of patients presenting with signs and symptoms of acute
ischemic stroke. MATERIALS AND METHODS: A discrete-event simulation
model of the process of stroke care from symptom onset through administration
of tissue plasminogen activator (tPA) was constructed. A literature
review was performed to determine process times, performance of computed
tomography (CT), health outcomes, and cost estimates. The following
were compared: (a) a "base-case" strategy determined on the basis
of findings in the literature and (b) a NINDS-compliant strategy
(ie, evaluation by emergency physician in less than 10 minutes, interpretation
of CT scans within 45 minutes, and administration of tPA within 1
hour after presentation). Strategies were compared with regard to
cost and effectiveness. Sensitivity analyses were performed for all
relevant cost, timing, and resource parameters. Outcomes of concern
were quality-adjusted life years and number of patients treated within
a 3-hour therapeutic window. RESULTS: The NINDS-compliant strategy
resulted in an average quality-adjusted life years value of 3.64,
versus 3.63 for the base case, at an approximate cost of 434 US dollars
per patient. The NINDS-compliant strategy increased the proportion
of treatable patients from 1.4% to 3.7% and remained cost-effective
for expenditures of up to 450 US dollars per patient. Assuming base-case
parameters are used, increasing the number of CT scanners from two
to eight raised the proportion of treatable patients to 1.5%. Increasing
the number of available neurologists from four to eight raised the
proportion to 1.44%. Reducing the time from stroke onset to emergency
department arrival by 30 minutes raised the proportion to up to 7.7%.
CONCLUSION: Applying NINDS recommendations is potentially cost-effective,
although reducing the time from stroke onset to emergency department
arrival may be even more so.
McMahon, Pamela M.; Araki, S. S.; Sandberg, E. A.; Neumann, P. J.; Gazelle, G. Scott
Cost-effectiveness of PET in the diagnosis of Alzheimer disease Journal Article
In: Radiology, vol. 228, no. 2, pp. 515-22, 2003, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{McMahon2003,
title = {Cost-effectiveness of PET in the diagnosis of Alzheimer disease},
author = {Pamela M. McMahon and S. S. Araki and E. A. Sandberg and P. J. Neumann and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12802006},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2003},
date = {2003-08-01},
journal = {Radiology},
volume = {228},
number = {2},
pages = {515-22},
abstract = {PURPOSE: To evaluate the cost-effectiveness of positron emission tomography
(PET) in the diagnosis of Alzheimer disease (AD) in community-dwelling
patients with mild or moderate dementia who present to specialized
AD centers. MATERIALS AND METHODS: A decision-analytic model was
used to compare costs and quality-adjusted life years (QALYs) associated
with strategies involving single photon emission computed tomography
(SPECT), dynamic susceptibility-weighted contrast material-enhanced
magnetic resonance (MR) imaging, and PET as functional imaging adjuncts
to the standard clinical work-up. Sensitivity analyses were performed
to examine changes in test characteristics, health-related quality-of-life
survey instruments, therapeutic effectiveness, and treatment rules.
RESULTS: The use of PET to confirm the results of the standard clinical
work-up cost more but yielded fewer benefits than a strategy in which
dynamic susceptibility-weighted contrast-enhanced MR imaging was
substituted for the typically performed structural computed tomography.
This relationship remained stable in scenarios in which standard
diagnostic work-up accuracy, drug treatment effectiveness, and version
of the Health Utilities Index were altered. Dynamic susceptibility-weighted
contrast-enhanced MR imaging cost US dollars 598800 per QALY gained
(range, US dollars 74400 to US dollars 1.9 million per QALY), compared
with the cost of the standard diagnostic work-up. Treating all patients
with dementia was the dominant imaging strategy, except when side
effects in patients with non-AD-related dementia were modeled. In
all scenarios, SPECT yielded fewer benefits than other strategies
at a higher cost. CONCLUSION: PET may have high diagnostic accuracy,
but adding it to the standard diagnostic regimen at AD clinics would
yield limited, if any, benefits at very high costs.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
(PET) in the diagnosis of Alzheimer disease (AD) in community-dwelling
patients with mild or moderate dementia who present to specialized
AD centers. MATERIALS AND METHODS: A decision-analytic model was
used to compare costs and quality-adjusted life years (QALYs) associated
with strategies involving single photon emission computed tomography
(SPECT), dynamic susceptibility-weighted contrast material-enhanced
magnetic resonance (MR) imaging, and PET as functional imaging adjuncts
to the standard clinical work-up. Sensitivity analyses were performed
to examine changes in test characteristics, health-related quality-of-life
survey instruments, therapeutic effectiveness, and treatment rules.
RESULTS: The use of PET to confirm the results of the standard clinical
work-up cost more but yielded fewer benefits than a strategy in which
dynamic susceptibility-weighted contrast-enhanced MR imaging was
substituted for the typically performed structural computed tomography.
This relationship remained stable in scenarios in which standard
diagnostic work-up accuracy, drug treatment effectiveness, and version
of the Health Utilities Index were altered. Dynamic susceptibility-weighted
contrast-enhanced MR imaging cost US dollars 598800 per QALY gained
(range, US dollars 74400 to US dollars 1.9 million per QALY), compared
with the cost of the standard diagnostic work-up. Treating all patients
with dementia was the dominant imaging strategy, except when side
effects in patients with non-AD-related dementia were modeled. In
all scenarios, SPECT yielded fewer benefits than other strategies
at a higher cost. CONCLUSION: PET may have high diagnostic accuracy,
but adding it to the standard diagnostic regimen at AD clinics would
yield limited, if any, benefits at very high costs.
Gazelle, G. Scott; Seltzer, S. E.; Judy, P. F.
Assessment and validation of imaging methods and technologies Journal Article
In: Acad Radiol, vol. 10, no. 8, pp. 894-6, 2003, ISSN: 1076-6332 (Print) 1076-6332 (Lin, ().
@article{Gazelle2003,
title = {Assessment and validation of imaging methods and technologies},
author = {G. Scott Gazelle and S. E. Seltzer and P. F. Judy},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12945926},
issn = {1076-6332 (Print) 1076-6332 (Lin},
year = {2003},
date = {2003-08-01},
urldate = {2003-08-01},
journal = {Acad Radiol},
volume = {10},
number = {8},
pages = {894-6},
abstract = {In summary, the group identified many challenges and opportunities
facing those wishing to conduct rigorous assessment and validation
of imaging technologies. Specific needs and recommendations were
outlined by the group. Overall, it was felt that the field has made
great progress in the past several years, and that the future is
promising.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
facing those wishing to conduct rigorous assessment and validation
of imaging technologies. Specific needs and recommendations were
outlined by the group. Overall, it was felt that the field has made
great progress in the past several years, and that the future is
promising.
Hur, Chin; Nishioka, N. S.; Gazelle, G. Scott
Cost-effectiveness of photodynamic therapy for treatment of Barrett's esophagus with high grade dysplasia Journal Article
In: Dig Dis Sci, vol. 48, no. 7, pp. 1273-83, 2003, ISSN: 0163-2116 (Print) 0163-2116 (Lin, ().
@article{Hur2003,
title = {Cost-effectiveness of photodynamic therapy for treatment of Barrett's
esophagus with high grade dysplasia},
author = {Chin Hur and N. S. Nishioka and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12870783},
issn = {0163-2116 (Print) 0163-2116 (Lin},
year = {2003},
date = {2003-07-01},
journal = {Dig Dis Sci},
volume = {48},
number = {7},
pages = {1273-83},
abstract = {The purpose of this study was to compare the effectiveness and cost-effectiveness
of photodynamic therapy (PDT) versus surgical esophagectomy and intensive
endoscopic surveillance for patients with Barrett's esophagus and
high-grade dysplasia (HGD) who are operative candidates. The results
of our Markov Monte Carlo model show that PDT increased life expectancy
by 1.8 years and quality-adjusted life expectancy (QALE) by 1.65
years when compared to the surveillance strategy. Relative to the
esophagectomy strategy, PDT resulted in a greater life expectancy
by 0.8 years and 2.17 additional quality-adjusted life years (QALYs).
Although PDT cost 20,400 dollars and 7,100 dollars more than surveillance
and esophagectomy respectively, the resulting incremental cost-effective
ratios (ICERs) of 12,400 dollars/QALY and 3,300 dollars/QALY are
within commonly accepted values. These findings were sensitive to
the value assigned to the quality of life after PDT, but only at
unrealistic values. In conclusion, PDT increases life expectancy
and is cost-effective when compared to endoscopic surveillance and
surgical esophagectomy.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
of photodynamic therapy (PDT) versus surgical esophagectomy and intensive
endoscopic surveillance for patients with Barrett's esophagus and
high-grade dysplasia (HGD) who are operative candidates. The results
of our Markov Monte Carlo model show that PDT increased life expectancy
by 1.8 years and quality-adjusted life expectancy (QALE) by 1.65
years when compared to the surveillance strategy. Relative to the
esophagectomy strategy, PDT resulted in a greater life expectancy
by 0.8 years and 2.17 additional quality-adjusted life years (QALYs).
Although PDT cost 20,400 dollars and 7,100 dollars more than surveillance
and esophagectomy respectively, the resulting incremental cost-effective
ratios (ICERs) of 12,400 dollars/QALY and 3,300 dollars/QALY are
within commonly accepted values. These findings were sensitive to
the value assigned to the quality of life after PDT, but only at
unrealistic values. In conclusion, PDT increases life expectancy
and is cost-effective when compared to endoscopic surveillance and
surgical esophagectomy.
Visser, K.; Kock, M. C.; Kuntz, K. M.; Donaldson, M. C.; Gazelle, G. Scott; Hunink, M. G.
Cost-effectiveness targets for multi-detector row CT angiography in the work-up of patients with intermittent claudication Journal Article
In: Radiology, vol. 227, no. 3, pp. 647-56, 2003, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Visser2003a,
title = {Cost-effectiveness targets for multi-detector row CT angiography
in the work-up of patients with intermittent claudication},
author = {K. Visser and M. C. Kock and K. M. Kuntz and M. C. Donaldson and G. Scott Gazelle and M. G. Hunink},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12773672},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2003},
date = {2003-06-01},
journal = {Radiology},
volume = {227},
number = {3},
pages = {647-56},
abstract = {PURPOSE: To determine the costs, sensitivity for detection of significant
stenoses, and proportion of equivocal multi-detector row computed
tomographic (CT) angiography results in the work-up of patients with
intermittent claudication that would make this imaging examination
cost-effective compared with gadolinium-enhanced magnetic resonance
(MR) angiography. MATERIALS AND METHODS: A decision model was used
to compare the societal cost-effectiveness of a new imaging modality
with that of gadolinium-enhanced MR angiography. Main outcome measures
were quality-adjusted life years (QALYs) and lifetime costs. By using
threshold analysis of a given willingness to pay per QALY, target
values for costs, sensitivity for detection of significant stenoses,
and proportion of cases requiring additional work-up with intraarterial
digital subtraction angiography owing to equivocal results of the
new modality were determined. The base case evaluated was that of
60-year-old men with severe intermittent claudication and assumed
an incremental cost-effectiveness threshold of 100,000 US dollars
per QALY. RESULTS: If treatment were limited to angioplasty, a new
imaging modality would be cost-effective if the costs were 300 US
dollars and the sensitivity was 85%, even if up to 35% of patients
needed additional work-up. When both angioplasty and bypass surgery
were considered as treatment options, a new imaging modality was
cost-effective if the costs were 300 US dollars, the sensitivity
was higher than 94%, and 20% of patients required additional work-up.
CONCLUSION: Multi-detector row CT angiography, as compared with currently
used imaging modalities such as MR angiography, has the potential
to be cost-effective in the evaluation of patients with intermittent
claudication.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
stenoses, and proportion of equivocal multi-detector row computed
tomographic (CT) angiography results in the work-up of patients with
intermittent claudication that would make this imaging examination
cost-effective compared with gadolinium-enhanced magnetic resonance
(MR) angiography. MATERIALS AND METHODS: A decision model was used
to compare the societal cost-effectiveness of a new imaging modality
with that of gadolinium-enhanced MR angiography. Main outcome measures
were quality-adjusted life years (QALYs) and lifetime costs. By using
threshold analysis of a given willingness to pay per QALY, target
values for costs, sensitivity for detection of significant stenoses,
and proportion of cases requiring additional work-up with intraarterial
digital subtraction angiography owing to equivocal results of the
new modality were determined. The base case evaluated was that of
60-year-old men with severe intermittent claudication and assumed
an incremental cost-effectiveness threshold of 100,000 US dollars
per QALY. RESULTS: If treatment were limited to angioplasty, a new
imaging modality would be cost-effective if the costs were 300 US
dollars and the sensitivity was 85%, even if up to 35% of patients
needed additional work-up. When both angioplasty and bypass surgery
were considered as treatment options, a new imaging modality was
cost-effective if the costs were 300 US dollars, the sensitivity
was higher than 94%, and 20% of patients required additional work-up.
CONCLUSION: Multi-detector row CT angiography, as compared with currently
used imaging modalities such as MR angiography, has the potential
to be cost-effective in the evaluation of patients with intermittent
claudication.
Hunink, M. G.; Gazelle, G. Scott
CT screening: a trade-off of risks, benefits, and costs Journal Article
In: J Clin Invest, vol. 111, no. 11, pp. 1612-9, 2003, ISSN: 0021-9738 (Print) 0021-9738 (Lin, ().
@article{Hunink2003,
title = {CT screening: a trade-off of risks, benefits, and costs},
author = {M. G. Hunink and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12782661},
issn = {0021-9738 (Print) 0021-9738 (Lin},
year = {2003},
date = {2003-06-01},
journal = {J Clin Invest},
volume = {111},
number = {11},
pages = {1612-9},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Gazelle, G. Scott; Hunink, M. G.; Kuntz, K. M.; McMahon, Pamela M.; Halpern, Elkan F.; Beinfeld, M.; Lester, J. S.; Tanabe, K. K.; Weinstein, M. C.
Cost-effectiveness of hepatic metastasectomy in patients with metastatic colorectal carcinoma: a state-transition Monte Carlo decision analysis Journal Article
In: Ann Surg, vol. 237, no. 4, pp. 544-55, 2003, ISSN: 0003-4932 (Print) 0003-4932 (Lin, ().
@article{Gazelle2003a,
title = {Cost-effectiveness of hepatic metastasectomy in patients with metastatic
colorectal carcinoma: a state-transition Monte Carlo decision analysis},
author = {G. Scott Gazelle and M. G. Hunink and K. M. Kuntz and Pamela M. McMahon and Elkan F. Halpern and M. Beinfeld and J. S. Lester and K. K. Tanabe and M. C. Weinstein},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12677152},
issn = {0003-4932 (Print) 0003-4932 (Lin},
year = {2003},
date = {2003-04-01},
journal = {Ann Surg},
volume = {237},
number = {4},
pages = {544-55},
abstract = {OBJECTIVE: To evaluate the cost-effectiveness of hepatic resection
("metastasectomy") in patients with metachronous liver metastases
from colorectal carcinoma (CRC), and to investigate the impact of
operative and follow-up strategies on outcomes, cost, and cost-effectiveness.
SUMMARY BACKGROUND DATA: There is substantial evidence that resection
of CRC liver metastases can result in long-term survival in some
patients. However, several unresolved issues are difficult to address
using currently available clinical data. These include the appropriate
threshold for resection, whether to perform repeat resection, and
the relative cost-effectiveness of the procedure(s). METHODS: The
authors developed a state-transition Monte Carlo decision model to
evaluate the (societal) cost-effectiveness of hepatic metastasectomy
in patients with metachronous CRC liver metastases. The model tracks
the presence, number, size, location, growth, detection, and removal
of up to 15 individual metastases in each patient. Survival, quality
of life, and cost are predicted on the basis of disease extent. Imaging
and surgery affect outcomes via detection and removal of individual
metastases. Several patient management strategies were developed
and compared with respect to cost, effectiveness, and incremental
cost-effectiveness ($/quality-adjusted life year [QALY]). A reference
strategy in which metastasectomy is not offered and imaging is not
performed for the purpose of assessing resectability or operative
planning ("no-surgery" strategy) was included for comparison. Extensive
sensitivity analysis was performed to evaluate the impact of alternative
model assumptions on results. RESULTS: A strategy permitting resection
of up to six metastases and one repeat resection, with CT follow-up
every 6 months, resulted in a gain of 2.63 QALYs relative to the
no-test/no-treat strategy, at an incremental cost of 18,100 US dollars/QALY.
When additional surgical strategies were considered, the incremental
cost-effectiveness ratio (ICER; relative to the next least effective
strategy) of the six metastases, one repeat, 6-month strategy was
31,700 US dollars/QALY. Across a range of model assumptions, more
aggressive treatment strategies (i.e., resection of more metastases,
resection of recurrent metastases) were superior to less aggressive
strategies and had ICERs below 35,000 US dollars/QALY. Findings were
insensitive to changes in most model parameters but somewhat sensitive
to changes in surgery and treatment costs. CONCLUSIONS: Hepatic metastasectomy
is a cost-effective option for selected patients with metachronous
CRC metastases limited to the liver. When considering metastasectomy,
more aggressive approaches are generally preferred to less aggressive
approaches. Overall, surgeons should be encouraged to consider resection
for all patients whose metastases can technically be removed.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
("metastasectomy") in patients with metachronous liver metastases
from colorectal carcinoma (CRC), and to investigate the impact of
operative and follow-up strategies on outcomes, cost, and cost-effectiveness.
SUMMARY BACKGROUND DATA: There is substantial evidence that resection
of CRC liver metastases can result in long-term survival in some
patients. However, several unresolved issues are difficult to address
using currently available clinical data. These include the appropriate
threshold for resection, whether to perform repeat resection, and
the relative cost-effectiveness of the procedure(s). METHODS: The
authors developed a state-transition Monte Carlo decision model to
evaluate the (societal) cost-effectiveness of hepatic metastasectomy
in patients with metachronous CRC liver metastases. The model tracks
the presence, number, size, location, growth, detection, and removal
of up to 15 individual metastases in each patient. Survival, quality
of life, and cost are predicted on the basis of disease extent. Imaging
and surgery affect outcomes via detection and removal of individual
metastases. Several patient management strategies were developed
and compared with respect to cost, effectiveness, and incremental
cost-effectiveness ($/quality-adjusted life year [QALY]). A reference
strategy in which metastasectomy is not offered and imaging is not
performed for the purpose of assessing resectability or operative
planning ("no-surgery" strategy) was included for comparison. Extensive
sensitivity analysis was performed to evaluate the impact of alternative
model assumptions on results. RESULTS: A strategy permitting resection
of up to six metastases and one repeat resection, with CT follow-up
every 6 months, resulted in a gain of 2.63 QALYs relative to the
no-test/no-treat strategy, at an incremental cost of 18,100 US dollars/QALY.
When additional surgical strategies were considered, the incremental
cost-effectiveness ratio (ICER; relative to the next least effective
strategy) of the six metastases, one repeat, 6-month strategy was
31,700 US dollars/QALY. Across a range of model assumptions, more
aggressive treatment strategies (i.e., resection of more metastases,
resection of recurrent metastases) were superior to less aggressive
strategies and had ICERs below 35,000 US dollars/QALY. Findings were
insensitive to changes in most model parameters but somewhat sensitive
to changes in surgery and treatment costs. CONCLUSIONS: Hepatic metastasectomy
is a cost-effective option for selected patients with metachronous
CRC metastases limited to the liver. When considering metastasectomy,
more aggressive approaches are generally preferred to less aggressive
approaches. Overall, surgeons should be encouraged to consider resection
for all patients whose metastases can technically be removed.
Stahl, James E.; Roberts, Mark S.; Gazelle, Scott
Optimizing management and financial performance of the teaching ambulatory care clinic. Journal Article
In: Journal of general internal medicine, vol. 18, pp. 266–274, 2003, ISSN: 0884-8734, ().
@article{Stahl2003,
title = {Optimizing management and financial performance of the teaching ambulatory care clinic.},
author = {James E. Stahl and Mark S. Roberts and Scott Gazelle},
url = {https://pubmed.ncbi.nlm.nih.gov/12709093/},
doi = {10.1046/j.1525-1497.2003.20726.x},
issn = {0884-8734},
year = {2003},
date = {2003-04-01},
journal = {Journal of general internal medicine},
volume = {18},
pages = {266--274},
abstract = {To examine how to optimize teaching ambulatory care clinics performance with regard to access to care, access to teaching, and financial viability. Optimization analysis using computer simulation. A discrete-event simulation model of the teaching ambulatory clinic setting was developed. This method captures flow time, waiting time, competition for resources, and the interdependency of events, providing insight into system dynamics. Sensitivity analyses were performed on staffing levels, room availability, patient characteristics such as "new" versus "established" status, and clinical complexity and pertinent probabilities. In the base-case, 4 trainees:preceptor, patient flow time (registration to check out) was 148 minutes (SD 5), wait time was 20.6 minutes (SD 4.4), the wait for precepting was 6.2 minutes (SD 1.2), and average daily net clinic income was $1,413. Utilization rates were preceptors (59%), trainees (61%), medical assistants (64%), and room (68%). Flow time and the wait times remained relatively constant for strategies with trainee:preceptor ratios \<4:1 but increased with number of trainees steadily thereafter. Maximum revenue occurred with 3 preceptors and 5 trainees per preceptor. The model was relatively insensitive to the proportion of patients presenting who were new, and relatively sensitive to average evaluation and management (E/M) level. Flow and wait times rose on average by 0.05 minutes and 0.01 minutes per percent new patient, respectively. For each increase in average E/M level, flow time increased 8.4 minutes, wait time 1.2 minutes, wait for precepting 0.8 minutes, and net income increased by $490. Teaching ambulatory care clinics appear to operate optimally, minimizing flow time and waiting time while maximizing revenue, with trainee-to-preceptor ratios between 3 and 7 to 1.},
keywords = {},
pubstate = {ppublish},
tppubtype = {article}
}
Stylopoulos, N.; Gazelle, G. Scott; Rattner, D. W.
A cost--utility analysis of treatment options for inguinal hernia in 1,513,008 adult patients Journal Article
In: Surg Endosc, vol. 17, no. 2, pp. 180-9, 2003, ISSN: 1432-2218 (Electronic) 0930-2794, ().
@article{Stylopoulos2003,
title = {A cost--utility analysis of treatment options for inguinal hernia in 1,513,008 adult patients},
author = {N. Stylopoulos and G. Scott Gazelle and D. W. Rattner},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12415334},
issn = {1432-2218 (Electronic) 0930-2794},
year = {2003},
date = {2003-02-01},
urldate = {2003-02-01},
journal = {Surg Endosc},
volume = {17},
number = {2},
pages = {180-9},
abstract = {BACKGROUND: The controversial issue of the cost-effectiveness of laparoscopic
inguinal hernia repair is examined, employing a decision analytic
method. MATERIALS AND METHODS: The NSAS, NHDS (National Center for
Health Statistics), HCUP-NIS (Agency for Healthcare Research and
Quality) databases and 51 randomized controlled trials were analyzed.
The study group constituted of a total of 1,513,008 hernia repairs.
Projection of the clinical, economic, and quality-of-life outcomes
expected from the different treatment options was done by using a
Markov Monte Carlo decision model. Two logistic regression models
were used to predict the probability of hospital admission after
an ambulatory procedure and the probability of death after inguinal
hernia repair. Four treatment strategies were modeled: (1) laparoscopic
repair (LR), (2) open mesh (OM), (3) open non-mesh (ONM), and (4)
expectant management. Costs were expressed in US dollars and effectiveness
in quality-adjusted life years (QALYs). The main outcome measures
were the average and the incremental cost-effectiveness (ICER) ratios.
RESULTS: Compared to the expectant management, the incremental cost
per QALY gained was 605 dollars (4086 dollars, 9.04 QALYs) for LR,
697 dollars (4290 dollars, 8.975 QALYs) for OM, and 1711 dollars
(6200 dollars, 8.546 QALYs) for ONM. In sensitivity analysis the
two major components that affect the cost-effectiveness ratio of
the different types of repair were the ambulatory facility cost and
the recurrence rate. At a LR ambulatory facility cost of 5526 dollars
the ICER of LR compared to OM surpasses the threshold of 50,000 dollars/QALY.
CONCLUSIONS: On the basis of our assumptions this mathematical model
shows that from a societal perspective laparoscopic approach can
be a cost-effective treatment option for inguinal hernia repair.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
inguinal hernia repair is examined, employing a decision analytic
method. MATERIALS AND METHODS: The NSAS, NHDS (National Center for
Health Statistics), HCUP-NIS (Agency for Healthcare Research and
Quality) databases and 51 randomized controlled trials were analyzed.
The study group constituted of a total of 1,513,008 hernia repairs.
Projection of the clinical, economic, and quality-of-life outcomes
expected from the different treatment options was done by using a
Markov Monte Carlo decision model. Two logistic regression models
were used to predict the probability of hospital admission after
an ambulatory procedure and the probability of death after inguinal
hernia repair. Four treatment strategies were modeled: (1) laparoscopic
repair (LR), (2) open mesh (OM), (3) open non-mesh (ONM), and (4)
expectant management. Costs were expressed in US dollars and effectiveness
in quality-adjusted life years (QALYs). The main outcome measures
were the average and the incremental cost-effectiveness (ICER) ratios.
RESULTS: Compared to the expectant management, the incremental cost
per QALY gained was 605 dollars (4086 dollars, 9.04 QALYs) for LR,
697 dollars (4290 dollars, 8.975 QALYs) for OM, and 1711 dollars
(6200 dollars, 8.546 QALYs) for ONM. In sensitivity analysis the
two major components that affect the cost-effectiveness ratio of
the different types of repair were the ambulatory facility cost and
the recurrence rate. At a LR ambulatory facility cost of 5526 dollars
the ICER of LR compared to OM surpasses the threshold of 50,000 dollars/QALY.
CONCLUSIONS: On the basis of our assumptions this mathematical model
shows that from a societal perspective laparoscopic approach can
be a cost-effective treatment option for inguinal hernia repair.
Livraghi, T.; Solbiati, L.; Meloni, M. F.; Gazelle, G. Scott; Halpern, Elkan F.; Goldberg, S. N.
Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study Journal Article
In: Radiology, vol. 226, no. 2, pp. 441-51, 2003, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Livraghi2003,
title = {Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study},
author = {T. Livraghi and L. Solbiati and M. F. Meloni and G. Scott Gazelle and Elkan F. Halpern and S. N. Goldberg},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12563138},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2003},
date = {2003-02-01},
urldate = {2003-02-01},
journal = {Radiology},
volume = {226},
number = {2},
pages = {441-51},
abstract = {PURPOSE: To report complications encountered by members of a collaborative
group who performed radio-frequency (RF) ablation in patients with
focal liver cancer. MATERIALS AND METHODS: Members of 41 Italian
centers that were part of a collaborative group used a percutaneous
internally cooled RF ablation technique and a standardized protocol
for follow-up. They completed a questionnaire regarding number of
deaths, presumed cause of death, and likelihood of its relationship
to the RF procedure; number and types of major complications; and
types of minor complications and side effects. Enrollment included
2,320 patients with 3,554 lesions (size, 3.1 cm +/- 1.1 [SD] in diameter):
1,610 had hepatocellular carcinoma with chronic liver disease; 693 had metastases, predominantly from colorectal cancer (n = 501); and
17 had cholangiocellular carcinoma. Number and characteristics of
complications (ie, deaths and major and minor complications) attributed
to the procedure were reported. Data were subsequently analyzed with
analysis of variance to determine whether the major complication
rate was related to tumor size, number of ablation sessions, or electrode
type (single or cluster). RESULTS: In total, 3,554 lesions were treated.
Six deaths (0.3%) were noted, including two caused by multiorgan
failure following intestinal perforation; one case each of septic
shock following Staphylococcus aureus-caused peritonitis, massive
hemorrhage following tumor rupture, liver failure following stenosis
of right bile duct; and one case of sudden death of unknown cause
3 days after the procedure. Fifty (2.2%) patients had additional
major complications. The most frequent of these were peritoneal hemorrhage,
neoplastic seeding, intrahepatic abscesses, and intestinal perforation.
An increased number of RF sessions were related to a higher rate
of major complications (P \<.01), whereas the number of complications
was not significantly different when tumor size or electrode type
were compared. Minor complications were observed in less than 5%
of patients. CONCLUSION: Results of this study confirm that RF ablation
is a relatively low-risk procedure for the treatment of focal liver
tumors.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
group who performed radio-frequency (RF) ablation in patients with
focal liver cancer. MATERIALS AND METHODS: Members of 41 Italian
centers that were part of a collaborative group used a percutaneous
internally cooled RF ablation technique and a standardized protocol
for follow-up. They completed a questionnaire regarding number of
deaths, presumed cause of death, and likelihood of its relationship
to the RF procedure; number and types of major complications; and
types of minor complications and side effects. Enrollment included
2,320 patients with 3,554 lesions (size, 3.1 cm +/- 1.1 [SD] in diameter):
1,610 had hepatocellular carcinoma with chronic liver disease; 693 had metastases, predominantly from colorectal cancer (n = 501); and
17 had cholangiocellular carcinoma. Number and characteristics of
complications (ie, deaths and major and minor complications) attributed
to the procedure were reported. Data were subsequently analyzed with
analysis of variance to determine whether the major complication
rate was related to tumor size, number of ablation sessions, or electrode
type (single or cluster). RESULTS: In total, 3,554 lesions were treated.
Six deaths (0.3%) were noted, including two caused by multiorgan
failure following intestinal perforation; one case each of septic
shock following Staphylococcus aureus-caused peritonitis, massive
hemorrhage following tumor rupture, liver failure following stenosis
of right bile duct; and one case of sudden death of unknown cause
3 days after the procedure. Fifty (2.2%) patients had additional
major complications. The most frequent of these were peritoneal hemorrhage,
neoplastic seeding, intrahepatic abscesses, and intestinal perforation.
An increased number of RF sessions were related to a higher rate
of major complications (P <.01), whereas the number of complications
was not significantly different when tumor size or electrode type
were compared. Minor complications were observed in less than 5%
of patients. CONCLUSION: Results of this study confirm that RF ablation
is a relatively low-risk procedure for the treatment of focal liver
tumors.
Visser, K.; Kuntz, K. M.; Donaldson, M. C.; Gazelle, G. Scott; Hunink, M. G.
Pretreatment imaging workup for patients with intermittent claudication: a cost-effectiveness analysis Journal Article
In: J Vasc Interv Radiol, vol. 14, no. 1, pp. 53-62, 2003, ISSN: 1051-0443 (Print) 1051-0443 (Lin, ().
@article{Visser2003,
title = {Pretreatment imaging workup for patients with intermittent claudication:
a cost-effectiveness analysis},
author = {K. Visser and K. M. Kuntz and M. C. Donaldson and G. Scott Gazelle and M. G. Hunink},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12525586},
issn = {1051-0443 (Print) 1051-0443 (Lin},
year = {2003},
date = {2003-01-01},
journal = {J Vasc Interv Radiol},
volume = {14},
number = {1},
pages = {53-62},
abstract = {PURPOSE: To determine the optimal imaging strategy in pretreatment
workup of patients with intermittent claudication with use of noninvasive
imaging modalities and intraarterial digital subtraction angiography
(DSA). MATERIALS AND METHODS: A decision-analytic model that considered
test characteristics such as sensitivity, complications induced by
the test, implications of missing lesions, and the consequences of
overtreating patients, was developed to evaluate the societal cost-effectiveness
(CE) of magnetic resonance (MR) angiography, duplex ultrasonography
(US), and DSA. Our main outcome measures were quality-adjusted life
years (QALYs), lifetime costs (in dollars), and incremental CE ratios.
The base-case analysis considered a cohort of 60-year old male patients
without a history of coronary artery disease who presented with severe
claudication to undergo pretreatment imaging workup. RESULTS: The
range in effectiveness and lifetime costs among different diagnostic
workup strategies was small (largest difference in effectiveness:
0.025 QALYs; largest difference in lifetime costs: $1,800). If treatment
was limited to angioplasty in patients with suitable lesions, MR
angiography had an incremental CE ratio of $35,000 per QALY compared
with no diagnostic workup, and DSA had an incremental CE ratio of
$471,000 per QALY compared with MR angiography. If treatment options
included both angioplasty and bypass surgery, DSA had an incremental
CE ratio of $179,000 per QALY compared with no diagnostic workup,
and MR angiography and duplex US were less effective and more costly.
CONCLUSIONS: The differences in costs and effectiveness among diagnostic
imaging strategies for patients with intermittent claudication are
slight and MR angiography or duplex US can replace DSA without substantial
loss in effectiveness and with a slight cost reduction.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
workup of patients with intermittent claudication with use of noninvasive
imaging modalities and intraarterial digital subtraction angiography
(DSA). MATERIALS AND METHODS: A decision-analytic model that considered
test characteristics such as sensitivity, complications induced by
the test, implications of missing lesions, and the consequences of
overtreating patients, was developed to evaluate the societal cost-effectiveness
(CE) of magnetic resonance (MR) angiography, duplex ultrasonography
(US), and DSA. Our main outcome measures were quality-adjusted life
years (QALYs), lifetime costs (in dollars), and incremental CE ratios.
The base-case analysis considered a cohort of 60-year old male patients
without a history of coronary artery disease who presented with severe
claudication to undergo pretreatment imaging workup. RESULTS: The
range in effectiveness and lifetime costs among different diagnostic
workup strategies was small (largest difference in effectiveness:
0.025 QALYs; largest difference in lifetime costs: $1,800). If treatment
was limited to angioplasty in patients with suitable lesions, MR
angiography had an incremental CE ratio of $35,000 per QALY compared
with no diagnostic workup, and DSA had an incremental CE ratio of
$471,000 per QALY compared with MR angiography. If treatment options
included both angioplasty and bypass surgery, DSA had an incremental
CE ratio of $179,000 per QALY compared with no diagnostic workup,
and MR angiography and duplex US were less effective and more costly.
CONCLUSIONS: The differences in costs and effectiveness among diagnostic
imaging strategies for patients with intermittent claudication are
slight and MR angiography or duplex US can replace DSA without substantial
loss in effectiveness and with a slight cost reduction.
Livraghi, T.; Solbiati, L.; Meloni, F.; Ierace, T.; Goldberg, S. N.; Gazelle, G. Scott
Percutaneous radiofrequency ablation of liver metastases in potential candidates for resection: the "test-of-time approach" Journal Article
In: Cancer, vol. 97, pp. 3027-35, 2003, ().
@article{Livraghi2003a,
title = {Percutaneous radiofrequency ablation of liver metastases in potential
candidates for resection: the "test-of-time approach"},
author = {T. Livraghi and L. Solbiati and F. Meloni and T. Ierace and S. N. Goldberg and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12784338},
year = {2003},
date = {2003-01-01},
journal = {Cancer},
volume = {97},
pages = {3027-35},
abstract = {BACKGROUND: Some surgeons have advocated delaying resection of liver
metastases to allow additional metastases which may be present, but
are undetected, to be identified. This "test-of-time" approach can
limit the number of resections performed on patients who ultimately
will develop additional metastases. The current study evaluated the
potential role and possible advantages of performing radiofrequency
(RF) ablation during the interval between diagnosis and hepatic metastasectomy
as part of a test-of-time management approach. METHODS: Eighty-eight
consecutive patients with 134 colorectal carcinoma liver metastases
were potential candidates for hepatic metastasectomy. They were treated
with percutaneous RF ablation using single (101 treatments) or triple-probe
cluster (22 treatments) 18-gauge internally cooled electrodes. Treatment
was performed under conscious sedation (22 of 119 treatments), anesthesia
(14 of 119 treatments), or general anesthesia (83 of 119 treatments).
At the time of the initial RF ablation procedure, 49 of 88 patients
(56 were found to have 1 metastasis, 32 of 88 patients (36 had 2
metastases, and 7 of 88 patients (8 had 3 metastases. Metastases
ranged from 0.6 to 4.0 cm in greatest dimension (mean, 2.1 cm). Follow-up
with serial computed tomography scans scans ranged from 18 to 75
months (median, 33 months) after the initial RF ablation. RESULTS:
A total of 119 RF ablations were performed. Complete necrosis was
obtained in 53 of 88 patients (60 and in 85 of 134 lesions (63. During
follow-up of these 53 patients, 16 (30 remained free of disease and
37 (70 developed new lesions. New lesions were intrahepatic in 26
of 37 patients (70, extrahepatic in 4 patients (11, and both intrahepatic
and extrahepatic in 7 patients (19. Of 26 patients whose new lesions
were intrahepatic only, 15 (58 were retreated with RF and 7 were
free of disease at the time of last follow-up (median follow-up,
28 months). Ten additional patients with only intrahepatic new lesions
were deemed untreatable and 1 patient underwent resection. Overall,
among the 53 patients in whom complete tumor necrosis was achieved
after RF ablation therapy, 52 (98 were spared surgical resection:
23 (44 because they have remained free of disease and 29 (56 because
they developed disease progression. Among all 88 patients, 21 (24
underwent resection after RF ablation (8 were free of disease at
the time of last follow-up), 23 (26 remained free of disease after
successful RF ablation, and 56 (64 developed untreatable disease
progression (44 after RF alone, 12 after RF and surgery). Lesions
in 35 of 88 patients (40 demonstrated local tumor recurrence on follow-up
imaging studies. Twenty of these 35 patients (57 underwent surgical
resection, whereas the remaining 15 patients (43 developed additional,
untreatable metastases. New lesions were intrahepatic in 9 of 15
patients (60, extrahepatic in 1 of 15 patients (7, and both intrahepatic
and extrahepatic in 5 of 15 patients (33. No patient who had been
treated with RF ablation became unresectable due to the growth of
metastases and there was no evidence of needle track seeding in any
patient after RF ablation. Overall, among the 35 patients in whom
complete tumor necrosis was not achieved after RF ablation therapy,
15 (43 were spared surgical resection. CONCLUSIONS: The results of
the current study suggest that current RF ablation techniques, when
used as part of a test-of-time management approach, can decrease
the number of resections performed. The approach results in complete
tumor necrosis in some patients and provide an interval for others
who ultimately will develop new intrahepatic and/or extrahepatic
metastases to do so.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
metastases to allow additional metastases which may be present, but
are undetected, to be identified. This "test-of-time" approach can
limit the number of resections performed on patients who ultimately
will develop additional metastases. The current study evaluated the
potential role and possible advantages of performing radiofrequency
(RF) ablation during the interval between diagnosis and hepatic metastasectomy
as part of a test-of-time management approach. METHODS: Eighty-eight
consecutive patients with 134 colorectal carcinoma liver metastases
were potential candidates for hepatic metastasectomy. They were treated
with percutaneous RF ablation using single (101 treatments) or triple-probe
cluster (22 treatments) 18-gauge internally cooled electrodes. Treatment
was performed under conscious sedation (22 of 119 treatments), anesthesia
(14 of 119 treatments), or general anesthesia (83 of 119 treatments).
At the time of the initial RF ablation procedure, 49 of 88 patients
(56 were found to have 1 metastasis, 32 of 88 patients (36 had 2
metastases, and 7 of 88 patients (8 had 3 metastases. Metastases
ranged from 0.6 to 4.0 cm in greatest dimension (mean, 2.1 cm). Follow-up
with serial computed tomography scans scans ranged from 18 to 75
months (median, 33 months) after the initial RF ablation. RESULTS:
A total of 119 RF ablations were performed. Complete necrosis was
obtained in 53 of 88 patients (60 and in 85 of 134 lesions (63. During
follow-up of these 53 patients, 16 (30 remained free of disease and
37 (70 developed new lesions. New lesions were intrahepatic in 26
of 37 patients (70, extrahepatic in 4 patients (11, and both intrahepatic
and extrahepatic in 7 patients (19. Of 26 patients whose new lesions
were intrahepatic only, 15 (58 were retreated with RF and 7 were
free of disease at the time of last follow-up (median follow-up,
28 months). Ten additional patients with only intrahepatic new lesions
were deemed untreatable and 1 patient underwent resection. Overall,
among the 53 patients in whom complete tumor necrosis was achieved
after RF ablation therapy, 52 (98 were spared surgical resection:
23 (44 because they have remained free of disease and 29 (56 because
they developed disease progression. Among all 88 patients, 21 (24
underwent resection after RF ablation (8 were free of disease at
the time of last follow-up), 23 (26 remained free of disease after
successful RF ablation, and 56 (64 developed untreatable disease
progression (44 after RF alone, 12 after RF and surgery). Lesions
in 35 of 88 patients (40 demonstrated local tumor recurrence on follow-up
imaging studies. Twenty of these 35 patients (57 underwent surgical
resection, whereas the remaining 15 patients (43 developed additional,
untreatable metastases. New lesions were intrahepatic in 9 of 15
patients (60, extrahepatic in 1 of 15 patients (7, and both intrahepatic
and extrahepatic in 5 of 15 patients (33. No patient who had been
treated with RF ablation became unresectable due to the growth of
metastases and there was no evidence of needle track seeding in any
patient after RF ablation. Overall, among the 35 patients in whom
complete tumor necrosis was not achieved after RF ablation therapy,
15 (43 were spared surgical resection. CONCLUSIONS: The results of
the current study suggest that current RF ablation techniques, when
used as part of a test-of-time management approach, can decrease
the number of resections performed. The approach results in complete
tumor necrosis in some patients and provide an interval for others
who ultimately will develop new intrahepatic and/or extrahepatic
metastases to do so.
Halpern, Elkan F.; Gazelle, G. Scott
Probability in radiology Journal Article
In: Radiology, vol. 226, no. 1, pp. 12-5, 2003, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Halpern2003,
title = {Probability in radiology},
author = {Elkan F. Halpern and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12511662},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2003},
date = {2003-01-01},
journal = {Radiology},
volume = {226},
number = {1},
pages = {12-5},
abstract = {In this article, a summary of the basic rules of probability using
examples of their application in radiology is presented. Those rules
describe how probabilities may be combined to obtain the chance of
"success" with either of two diagnostic or therapeutic procedures
or with both. They define independence and relate it to the conditional
probability. They describe the relationship (Bayes rule) between
sensitivity, specificity, and prevalence on the one hand and the
positive and negative predictive values on the other. Finally, the
two distributions most commonly encountered in statistical models
of radiologic data are presented: the binomial and normal distributions.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
examples of their application in radiology is presented. Those rules
describe how probabilities may be combined to obtain the chance of
"success" with either of two diagnostic or therapeutic procedures
or with both. They define independence and relate it to the conditional
probability. They describe the relationship (Bayes rule) between
sensitivity, specificity, and prevalence on the one hand and the
positive and negative predictive values on the other. Finally, the
two distributions most commonly encountered in statistical models
of radiologic data are presented: the binomial and normal distributions.
Carson, Paul L.; Giger, Maryellen; Welch, Michael J.; Halpern, Howard; Kurdziel, Karen; Vannier, Michael; Evelhoch, Jeffrey L.; Gazelle, G. Scott; Seltzer, Steven E.; Judy, Philip; Hendee, William R.; Bourland, J. Daniel
Biomedical Imaging Research Opportunities Workshop: report and recommendations Journal Article
In: Radiology, vol. 229, pp. 328-39, 2003, ().
@article{Carson2003,
title = {Biomedical Imaging Research Opportunities Workshop: report and recommendations},
author = {Paul L. Carson and Maryellen Giger and Michael J. Welch and Howard Halpern and Karen Kurdziel and Michael Vannier and Jeffrey L. Evelhoch and G. Scott Gazelle and Steven E. Seltzer and Philip Judy and William R. Hendee and J. Daniel Bourland},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12925715},
year = {2003},
date = {2003-01-01},
journal = {Radiology},
volume = {229},
pages = {328-39},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2002
Beinfeld, M. T.; Bosch, Johanna; Gazelle, G. Scott
Hospital costs of uterine artery embolization and hysterectomy for uterine fibroid tumors Journal Article
In: Acad Radiol, vol. 9, no. 11, pp. 1300-4, 2002, ISSN: 1076-6332 (Print) 1076-6332 (Lin, ().
@article{Beinfeld2002,
title = {Hospital costs of uterine artery embolization and hysterectomy for uterine fibroid tumors},
author = {M. T. Beinfeld and Johanna Bosch and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12449362},
issn = {1076-6332 (Print) 1076-6332 (Lin},
year = {2002},
date = {2002-11-01},
urldate = {2002-11-01},
journal = {Acad Radiol},
volume = {9},
number = {11},
pages = {1300-4},
abstract = {RATIONALE AND OBJECTIVES: The purpose of this study was to compare
the total actual hospital costs of uterine artery embolization (UAE)
and hysterectomy for treatment of uterine fibroid tumors and to evaluate
factors that might influence cost. MATERIALS AND METHODS: Total actual
hospital costs were collected from the institution's cost accounting system on patients who underwent UAE (n = 57) or hysterectomy (n = 300) for uterine fibroids between 1998 and 2001. Electronic medical
records were reviewed to collect clinical information. Standard statistical
techniques were used to determine which factors influenced hospital
costs. RESULTS: The mean total actual hospital costs of UAE were
significantly higher than hysterectomy ($8,223 vs $6,046, P \< .0001),
but the mean length of stay was shorter (0.95 vs 2.6 days, P \< .0001).
In linear regression analyses, complications were predictive of increased
costs of UAE; length of stay, complications, and laparoscopic hysterectomy
were predictive of increased costs of hysterectomy. CONCLUSION: Hospital
costs of UAE were higher than hysterectomy for the treatment of uterine
fibroids, but the hospital stays were shorter.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
the total actual hospital costs of uterine artery embolization (UAE)
and hysterectomy for treatment of uterine fibroid tumors and to evaluate
factors that might influence cost. MATERIALS AND METHODS: Total actual
hospital costs were collected from the institution's cost accounting system on patients who underwent UAE (n = 57) or hysterectomy (n = 300) for uterine fibroids between 1998 and 2001. Electronic medical
records were reviewed to collect clinical information. Standard statistical
techniques were used to determine which factors influenced hospital
costs. RESULTS: The mean total actual hospital costs of UAE were
significantly higher than hysterectomy ($8,223 vs $6,046, P < .0001),
but the mean length of stay was shorter (0.95 vs 2.6 days, P < .0001).
In linear regression analyses, complications were predictive of increased
costs of UAE; length of stay, complications, and laparoscopic hysterectomy
were predictive of increased costs of hysterectomy. CONCLUSION: Hospital
costs of UAE were higher than hysterectomy for the treatment of uterine
fibroids, but the hospital stays were shorter.
Stylopoulos, Nicholas; Gazelle, G. Scott; Rattner, David W.
Paraesophageal hernias: operation or observation? Journal Article
In: Annals of surgery, vol. 236, pp. 492–500; discussion 500-1, 2002, ISSN: 0003-4932, ().
@article{Stylopoulos2002,
title = {Paraesophageal hernias: operation or observation?},
author = {Nicholas Stylopoulos and G. Scott Gazelle and David W. Rattner},
url = {https://pubmed.ncbi.nlm.nih.gov/12368678/},
doi = {10.1097/00000658-200210000-00012},
issn = {0003-4932},
year = {2002},
date = {2002-10-01},
journal = {Annals of surgery},
volume = {236},
pages = {492--500; discussion 500-1},
abstract = {To examine the hypothesis that elective laparoscopic repair should be routinely performed on patients with asymptomatic or minimally symptomatic paraesophageal hernias. The management of asymptomatic paraesophageal hernias is a controversial issue. Most surgeons believe that all paraesophageal hernias should be corrected electively on diagnosis, irrespective of symptoms, to prevent the development of complications and avoid the risk of emergency surgery. A Markov Monte Carlo decision analytic model was developed to track a hypothetical cohort of patients with asymptomatic or minimally symptomatic paraesophageal hernia and reflect the possible clinical outcomes associated with two treatment strategies: elective laparoscopic paraesophageal hernia repair (ELHR) or watchful waiting (WW). The input variables for ELHR were estimated from a pooled analysis of 20 published studies, while those for WW and emergency surgery were derived from the 1997 HCUP-NIS database and surgical literature published from 1964 to 2000. Outcomes for the two strategies were expressed in quality-adjusted life-years (QALYs). Analysis of the HCUP-NIS database showed that published studies overestimate the mortality of emergency surgery (17% vs. 5.4%). The mortality rate of ELHR was 1.4%. The annual probability of developing acute symptoms requiring emergency surgery with the WW strategy was 1.1%. For patients 65 years of age, ELHR resulted in reduction of 0.13 QALYs (10.78 vs. 10.65) compared with WW. The model predicted that WW was the optimal treatment strategy in 83% of patients and ELHR in the remaining 17%. The model was sensitive only to alterations of the mortality rates of ELHR and emergency surgery. If ELHR is routinely recommended, it would be more beneficial than WW in fewer than one of five patients. WW is a reasonable alternative for the initial management of patients with asymptomatic or minimally symptomatic paraesophageal hernias, and even if an emergency operation is required, the burden of the procedure is not as severe as was thought in the past.},
keywords = {},
pubstate = {ppublish},
tppubtype = {article}
}
Monsky, W. L.; Kruskal, J. B.; Lukyanov, A. N.; Girnun, G. D.; Ahmed, M.; Gazelle, G. Scott; Huertas, J. C.; Stuart, K. E.; Torchilin, V. P.; Goldberg, S. N.
Radio-frequency ablation increases intratumoral liposomal doxorubicin accumulation in a rat breast tumor model Journal Article
In: Radiology, vol. 224, no. 3, pp. 823-9, 2002, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Monsky2002,
title = {Radio-frequency ablation increases intratumoral liposomal doxorubicin
accumulation in a rat breast tumor model},
author = {W. L. Monsky and J. B. Kruskal and A. N. Lukyanov and G. D. Girnun and M. Ahmed and G. Scott Gazelle and J. C. Huertas and K. E. Stuart and V. P. Torchilin and S. N. Goldberg},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12202721},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2002},
date = {2002-09-01},
journal = {Radiology},
volume = {224},
number = {3},
pages = {823-9},
abstract = {PURPOSE: To determine whether intratumoral accumulation of liposomal
doxorubicin or free unencapsulated doxorubicin is increased when
combined with radio-frequency (RF) ablation. MATERIALS AND METHODS:
Two 1.2-1.5-cm R3230 mammary adenocarcinomas were grown within the
mammary fat pads of 19 female Fischer rats. One tumor of each pair
was treated with RF ablation (tip temperature, 70 degrees C +/- 2
[SD]; 120 mA +/- 75) for 5 minutes, whereas the other tumor was a
control. Intravenous liposomal doxorubicin (1 mg in 500 micro},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
doxorubicin or free unencapsulated doxorubicin is increased when
combined with radio-frequency (RF) ablation. MATERIALS AND METHODS:
Two 1.2-1.5-cm R3230 mammary adenocarcinomas were grown within the
mammary fat pads of 19 female Fischer rats. One tumor of each pair
was treated with RF ablation (tip temperature, 70 degrees C +/- 2
[SD]; 120 mA +/- 75) for 5 minutes, whereas the other tumor was a
control. Intravenous liposomal doxorubicin (1 mg in 500 micro
Adriaensen, M. E.; Bosch, Johanna; Halpern, Elkan F.; Hunink, M. G. Myriam; Gazelle, G. Scott
Elective endovascular versus open surgical repair of abdominal aortic aneurysms: systematic review of short-term results Journal Article
In: Radiology, vol. 224, no. 3, pp. 739-47, 2002, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Adriaensen2002,
title = {Elective endovascular versus open surgical repair of abdominal aortic aneurysms: systematic review of short-term results},
author = {M. E. Adriaensen and Johanna Bosch and Elkan F. Halpern and M. G. Myriam Hunink and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12202708},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2002},
date = {2002-09-01},
urldate = {2002-09-01},
journal = {Radiology},
volume = {224},
number = {3},
pages = {739-47},
abstract = {PURPOSE: To summarize and compare published short-term results of
elective endovascular and open surgical repair of abdominal aortic
aneurysms. MATERIALS AND METHODS: A MEDLINE search of the English
literature was performed. Studies with at least 10 patients in each
treatment group were included if they reported patient characteristics,
complications, and mortality. Two reviewers independently extracted
the data. A random-effects model was used to pool the data and calculate
pooled odds ratios (endovascular vs open surgical repair). RESULTS:
Nine studies were included, reporting results of 1,318 procedures
(687 endovascular repair and 631 open surgical repair). Mean blood
loss was 456 mL for endovascular repair and 1,202 mL for open surgical repair (P =.003). On average, patients undergoing endovascular repair
spent 0.5 days in the intensive care unit and 3.9 days in the hospital, and patients undergoing open surgical repair spent 2.2 days (P =.04) in the intensive care unit and 10.3 days (P =.02) in the hospital.
The pooled 30-day-mortality was 0.03 for endovascular repair (95%
CI: 0.02, 0.04) and 0.04 for open surgical repair (95% CI: 0.00, 0.07) (P =.03), and the odds ratio was 0.55 (95% CI: 0.33, 0.92).
The pooled local and/or vascular complication rate was 0.16 for endovascular
repair (95% CI: 0.06, 0.25) and 0.12 for open surgical repair (95% CI: 0.06, 0.18) (P =.46), and the odds ratio was 0.97 (95% CI: 0.62,
1.54). The pooled systemic and/or remote complication rate was 0.17
for endovascular repair (95% CI: 0.09, 0.25) and 0.44 for open surgical
repair (95% CI: 0.21, 0.66) (P \<.001), and the odds ratio was 0.22
(95% CI: 0.11, 0.45). CONCLUSION: On the basis of this systematic
review, endovascular repair results in less blood loss, shorter intensive
care unit and hospital stays, lower 30-day mortality, and lower systemic
and/or remote complication rates than those of open surgical repair.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
elective endovascular and open surgical repair of abdominal aortic
aneurysms. MATERIALS AND METHODS: A MEDLINE search of the English
literature was performed. Studies with at least 10 patients in each
treatment group were included if they reported patient characteristics,
complications, and mortality. Two reviewers independently extracted
the data. A random-effects model was used to pool the data and calculate
pooled odds ratios (endovascular vs open surgical repair). RESULTS:
Nine studies were included, reporting results of 1,318 procedures
(687 endovascular repair and 631 open surgical repair). Mean blood
loss was 456 mL for endovascular repair and 1,202 mL for open surgical repair (P =.003). On average, patients undergoing endovascular repair
spent 0.5 days in the intensive care unit and 3.9 days in the hospital, and patients undergoing open surgical repair spent 2.2 days (P =.04) in the intensive care unit and 10.3 days (P =.02) in the hospital.
The pooled 30-day-mortality was 0.03 for endovascular repair (95%
CI: 0.02, 0.04) and 0.04 for open surgical repair (95% CI: 0.00, 0.07) (P =.03), and the odds ratio was 0.55 (95% CI: 0.33, 0.92).
The pooled local and/or vascular complication rate was 0.16 for endovascular
repair (95% CI: 0.06, 0.25) and 0.12 for open surgical repair (95% CI: 0.06, 0.18) (P =.46), and the odds ratio was 0.97 (95% CI: 0.62,
1.54). The pooled systemic and/or remote complication rate was 0.17
for endovascular repair (95% CI: 0.09, 0.25) and 0.44 for open surgical
repair (95% CI: 0.21, 0.66) (P <.001), and the odds ratio was 0.22
(95% CI: 0.11, 0.45). CONCLUSION: On the basis of this systematic
review, endovascular repair results in less blood loss, shorter intensive
care unit and hospital stays, lower 30-day mortality, and lower systemic
and/or remote complication rates than those of open surgical repair.
Ahmed, M.; Lobo, S. M.; Weinstein, J.; Kruskal, J. B.; Gazelle, G. Scott; Halpern, Elkan F.; Afzal, S. K.; Lenkinski, R. E.; Goldberg, S. N.
Improved coagulation with saline solution pretreatment during radiofrequency tumor ablation in a canine model Journal Article
In: J Vasc Interv Radiol, vol. 13, no. 7, pp. 717-24, 2002, ISSN: 1051-0443 (Print) 1051-0443 (Lin, ().
@article{Ahmed2002,
title = {Improved coagulation with saline solution pretreatment during radiofrequency tumor ablation in a canine model},
author = {M. Ahmed and S. M. Lobo and J. Weinstein and J. B. Kruskal and G. Scott Gazelle and Elkan F. Halpern and S. K. Afzal and R. E. Lenkinski and S. N. Goldberg},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12119331},
issn = {1051-0443 (Print) 1051-0443 (Lin},
year = {2002},
date = {2002-07-01},
urldate = {2002-07-01},
journal = {J Vasc Interv Radiol},
volume = {13},
number = {7},
pages = {717-24},
abstract = {PURPOSE: To determine whether pretreatment with local NaCl injection
can increase radiofrequency (RF)-induced coagulation in a large animal
model. MATERIAL AND METHODS: Multiple canine venereal sarcomas (n = 25) were implanted subcutaneously in eight mildly immunosuppressed
dogs (25 mg/kg cyclosporin A twice daily). Tumors were incubated
for 8-12 weeks to a diameter of 4.2-6.3 cm (5.1 cm +/- 0.7). Internally
cooled RF ablation (1-cm tip; 12 min; pulsed technique; 2,000-mA
maximum) was performed. Tumors were pretreated with 6 mL of 18%,
24%, or 36% NaCl injected intratumorally under direct ultrasound
guidance after RF electrode insertion, and this treatment was compared
to RF treatment without NaCl injection and to 36% NaCl injection
without RF ablation. Impedance measurements and remote thermometry
were performed. These measurements and resultant coagulation were
compared. RESULTS: Significantly greater RF heating (73 degrees C
+/- 11 degrees C at 20 mm) was observed when the tumors were treated
with 24% or 36% NaCl pretreatment, compared to the 47 degrees C +/-
5 degrees C observed when 18% or no NaCl was injected (P \<.02). In
the 36% NaCl group, the entire tumor (5.2 cm +/- 0.8 diameter) was
completely ablated in every case, with coagulation extending several
centimeters into the surrounding tissues. By comparison, control
tumors (without NaCl injection) contained coagulation measuring 3.1
cm +/- 0.2, surrounded by viable, well-perfused tumor (P \<.01), and
36% NaCl alone produced 2.7 cm +/- 0.6 of patchy necrosis. CONCLUSIONS:
Pretreatment with intratumoral injection of small volumes of highly
concentrated NaCl markedly increases RF heating and coagulation in
a large animal tumor model. The complete destruction of tumors 5
cm in diameter or larger suggests that this substantial increase
may be achieved for tumor ablation in clinical practice.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
can increase radiofrequency (RF)-induced coagulation in a large animal
model. MATERIAL AND METHODS: Multiple canine venereal sarcomas (n = 25) were implanted subcutaneously in eight mildly immunosuppressed
dogs (25 mg/kg cyclosporin A twice daily). Tumors were incubated
for 8-12 weeks to a diameter of 4.2-6.3 cm (5.1 cm +/- 0.7). Internally
cooled RF ablation (1-cm tip; 12 min; pulsed technique; 2,000-mA
maximum) was performed. Tumors were pretreated with 6 mL of 18%,
24%, or 36% NaCl injected intratumorally under direct ultrasound
guidance after RF electrode insertion, and this treatment was compared
to RF treatment without NaCl injection and to 36% NaCl injection
without RF ablation. Impedance measurements and remote thermometry
were performed. These measurements and resultant coagulation were
compared. RESULTS: Significantly greater RF heating (73 degrees C
+/- 11 degrees C at 20 mm) was observed when the tumors were treated
with 24% or 36% NaCl pretreatment, compared to the 47 degrees C +/-
5 degrees C observed when 18% or no NaCl was injected (P <.02). In
the 36% NaCl group, the entire tumor (5.2 cm +/- 0.8 diameter) was
completely ablated in every case, with coagulation extending several
centimeters into the surrounding tissues. By comparison, control
tumors (without NaCl injection) contained coagulation measuring 3.1
cm +/- 0.2, surrounded by viable, well-perfused tumor (P <.01), and
36% NaCl alone produced 2.7 cm +/- 0.6 of patchy necrosis. CONCLUSIONS:
Pretreatment with intratumoral injection of small volumes of highly
concentrated NaCl markedly increases RF heating and coagulation in
a large animal tumor model. The complete destruction of tumors 5
cm in diameter or larger suggests that this substantial increase
may be achieved for tumor ablation in clinical practice.
Goldberg, S. N.; Girnan, G. D.; Lukyanov, A. N.; Ahmed, M.; Monsky, W. L.; Gazelle, G. Scott; Huertas, J. C.; Stuart, K. E.; Jacobs, T.; Torchillin, V. P.; Halpern, Elkan F.; Kruskal, J. B.
In: Radiology, vol. 222, no. 3, pp. 797-804, 2002, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Goldberg2002,
title = {Percutaneous tumor ablation: increased necrosis with combined radio-frequency
ablation and intravenous liposomal doxorubicin in a rat breast tumor
model},
author = {S. N. Goldberg and G. D. Girnan and A. N. Lukyanov and M. Ahmed and W. L. Monsky and G. Scott Gazelle and J. C. Huertas and K. E. Stuart and T. Jacobs and V. P. Torchillin and Elkan F. Halpern and J. B. Kruskal},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11867804},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2002},
date = {2002-03-01},
journal = {Radiology},
volume = {222},
number = {3},
pages = {797-804},
abstract = {PURPOSE: To determine whether a combination of intravenous liposomal
doxorubicin and radio-frequency (RF) ablation increases tumor destruction
compared with RF alone in an animal tumor model. MATERIALS AND METHODS:
R3230 mammary adenocarcinoma 1.4-1.8-cm- diameter nodules were implanted
subcutaneously in 132 female Fischer rats. Initially, tumors were
treated with (a) conventional, monopolar RF (mean, 250 mA +/- 25
[SD] at 70 degrees C +/- 1 for 5 minutes) ablation alone, (b) RF
ablation followed by intravenous administration of 1 mg of liposomal
doxorubicin, (c) RF ablation followed by intravenous administration
of 1 mg of empty liposomes, (d) RF ablation and direct intratumoral
administration of liposomal doxorubicin, or (e) no treatment. Subsequently,
the dose (0.06-2.00 mg) of liposomal doxorubicin, the timing of administration
(3 days before to 3 days after RF ablation), and the time of pathologic
examination (0-72 hours after treatment) were varied. RESULTS: Mean
coagulation diameter for treated tumors follows: 6.7 mm +/- 0.6,
RF ablation alone; 11.1 mm +/- 1.5, RF ablation and intravenous administration
of empty liposomes (P \<.05, compared with RF ablation alone); and
8.4 mm +/- 1.1, RF ablation with intratumoral administration of liposomal
doxorubicin (P \<.05, compared with RF ablation alone). Maximal increased
mean coagulation diameter (13.1 mm +/- 1.5) was observed with a combination
of liposomal doxorubicin and RF ablation (P \<.001, for all comparisons).
The increased coagulation for combination therapy developed over
48 hours after therapy. Coagulation diameter did not vary with the
doxorubicin concentration range and was not dependent on the timing
of administration of liposomal doxorubicin from 3 days before to
24 hours after RF ablation. CONCLUSION: Intravenous administration
of liposomal doxorubicin can improve RF ablation, since it increases
coagulation diameter in solid tumors compared with RF ablation alone
or a combination of RF ablation with administration of empty liposomes.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
doxorubicin and radio-frequency (RF) ablation increases tumor destruction
compared with RF alone in an animal tumor model. MATERIALS AND METHODS:
R3230 mammary adenocarcinoma 1.4-1.8-cm- diameter nodules were implanted
subcutaneously in 132 female Fischer rats. Initially, tumors were
treated with (a) conventional, monopolar RF (mean, 250 mA +/- 25
[SD] at 70 degrees C +/- 1 for 5 minutes) ablation alone, (b) RF
ablation followed by intravenous administration of 1 mg of liposomal
doxorubicin, (c) RF ablation followed by intravenous administration
of 1 mg of empty liposomes, (d) RF ablation and direct intratumoral
administration of liposomal doxorubicin, or (e) no treatment. Subsequently,
the dose (0.06-2.00 mg) of liposomal doxorubicin, the timing of administration
(3 days before to 3 days after RF ablation), and the time of pathologic
examination (0-72 hours after treatment) were varied. RESULTS: Mean
coagulation diameter for treated tumors follows: 6.7 mm +/- 0.6,
RF ablation alone; 11.1 mm +/- 1.5, RF ablation and intravenous administration
of empty liposomes (P <.05, compared with RF ablation alone); and
8.4 mm +/- 1.1, RF ablation with intratumoral administration of liposomal
doxorubicin (P <.05, compared with RF ablation alone). Maximal increased
mean coagulation diameter (13.1 mm +/- 1.5) was observed with a combination
of liposomal doxorubicin and RF ablation (P <.001, for all comparisons).
The increased coagulation for combination therapy developed over
48 hours after therapy. Coagulation diameter did not vary with the
doxorubicin concentration range and was not dependent on the timing
of administration of liposomal doxorubicin from 3 days before to
24 hours after RF ablation. CONCLUSION: Intravenous administration
of liposomal doxorubicin can improve RF ablation, since it increases
coagulation diameter in solid tumors compared with RF ablation alone
or a combination of RF ablation with administration of empty liposomes.
Gazelle, G. Scott; Dunnick, N. R.
Subsidizing radiology research Journal Article
In: Acad Radiol, vol. 9, no. 2, pp. 195-7, 2002, ISSN: 1076-6332 (Print) 1076-6332 (Lin, ().
@article{Gazelle2002,
title = {Subsidizing radiology research},
author = {G. Scott Gazelle and N. R. Dunnick},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11918372},
issn = {1076-6332 (Print) 1076-6332 (Lin},
year = {2002},
date = {2002-02-01},
journal = {Acad Radiol},
volume = {9},
number = {2},
pages = {195-7},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Shaffer, D. W.; Kigin, C. M.; Kaput, J. J.; Gazelle, G. Scott
What is digital medicine? Journal Article
In: Stud Health Technol Inform, vol. 80, pp. 195-204, 2002, ().
@article{Shaffer2002,
title = {What is digital medicine?},
author = {D. W. Shaffer and C. M. Kigin and J. J. Kaput and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12026129},
year = {2002},
date = {2002-01-01},
journal = {Stud Health Technol Inform},
volume = {80},
pages = {195-204},
abstract = {Changes in health care are a fundamental part of social and intellectual
evolution. The modern practice of scientific medicine depends on
the existence of the written and printed word to store medical information.
Because computers can transform information as well as store it,
new digital tools cannot only record clinical data, they can also
generate medical knowledge. In doing so, they make it possible to
develop "digital medicine" that is potentially more precise, more
effective, more experimental, more widely distributed, and more egalitarian
than current medical practice. Critical steps in the creation of
digital medicine are careful analysis of the impact of new technologies
and coordinated efforts to direct technological development towards
creating a new paradigm of medical care.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
evolution. The modern practice of scientific medicine depends on
the existence of the written and printed word to store medical information.
Because computers can transform information as well as store it,
new digital tools cannot only record clinical data, they can also
generate medical knowledge. In doing so, they make it possible to
develop "digital medicine" that is potentially more precise, more
effective, more experimental, more widely distributed, and more egalitarian
than current medical practice. Critical steps in the creation of
digital medicine are careful analysis of the impact of new technologies
and coordinated efforts to direct technological development towards
creating a new paradigm of medical care.
Bosch, Johanna; Halpern, Elkan F.; Gazelle, G. Scott
In: Med Decis Making, vol. 22, pp. 403-9, 2002, ().
@article{Bosch2002,
title = {Comparison of preference-based utilities of the Short-Form 36 Health Survey and Health Utilities Index before and after treatment of patients with intermittent claudication},
author = {Johanna Bosch and Elkan F. Halpern and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12365482},
year = {2002},
date = {2002-01-01},
urldate = {2002-01-01},
journal = {Med Decis Making},
volume = {22},
pages = {403-9},
abstract = {The authors compared SF-36 utilities with Health Utilities Index (HUI)
utilities (HUI2 and HUI3) assessed in patients with intermittent
claudication. A total of 87 patients with intermittent claudication
completed the SF-36 and HUI before and 1, 3, and 12 months after
revascularization. Utilities were estimated using SF-36 and HUI published
algorithms (i.e., both algorithms were based on standard-gamble utilities
assessed in random samples of the general population). The utilities
were compared using repeated-measures multivariate analysis of variance,
paired t tests, and univariate linear regression analyses. Before
treatment, the mean SF-36 and HUI3 utilities were the same (0.66 vs. 0.6},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
utilities (HUI2 and HUI3) assessed in patients with intermittent
claudication. A total of 87 patients with intermittent claudication
completed the SF-36 and HUI before and 1, 3, and 12 months after
revascularization. Utilities were estimated using SF-36 and HUI published
algorithms (i.e., both algorithms were based on standard-gamble utilities
assessed in random samples of the general population). The utilities
were compared using repeated-measures multivariate analysis of variance,
paired t tests, and univariate linear regression analyses. Before
treatment, the mean SF-36 and HUI3 utilities were the same (0.66 vs. 0.6
McMahon, Pamela M.; Gazelle, G. Scott
Colorectal cancer screening issues: a role for CT colonography? Journal Article
In: Abdom Imaging, vol. 27, no. 3, pp. 235-43, 2002, ISSN: 0942-8925 (Print) 0942-8925 (Lin, ().
@article{McMahon2002,
title = {Colorectal cancer screening issues: a role for CT colonography?},
author = {Pamela M. McMahon and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12173353},
issn = {0942-8925 (Print) 0942-8925 (Lin},
year = {2002},
date = {2002-00-01},
journal = {Abdom Imaging},
volume = {27},
number = {3},
pages = {235-43},
abstract = {Colorectal cancer is the third most common cancer in the United States
and will cause 56,700 deaths in 2001, despite the availability of
screening tests capable of detecting the disease at earlier stages
and reducing mortality. This article reviews the natural history
of colorectal cancer, common risk factors and prevention strategies,
and the strengths, limitations, and cost effectiveness of available
screening tests. Although reminders to undergo colorectal cancer
screening have become commonplace in the popular media, compliance
with screening guidelines remains poor. Although still an unproven
technology for widespread screening, computed tomographic (CT) colonography
has several attractive characteristics for a screening test. For
example, CT scanners are widely available, in contrast to limited
numbers of gastroenterologists and radiologists' declining skill
and interest in barium enema examinations. Also, patients may be
less reluctant to undergo CT colonography than screening colonoscopy.
Development of virtual bowel cleansing could further increase compliance
and thereby reduce mortality from colorectal cancer. Other articles
in this Feature Section discuss technical details of CT colonography
and its methodologic challenges.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
and will cause 56,700 deaths in 2001, despite the availability of
screening tests capable of detecting the disease at earlier stages
and reducing mortality. This article reviews the natural history
of colorectal cancer, common risk factors and prevention strategies,
and the strengths, limitations, and cost effectiveness of available
screening tests. Although reminders to undergo colorectal cancer
screening have become commonplace in the popular media, compliance
with screening guidelines remains poor. Although still an unproven
technology for widespread screening, computed tomographic (CT) colonography
has several attractive characteristics for a screening test. For
example, CT scanners are widely available, in contrast to limited
numbers of gastroenterologists and radiologists' declining skill
and interest in barium enema examinations. Also, patients may be
less reluctant to undergo CT colonography than screening colonoscopy.
Development of virtual bowel cleansing could further increase compliance
and thereby reduce mortality from colorectal cancer. Other articles
in this Feature Section discuss technical details of CT colonography
and its methodologic challenges.
2001
Solbiati, L.; Livraghi, T.; Goldberg, S. N.; Ierace, T.; Meloni, F.; Dellanoce, M.; Cova, L.; Halpern, Elkan F.; Gazelle, G. Scott
Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients Journal Article
In: Radiology, vol. 221, no. 1, pp. 159-66, 2001, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Solbiati2001,
title = {Percutaneous radio-frequency ablation of hepatic metastases from
colorectal cancer: long-term results in 117 patients},
author = {L. Solbiati and T. Livraghi and S. N. Goldberg and T. Ierace and F. Meloni and M. Dellanoce and L. Cova and Elkan F. Halpern and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11568334},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2001},
date = {2001-10-01},
journal = {Radiology},
volume = {221},
number = {1},
pages = {159-66},
abstract = {PURPOSE: To describe the results of an ongoing radio-frequency (RF)
ablation study in patients with hepatic metastases from colorectal
carcinoma. MATERIALS AND METHODS: In 117 patients, 179 metachronous
colorectal carcinoma hepatic metastases (0.9-9.6 cm in diameter)
were treated with RF ablation by using 17-gauge internally cooled
electrodes. Computed tomographic follow-up was performed every 4-6
months. Recurrent tumors were retreated when feasible. Time to new
metastases and death for each patient and time to local recurrence
for individual lesions were modeled with Kaplan-Meier analysis. Modeling
determined the effect of number of metastases on the time to new
metastases and death and effect of tumor size on local recurrence.
RESULTS: Estimated median survival was 36 months (95% CI; 28, 52
months). Estimated 1, 2, and 3-year survival rates were 93%, 69%,
and 46%, respectively. Survival was not significantly related to
number of metastases treated. In 77 (66%) of 117 patients, new metastases
were observed at follow-up. Estimated median time until new metastases
was 12 months (95% CI; 10, 18 months). Percentages of patients with
no new metastases after initial treatment at 1 and 2 years were 49%
and 35%, respectively. Time to new metastases was not significantly
related to number of metastases. Seventy (39%) of 179 lesions developed
local recurrence after treatment. Of these, 54 were observed by 6
months and 67 by 1 year. No local recurrence was observed after 18
months. Frequency and time to local recurrence were related to lesion size (P \< or =.001). CONCLUSION: RF ablation is an effective method
to treat hepatic metastases from colorectal carcinoma.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
ablation study in patients with hepatic metastases from colorectal
carcinoma. MATERIALS AND METHODS: In 117 patients, 179 metachronous
colorectal carcinoma hepatic metastases (0.9-9.6 cm in diameter)
were treated with RF ablation by using 17-gauge internally cooled
electrodes. Computed tomographic follow-up was performed every 4-6
months. Recurrent tumors were retreated when feasible. Time to new
metastases and death for each patient and time to local recurrence
for individual lesions were modeled with Kaplan-Meier analysis. Modeling
determined the effect of number of metastases on the time to new
metastases and death and effect of tumor size on local recurrence.
RESULTS: Estimated median survival was 36 months (95% CI; 28, 52
months). Estimated 1, 2, and 3-year survival rates were 93%, 69%,
and 46%, respectively. Survival was not significantly related to
number of metastases treated. In 77 (66%) of 117 patients, new metastases
were observed at follow-up. Estimated median time until new metastases
was 12 months (95% CI; 10, 18 months). Percentages of patients with
no new metastases after initial treatment at 1 and 2 years were 49%
and 35%, respectively. Time to new metastases was not significantly
related to number of metastases. Seventy (39%) of 179 lesions developed
local recurrence after treatment. Of these, 54 were observed by 6
months and 67 by 1 year. No local recurrence was observed after 18
months. Frequency and time to local recurrence were related to lesion size (P < or =.001). CONCLUSION: RF ablation is an effective method
to treat hepatic metastases from colorectal carcinoma.
McMahon, Pamela M.; Halpern, Elkan F.; Castillo, C. Fernandez-del; Clark, J. W.; Gazelle, G. Scott
Pancreatic cancer: cost-effectiveness of imaging technologies for assessing resectability Journal Article
In: Radiology, vol. 221, no. 1, pp. 93-106, 2001, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{McMahon2001,
title = {Pancreatic cancer: cost-effectiveness of imaging technologies for
assessing resectability},
author = {Pamela M. McMahon and Elkan F. Halpern and C. Fernandez-del Castillo and J. W. Clark and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11568326},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2001},
date = {2001-10-01},
journal = {Radiology},
volume = {221},
number = {1},
pages = {93-106},
abstract = {PURPOSE: To evaluate the cost-effectiveness of imaging strategies
for the assessment of resectability in patients with pancreatic cancer.
MATERIALS AND METHODS: A decision model was developed to calculate
costs and benefits (survival) accruing to hypothetical cohorts of
patients with known or suspected pancreatic cancer. Results are presented
as cost per life-year gained under various scenarios and assumptions
of diagnostic test characteristics, surgical mortality, disease characteristics,
and costs. RESULTS: With best estimates for all data inputs, the
strategy of computed tomography (CT) followed by laparoscopy and
laparoscopic ultrasonography (US) had an incremental cost-effectiveness
ratio of $87,502 per life-year gained, compared with best supportive
care. This strategy was significantly more cost-effective than CT
followed by magnetic resonance (MR) imaging and was significantly
less expensive than other imaging strategies while providing a statistically
and clinically insignificant difference in life-year gains. A strategy
involving no imaging (immediate surgery) was more expensive but less
effective than all imaging strategies. A hypothetical perfect test
with cost equal to that of CT followed by MR had an incremental cost-effectiveness
ratio of $64,401 per life-year gained, compared to best supportive
care. CONCLUSION: Most available imaging tests for assessing resectability
of pancreatic cancer do not differ in effectiveness, but a strategy
of CT, laparoscopy, and laparoscopic US would consistently result
in significantly lower costs than other imaging tests under a wide
range of scenarios.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
for the assessment of resectability in patients with pancreatic cancer.
MATERIALS AND METHODS: A decision model was developed to calculate
costs and benefits (survival) accruing to hypothetical cohorts of
patients with known or suspected pancreatic cancer. Results are presented
as cost per life-year gained under various scenarios and assumptions
of diagnostic test characteristics, surgical mortality, disease characteristics,
and costs. RESULTS: With best estimates for all data inputs, the
strategy of computed tomography (CT) followed by laparoscopy and
laparoscopic ultrasonography (US) had an incremental cost-effectiveness
ratio of $87,502 per life-year gained, compared with best supportive
care. This strategy was significantly more cost-effective than CT
followed by magnetic resonance (MR) imaging and was significantly
less expensive than other imaging strategies while providing a statistically
and clinically insignificant difference in life-year gains. A strategy
involving no imaging (immediate surgery) was more expensive but less
effective than all imaging strategies. A hypothetical perfect test
with cost equal to that of CT followed by MR had an incremental cost-effectiveness
ratio of $64,401 per life-year gained, compared to best supportive
care. CONCLUSION: Most available imaging tests for assessing resectability
of pancreatic cancer do not differ in effectiveness, but a strategy
of CT, laparoscopy, and laparoscopic US would consistently result
in significantly lower costs than other imaging tests under a wide
range of scenarios.
Gleason, S.; Furie, K. L.; Lev, M. H.; O'Donnell, J.; McMahon, Pamela M.; Beinfeld, M. T.; Halpern, Elkan F.; Mullins, M.; Harris, G.; Koroshetz, W. J.; Gazelle, G. Scott
Potential influence of acute CT on inpatient costs in patients with ischemic stroke Journal Article
In: Acad Radiol, vol. 8, no. 10, pp. 955-64, 2001, ISSN: 1076-6332 (Print) 1076-6332 (Lin, ().
@article{Gleason2001,
title = {Potential influence of acute CT on inpatient costs in patients with
ischemic stroke},
author = {S. Gleason and K. L. Furie and M. H. Lev and J. O'Donnell and Pamela M. McMahon and M. T. Beinfeld and Elkan F. Halpern and M. Mullins and G. Harris and W. J. Koroshetz and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11699848},
issn = {1076-6332 (Print) 1076-6332 (Lin},
year = {2001},
date = {2001-10-01},
journal = {Acad Radiol},
volume = {8},
number = {10},
pages = {955-64},
abstract = {RATIONALE AND OBJECTIVES: Patients presenting with ischemic brain
symptoms have widely variable outcomes dependent to some degree on
the pathologic basis of their stroke syndrome. The purpose of this
study was to determine the cost implications of the emergency use
of a computed tomographic (CT) protocol comprising unenhanced CT,
head and neck CT angiography, and whole-brain CT perfusion. MATERIALS
AND METHODS: By using a retrospective patient database from a tertiary
care facility and publicly available cost data, the authors derived
the potential savings from the use of CT angiography. CT perfusion,
or both at hospital arrival by means of a cost model. The cost of
the CT angiography-CT perfusion protocol was determined from Medicare
reimbursement rates and compared with that of traditional imaging
protocols. Cost savings were estimated as a decrease in the length
of stay for most stroke patients, whereas the most benign (lacunar)
strokes were assumed to be managed in a non-acute setting. Misdiagnosis
cost (erroneously not admitting a patient with nonlacunar stroke)
was calculated as the cost of a severe complication. Sensitivity
testing included varying the percentage of misdiagnosed patients
and admitting patients with lacunar stroke. RESULTS: The nationwide
net savings that would result from the adoption of the CT angiography-CT
perfusion protocol are in the $1.2 billion range (-$154 million to
$2.1 billion) when patients with lacunar strokes are treated nonacutely
and $1.8 billion when those patients are admitted for acute care.
CONCLUSION: The results demonstrate the potential effect of implementing
a CT angiography-CT perfusion protocol. In particular, prompt CT
angiography-CT perfusion imaging could have an effect on the cost
of acute care in the treatment of stroke.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
symptoms have widely variable outcomes dependent to some degree on
the pathologic basis of their stroke syndrome. The purpose of this
study was to determine the cost implications of the emergency use
of a computed tomographic (CT) protocol comprising unenhanced CT,
head and neck CT angiography, and whole-brain CT perfusion. MATERIALS
AND METHODS: By using a retrospective patient database from a tertiary
care facility and publicly available cost data, the authors derived
the potential savings from the use of CT angiography. CT perfusion,
or both at hospital arrival by means of a cost model. The cost of
the CT angiography-CT perfusion protocol was determined from Medicare
reimbursement rates and compared with that of traditional imaging
protocols. Cost savings were estimated as a decrease in the length
of stay for most stroke patients, whereas the most benign (lacunar)
strokes were assumed to be managed in a non-acute setting. Misdiagnosis
cost (erroneously not admitting a patient with nonlacunar stroke)
was calculated as the cost of a severe complication. Sensitivity
testing included varying the percentage of misdiagnosed patients
and admitting patients with lacunar stroke. RESULTS: The nationwide
net savings that would result from the adoption of the CT angiography-CT
perfusion protocol are in the $1.2 billion range (-$154 million to
$2.1 billion) when patients with lacunar strokes are treated nonacutely
and $1.8 billion when those patients are admitted for acute care.
CONCLUSION: The results demonstrate the potential effect of implementing
a CT angiography-CT perfusion protocol. In particular, prompt CT
angiography-CT perfusion imaging could have an effect on the cost
of acute care in the treatment of stroke.
Bosch, Johanna; Beinfeld, M. T.; Halpern, Elkan F.; Lester, J. S.; Gazelle, G. Scott
Endovascular versus open surgical elective repair of infrarenal abdominal aortic aneurysm: predictors of patient discharge destination Journal Article
In: Radiology, vol. 220, no. 3, pp. 576-80, 2001, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Bosch2001,
title = {Endovascular versus open surgical elective repair of infrarenal abdominal aortic aneurysm: predictors of patient discharge destination},
author = {Johanna Bosch and M. T. Beinfeld and Elkan F. Halpern and J. S. Lester and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11526250},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2001},
date = {2001-09-01},
urldate = {2001-09-01},
journal = {Radiology},
volume = {220},
number = {3},
pages = {576-80},
abstract = {PURPOSE: To evaluate patient discharge destination after elective
endovascular or open surgical repair of infrarenal abdominal aortic
aneurysm and to determine predictors for discharge to home or to
a rehabilitation center. MATERIALS AND METHODS: All patients electively
treated for infrarenal abdominal aortic aneurysm with endovascular repair (n = 182) or open surgery (n = 274) between January 1997 and
September 1999 were included. From the hospital database, information
on discharge destination, patient characteristics, complications,
and length of stay was retrieved. Multiple logistic regression analysis
was performed to determine predictors for discharge to home or to
a rehabilitation center. RESULTS: Patient characteristics did not
differ significantly between the treatment groups, with the exception
of age (mean age, 75.1 vs 72.9 years in the endovascular and open surgical group, respectively; P =.005). Patient discharge destinations differed significantly between the treatment groups (P =.001). After
endovascular procedures, 156 (85.7%) of 182 patients went home and
19 (10.4%) of 182 patients went to a rehabilitation center. After
open surgery, 187 (68.2%) of 274 patients went home and 64 (23.4%)
of 274 patients went to a rehabilitation center. The odds ratio of
discharge to a rehabilitation center, instead of home, following
endovascular procedures versus open surgery was 0.23 (95% CI: 0.13,
0.43). CONCLUSION: Following elective repair of infrarenal abdominal
aortic aneurysm, significantly more patients went home after an endovascular
procedure than after open surgery. Procedure type was a significant
predictor of discharge destination.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
endovascular or open surgical repair of infrarenal abdominal aortic
aneurysm and to determine predictors for discharge to home or to
a rehabilitation center. MATERIALS AND METHODS: All patients electively
treated for infrarenal abdominal aortic aneurysm with endovascular repair (n = 182) or open surgery (n = 274) between January 1997 and
September 1999 were included. From the hospital database, information
on discharge destination, patient characteristics, complications,
and length of stay was retrieved. Multiple logistic regression analysis
was performed to determine predictors for discharge to home or to
a rehabilitation center. RESULTS: Patient characteristics did not
differ significantly between the treatment groups, with the exception
of age (mean age, 75.1 vs 72.9 years in the endovascular and open surgical group, respectively; P =.005). Patient discharge destinations differed significantly between the treatment groups (P =.001). After
endovascular procedures, 156 (85.7%) of 182 patients went home and
19 (10.4%) of 182 patients went to a rehabilitation center. After
open surgery, 187 (68.2%) of 274 patients went home and 64 (23.4%)
of 274 patients went to a rehabilitation center. The odds ratio of
discharge to a rehabilitation center, instead of home, following
endovascular procedures versus open surgery was 0.23 (95% CI: 0.13,
0.43). CONCLUSION: Following elective repair of infrarenal abdominal
aortic aneurysm, significantly more patients went home after an endovascular
procedure than after open surgery. Procedure type was a significant
predictor of discharge destination.
Goldberg, S. N.; Saldinger, P. F.; Gazelle, G. Scott; Huertas, J. C.; Stuart, K. E.; Jacobs, T.; Kruskal, J. B.
In: Radiology, vol. 220, no. 2, pp. 420-7, 2001, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Goldberg2001b,
title = {Percutaneous tumor ablation: increased necrosis with combined radio-frequency
ablation and intratumoral doxorubicin injection in a rat breast tumor
model},
author = {S. N. Goldberg and P. F. Saldinger and G. Scott Gazelle and J. C. Huertas and K. E. Stuart and T. Jacobs and J. B. Kruskal},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11477246},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2001},
date = {2001-08-01},
journal = {Radiology},
volume = {220},
number = {2},
pages = {420-7},
abstract = {PURPOSE: To determine whether a combination of intratumoral doxorubicin
injection and radio-frequency (RF) ablation increases tumor destruction
compared with RF ablation alone in an animal tumor model. MATERIALS
AND METHODS: R3230 mammary adenocarcinoma 1.2-1.5-cm- diameter nodules (n = 110) were implanted subcutaneously in 84 female Fischer rats. For initial experiments (n = 46), tumors were treated with (a) conventional,
monopolar RF (250 mA +/- 25 [SD] at 70 degrees C +/- 1 for 5 minutes)
ablation alone; (b) direct intratumoral doxorubicin injection (volume,
250 microL; total dose, 0.5 mg) alone; (c) combined therapy (doxorubicin
injection immediately followed by RF ablation); (d) RF ablation and
injection of 250 microL of distilled water; or (e) no treatment.
In subsequent experiments, amount of doxorubicin (0.02-2.50 mg; n = 40 additional tumors) and timing of doxorubicin administration (2 days before to 2 days after RF ablation; n = 24 more tumors) were
varied. Pathologic examination, including staining for mitochondrial
enzyme activity and perfusion, was performed, and the resultant tumor
destruction from each treatment was evaluated. RESULTS: Coagulation
diameter was 6.7 mm +/- 0.6 for tumors treated with RF ablation alone
and 6.9 mm +/- 0.7 for those treated with RF ablation and water (P =.52), while intratumoral doxorubicin injection alone produced only
2.0-3.0 mm of coagulation (P \<.001). Increased coagulation was observed
only with combined doxorubicin injection and RF therapy (P \<.001).
Coagulation was dependent on concentration and timing of doxorubicin
administration, with greatest coagulation (11.5 mm +/- 1.1) observed
for doxorubicin administered within 30 minutes of RF ablation. CONCLUSION:
Adjuvant intratumoral doxorubicin injection increases coagulation
in solid tumors compared with RF ablation alone. Increased tumor
destruction is also seen when doxorubicin is administered after RF
ablation, which suggests that RF ablation may sensitize tumors to
chemotherapy. Such combination therapies may, therefore, offer improved
methods for ablating solid tumors.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
injection and radio-frequency (RF) ablation increases tumor destruction
compared with RF ablation alone in an animal tumor model. MATERIALS
AND METHODS: R3230 mammary adenocarcinoma 1.2-1.5-cm- diameter nodules (n = 110) were implanted subcutaneously in 84 female Fischer rats. For initial experiments (n = 46), tumors were treated with (a) conventional,
monopolar RF (250 mA +/- 25 [SD] at 70 degrees C +/- 1 for 5 minutes)
ablation alone; (b) direct intratumoral doxorubicin injection (volume,
250 microL; total dose, 0.5 mg) alone; (c) combined therapy (doxorubicin
injection immediately followed by RF ablation); (d) RF ablation and
injection of 250 microL of distilled water; or (e) no treatment.
In subsequent experiments, amount of doxorubicin (0.02-2.50 mg; n = 40 additional tumors) and timing of doxorubicin administration (2 days before to 2 days after RF ablation; n = 24 more tumors) were
varied. Pathologic examination, including staining for mitochondrial
enzyme activity and perfusion, was performed, and the resultant tumor
destruction from each treatment was evaluated. RESULTS: Coagulation
diameter was 6.7 mm +/- 0.6 for tumors treated with RF ablation alone
and 6.9 mm +/- 0.7 for those treated with RF ablation and water (P =.52), while intratumoral doxorubicin injection alone produced only
2.0-3.0 mm of coagulation (P <.001). Increased coagulation was observed
only with combined doxorubicin injection and RF therapy (P <.001).
Coagulation was dependent on concentration and timing of doxorubicin
administration, with greatest coagulation (11.5 mm +/- 1.1) observed
for doxorubicin administered within 30 minutes of RF ablation. CONCLUSION:
Adjuvant intratumoral doxorubicin injection increases coagulation
in solid tumors compared with RF ablation alone. Increased tumor
destruction is also seen when doxorubicin is administered after RF
ablation, which suggests that RF ablation may sensitize tumors to
chemotherapy. Such combination therapies may, therefore, offer improved
methods for ablating solid tumors.
Bosch, Johanna; Lester, J. S.; McMahon, Pamela M.; Beinfeld, M. T.; Halpern, Elkan F.; Kaufman, J. A.; Brewster, D. C.; Gazelle, G. Scott
Hospital costs for elective endovascular and surgical repairs of infrarenal abdominal aortic aneurysms Journal Article
In: Radiology, vol. 220, no. 2, pp. 492–497, 2001, ().
@article{Bosch2001a,
title = {Hospital costs for elective endovascular and surgical repairs of infrarenal abdominal aortic aneurysms},
author = {Johanna Bosch and J. S. Lester and Pamela M. McMahon and M. T. Beinfeld and Elkan F. Halpern and J. A. Kaufman and D. C. Brewster and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11477259},
doi = {10.1148/radiology.220.2.r01au29492},
year = {2001},
date = {2001-08-01},
urldate = {2001-08-01},
journal = {Radiology},
volume = {220},
number = {2},
pages = {492--497},
institution = {Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Pl, Suite 2H, Boston, MA 02114, USA. },
abstract = {To determine and compare the average in-hospital costs of elective
open surgical and endovascular repairs of infrarenal abdominal aortic
aneurysms.Total actual cost data for patients undergoing elective endovascular (n = 181) or open surgical (n = 273) repair of abdominal
aortic aneurysms between 1997 and 1999 were retrieved. The mean total
hospital cost (including stent-graft costs and excluding attending
physician fees) and mean postoperative length of stay were calculated
for each treatment group. Costs were expressed in 1999 U.S. dollars.Endovascular
repair yielded a shorter postoperative length of stay than did open
surgery (mean stay, 3.4 vs 8.0 days; P ely $6,400 according to literature data).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
open surgical and endovascular repairs of infrarenal abdominal aortic
aneurysms.Total actual cost data for patients undergoing elective endovascular (n = 181) or open surgical (n = 273) repair of abdominal
aortic aneurysms between 1997 and 1999 were retrieved. The mean total
hospital cost (including stent-graft costs and excluding attending
physician fees) and mean postoperative length of stay were calculated
for each treatment group. Costs were expressed in 1999 U.S. dollars.Endovascular
repair yielded a shorter postoperative length of stay than did open
surgery (mean stay, 3.4 vs 8.0 days; P ely $6,400 according to literature data).
Livraghi, T.; Goldberg, S. N.; Solbiati, L.; Meloni, F.; Ierace, T.; Gazelle, G. Scott
Percutaneous radio-frequency ablation of liver metastases from breast cancer: initial experience in 24 patients Journal Article
In: Radiology, vol. 220, no. 1, pp. 145-9, 2001, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Livraghi2001,
title = {Percutaneous radio-frequency ablation of liver metastases from breast
cancer: initial experience in 24 patients},
author = {T. Livraghi and S. N. Goldberg and L. Solbiati and F. Meloni and T. Ierace and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11425987},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2001},
date = {2001-07-01},
journal = {Radiology},
volume = {220},
number = {1},
pages = {145-9},
abstract = {PURPOSE: To evaluate the authors' initial experience in a consecutive
series of 24 patients with breast cancer liver metastases treated
with radio-frequency (RF) ablation. MATERIALS AND METHODS: Twenty-four
consecutive patients with 64 metastases measuring 1.0--6.6 cm in
diameter (mean, 1.9 cm) underwent ultrasonography-guided percutaneous
RF ablation with 18-gauge, internally cooled electrodes. Treatment
was performed with the patient under conscious sedation and analgesia
or general anesthesia. A single lesion was treated in 16 patients,
and multiple lesions were treated in eight patients. Follow-up with
serial computed tomography ranged from 4 to 44 months (mean, 10 months;
median, 19 months). RESULTS: Complete necrosis was achieved in 59
(92%) of 64 lesions. Among the 59 lesions, complete necrosis required
a single treatment session in 58 lesions (92%) and two treatment
sessions in one lesion (2%). In 14 (58%) of 24 patients, new metastases
developed during follow-up. Ten (71%) of these 14 patients developed
new liver metastases. Currently, 10 (63%) of 16 patients whose lesions
were initially confined to the liver are free of disease. One patient
died of progressive brain metastases. No major complications occurred.
Two minor complications were observed. CONCLUSION: On the basis of
preliminary study results, percutaneous RF ablation appears to be
a simple, safe, and effective treatment for focal liver metastases
in selected patients with breast cancer.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
series of 24 patients with breast cancer liver metastases treated
with radio-frequency (RF) ablation. MATERIALS AND METHODS: Twenty-four
consecutive patients with 64 metastases measuring 1.0--6.6 cm in
diameter (mean, 1.9 cm) underwent ultrasonography-guided percutaneous
RF ablation with 18-gauge, internally cooled electrodes. Treatment
was performed with the patient under conscious sedation and analgesia
or general anesthesia. A single lesion was treated in 16 patients,
and multiple lesions were treated in eight patients. Follow-up with
serial computed tomography ranged from 4 to 44 months (mean, 10 months;
median, 19 months). RESULTS: Complete necrosis was achieved in 59
(92%) of 64 lesions. Among the 59 lesions, complete necrosis required
a single treatment session in 58 lesions (92%) and two treatment
sessions in one lesion (2%). In 14 (58%) of 24 patients, new metastases
developed during follow-up. Ten (71%) of these 14 patients developed
new liver metastases. Currently, 10 (63%) of 16 patients whose lesions
were initially confined to the liver are free of disease. One patient
died of progressive brain metastases. No major complications occurred.
Two minor complications were observed. CONCLUSION: On the basis of
preliminary study results, percutaneous RF ablation appears to be
a simple, safe, and effective treatment for focal liver metastases
in selected patients with breast cancer.
Lester, J. S.; Bosch, Johanna; Kaufman, J. A.; Halpern, Elkan F.; Gazelle, G. Scott
Inpatient costs of routine endovascular repair of abdominal aortic aneurysm Journal Article
In: Acad Radiol, vol. 8, no. 7, pp. 639-46, 2001, ISSN: 1076-6332 (Print) 1076-6332 (Lin, ().
@article{Lester2001,
title = {Inpatient costs of routine endovascular repair of abdominal aortic aneurysm},
author = {J. S. Lester and Johanna Bosch and J. A. Kaufman and Elkan F. Halpern and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11450965},
issn = {1076-6332 (Print) 1076-6332 (Lin},
year = {2001},
date = {2001-07-01},
urldate = {2001-07-01},
journal = {Acad Radiol},
volume = {8},
number = {7},
pages = {639-46},
abstract = {RATIONALE AND OBJECTIVES: The purpose of this study was to determine
the inpatient cost of routine (ie, without emergent conversion to
open repair during the hospital stay) endovascular stent-graft placement
in a consecutive series of patients undergoing elective endovascular
repair of abdominal aortic aneurysm (AAA) at a single institution.
MATERIALS AND METHODS: Inpatient hospital costs of 91 patients who
underwent initial elective endovascular repair of AAA were analyzed
retrospectively. All patients had participated in clinical trials
at the authors' institution during the previous 6 years. Financial
data were derived from the hospital's cost-accounting system; additional
procedural data were collected from a departmental database and with
chart review. Stent-graft and professional costs were excluded. RESULTS:
The mean total cost for endovascular repair was $11,842 (standard
deviation [SD], $5,127), mean procedure time was 149 minutes (SD,
79 minutes), and mean length of stay was 3.5 days (SD, 2.3 days).
Total cost depended on stent-graft type (means, $12,428 [bifurcated] vs $9,622 [tube]; P = .0002) and strongly correlated with procedure time and length of hospital stay (r = 0.78 and 0.66, respectively;
P \< .0001). Ninety-six percent of total costs for all patients were
attributable to the following departments: operating theater (31%),
radiology (31%), nursing (22%), and anesthesia (12%). CONCLUSION:
Overall costs are greater with bifurcated than with tube stent-grafts.
Total procedure-related costs are divided relatively equally between
the operating theater, the radiology department, and the combination
of the nursing and anesthesia departments.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
the inpatient cost of routine (ie, without emergent conversion to
open repair during the hospital stay) endovascular stent-graft placement
in a consecutive series of patients undergoing elective endovascular
repair of abdominal aortic aneurysm (AAA) at a single institution.
MATERIALS AND METHODS: Inpatient hospital costs of 91 patients who
underwent initial elective endovascular repair of AAA were analyzed
retrospectively. All patients had participated in clinical trials
at the authors' institution during the previous 6 years. Financial
data were derived from the hospital's cost-accounting system; additional
procedural data were collected from a departmental database and with
chart review. Stent-graft and professional costs were excluded. RESULTS:
The mean total cost for endovascular repair was $11,842 (standard
deviation [SD], $5,127), mean procedure time was 149 minutes (SD,
79 minutes), and mean length of stay was 3.5 days (SD, 2.3 days).
Total cost depended on stent-graft type (means, $12,428 [bifurcated] vs $9,622 [tube]; P = .0002) and strongly correlated with procedure time and length of hospital stay (r = 0.78 and 0.66, respectively;
P < .0001). Ninety-six percent of total costs for all patients were
attributable to the following departments: operating theater (31%),
radiology (31%), nursing (22%), and anesthesia (12%). CONCLUSION:
Overall costs are greater with bifurcated than with tube stent-grafts.
Total procedure-related costs are divided relatively equally between
the operating theater, the radiology department, and the combination
of the nursing and anesthesia departments.
McMahon, Pamela M.; Bosch, Johanna; Gleason, S.; Halpern, Elkan F.; Lester, J. S.; Gazelle, G. Scott
Cost-effectiveness of colorectal cancer screening Journal Article
In: Radiology, vol. 219, no. 1, pp. 44-50, 2001, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{McMahon2001a,
title = {Cost-effectiveness of colorectal cancer screening},
author = {Pamela M. McMahon and Johanna Bosch and S. Gleason and Elkan F. Halpern and J. S. Lester and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11274533},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2001},
date = {2001-04-01},
journal = {Radiology},
volume = {219},
number = {1},
pages = {44-50},
abstract = {PURPOSE: To determine the most cost-effective colorectal cancer screening
strategy costing less than $100,000 per life-year saved and to determine
how available strategies compare with each other. MATERIALS AND METHODS:
Standardized methods were used to calculate incremental cost-effectiveness
ratios (ICERs) from published estimates of cost and effectiveness
of colorectal cancer screening strategies, and the direction and
magnitude of any effect on the ratio from parameter estimate adjustments
based on literature values were estimated. RESULTS: Strategies in
which double-contrast barium enema examination was performed emerged
as optimal from all studies included. In average-risk individuals,
screening with double-contrast barium enema examination every 3 years,
or every 5 years with annual fecal occult blood testing, had an ICER
of less than $55,600 per life-year saved. However, double-contrast
barium enema examination screening every 3 years plus annual fecal
occult blood testing had an ICER of more than $100,000 per life-year
saved. Colonoscopic screening had an ICER of more than $100,000 per
life-year saved, was dominated by other screening strategies, and
offered less benefit than did double-contrast barium enema examination
screening. CONCLUSION: Double-contrast barium enema examination can
be a cost-effective component of colorectal cancer screening, but
further modeling efforts are necessary.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
strategy costing less than $100,000 per life-year saved and to determine
how available strategies compare with each other. MATERIALS AND METHODS:
Standardized methods were used to calculate incremental cost-effectiveness
ratios (ICERs) from published estimates of cost and effectiveness
of colorectal cancer screening strategies, and the direction and
magnitude of any effect on the ratio from parameter estimate adjustments
based on literature values were estimated. RESULTS: Strategies in
which double-contrast barium enema examination was performed emerged
as optimal from all studies included. In average-risk individuals,
screening with double-contrast barium enema examination every 3 years,
or every 5 years with annual fecal occult blood testing, had an ICER
of less than $55,600 per life-year saved. However, double-contrast
barium enema examination screening every 3 years plus annual fecal
occult blood testing had an ICER of more than $100,000 per life-year
saved. Colonoscopic screening had an ICER of more than $100,000 per
life-year saved, was dominated by other screening strategies, and
offered less benefit than did double-contrast barium enema examination
screening. CONCLUSION: Double-contrast barium enema examination can
be a cost-effective component of colorectal cancer screening, but
further modeling efforts are necessary.
Goldberg, S. N.; Ahmed, M.; Gazelle, G. Scott; Kruskal, J. B.; Huertas, J. C.; Halpern, Elkan F.; Oliver, B. S.; Lenkinski, R. E.
In: Radiology, vol. 219, no. 1, pp. 157-65, 2001, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Goldberg2001a,
title = {Radio-frequency thermal ablation with NaCl solution injection: effect
of electrical conductivity on tissue heating and coagulation-phantom
and porcine liver study},
author = {S. N. Goldberg and M. Ahmed and G. Scott Gazelle and J. B. Kruskal and J. C. Huertas and Elkan F. Halpern and B. S. Oliver and R. E. Lenkinski},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11274551},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2001},
date = {2001-04-01},
journal = {Radiology},
volume = {219},
number = {1},
pages = {157-65},
abstract = {PURPOSE: To characterize the effects of NaCl concentration on tissue
electrical conductivity, radio-frequency (RF) deposition, and heating
in phantoms and optimize adjunctive NaCl solution injection for RF
ablation in an in vivo model. MATERIALS AND METHODS: RF was applied
for 12-15 minutes with internally cooled electrodes. For phantom experiments (n = 51), the NaCl concentration in standardized 5% agar
was varied (0%-25.0%). A nonlinear simplex optimization strategy was then used in normal porcine liver (n = 44) to determine optimal
pre-RF NaCl solution injection parameters (concentration, 0%-38.5%;
volume, 0-25 mL). NaCl concentration and tissue conductivity were
correlated with RF energy deposition, tissue heating, and induced
coagulation. RESULTS: NaCl concentration had significant but nonlinear
effects on electrical conductivity, RF deposition, and heating of
agar phantoms (P\<.01). Progressively greater heating was observed
to 5.0% NaCl, with reduced temperatures at higher concentrations.
For in vivo liver, NaCl solution volume and concentration significantly
influenced both tissue heating and coagulation (P\<.001). Maximum
heating 20 mm from the electrode (102.9 degrees C +/- 4.3 [SD]) and
coagulation (7.1 cm +/- 1.1) occurred with injection of 6 mL of 38.5%
(saturated) NaCl solution. CONCLUSION: Injection of NaCl solution
before RF ablation can increase energy deposition, tissue heating,
and induced coagulation, which will likely benefit clinical RF ablation.
In normal well-perfused liver, maximum coagulation (7.0 cm) occurs
with injection of small volumes of saturated NaCl solution.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
electrical conductivity, radio-frequency (RF) deposition, and heating
in phantoms and optimize adjunctive NaCl solution injection for RF
ablation in an in vivo model. MATERIALS AND METHODS: RF was applied
for 12-15 minutes with internally cooled electrodes. For phantom experiments (n = 51), the NaCl concentration in standardized 5% agar
was varied (0%-25.0%). A nonlinear simplex optimization strategy was then used in normal porcine liver (n = 44) to determine optimal
pre-RF NaCl solution injection parameters (concentration, 0%-38.5%;
volume, 0-25 mL). NaCl concentration and tissue conductivity were
correlated with RF energy deposition, tissue heating, and induced
coagulation. RESULTS: NaCl concentration had significant but nonlinear
effects on electrical conductivity, RF deposition, and heating of
agar phantoms (P<.01). Progressively greater heating was observed
to 5.0% NaCl, with reduced temperatures at higher concentrations.
For in vivo liver, NaCl solution volume and concentration significantly
influenced both tissue heating and coagulation (P<.001). Maximum
heating 20 mm from the electrode (102.9 degrees C +/- 4.3 [SD]) and
coagulation (7.1 cm +/- 1.1) occurred with injection of 6 mL of 38.5%
(saturated) NaCl solution. CONCLUSION: Injection of NaCl solution
before RF ablation can increase energy deposition, tissue heating,
and induced coagulation, which will likely benefit clinical RF ablation.
In normal well-perfused liver, maximum coagulation (7.0 cm) occurs
with injection of small volumes of saturated NaCl solution.
Zalis, M. E.; Hahn, P. F.; Arellano, R. S.; Gazelle, G. Scott; Mueller, P. R.
CT colonography with teleradiology: effect of lossy wavelet compression on polyp detection--initial observations Journal Article
In: Radiology, vol. 220, pp. 387-92, 2001, ().
@article{Zalis2001,
title = {CT colonography with teleradiology: effect of lossy wavelet compression
on polyp detection--initial observations},
author = {M. E. Zalis and P. F. Hahn and R. S. Arellano and G. Scott Gazelle and P. R. Mueller},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11477241},
year = {2001},
date = {2001-01-01},
journal = {Radiology},
volume = {220},
pages = {387-92},
abstract = {PURPOSE: To assess the consequences of lossy compression on the diagnostic
accuracy of CT colonography for detecting colonic polyps. MATERIALS
AND METHODS: Helical CT images of cleansed colonic segments were
evaluated. Source images were compressed to 1:1, 10:1, and 20:1 ratios
with lossy wavelet compression. Two independent readers blinded to
corresponding colonoscopic results analyzed 144 randomly ordered
colonic segments in multiplanar and volume-rendered endoscopic views.
Sensitivity, specificity, and receiver operating characteristic curves
were generated for each compression ratio on the basis of expressed
confidence in lesion presence. Similar analyses were performed to
assess distention and bowel preparation adequacy and evaluation time
required. RESULTS: Results based on video colonoscopy-confirmed lesions
revealed 100% (four of four) sensitivity for lesions larger than
10 mm for compression ratios 1:1, 10:1, and 20:1 for both readers;
sensitivities for all lesions smaller than 10 mm were 5078 3867 and
3867% for respective ratios for both readers. Differences in diagnostic
performance for each reader across ratios were not significant (P =.30-.99, McNemar test). The time required to evaluate and assess
bowel preparation and distention adequacy did not change significantly
across ratios. CONCLUSION: On the basis of the patient sample, lossy
compression of transverse source images to at least a 20:1 ratio
did not adversely affect diagnostic performance or evaluation time
for CT colonography.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
accuracy of CT colonography for detecting colonic polyps. MATERIALS
AND METHODS: Helical CT images of cleansed colonic segments were
evaluated. Source images were compressed to 1:1, 10:1, and 20:1 ratios
with lossy wavelet compression. Two independent readers blinded to
corresponding colonoscopic results analyzed 144 randomly ordered
colonic segments in multiplanar and volume-rendered endoscopic views.
Sensitivity, specificity, and receiver operating characteristic curves
were generated for each compression ratio on the basis of expressed
confidence in lesion presence. Similar analyses were performed to
assess distention and bowel preparation adequacy and evaluation time
required. RESULTS: Results based on video colonoscopy-confirmed lesions
revealed 100% (four of four) sensitivity for lesions larger than
10 mm for compression ratios 1:1, 10:1, and 20:1 for both readers;
sensitivities for all lesions smaller than 10 mm were 5078 3867 and
3867% for respective ratios for both readers. Differences in diagnostic
performance for each reader across ratios were not significant (P =.30-.99, McNemar test). The time required to evaluate and assess
bowel preparation and distention adequacy did not change significantly
across ratios. CONCLUSION: On the basis of the patient sample, lossy
compression of transverse source images to at least a 20:1 ratio
did not adversely affect diagnostic performance or evaluation time
for CT colonography.
Rubin, J. P.; Cober, S. R.; Butler, P. E.; Randolph, M. A.; Gazelle, G. Scott; Ierino, F. L.; Sachs, D. H.; Lee, W. P.
Injection of allogeneic bone marrow cells into the portal vein of swine in utero Journal Article
In: J Surg Res, vol. 95, pp. 188-94, 2001, ().
@article{Rubin2001,
title = {Injection of allogeneic bone marrow cells into the portal vein of swine in utero},
author = {J. P. Rubin and S. R. Cober and P. E. Butler and M. A. Randolph and G. Scott Gazelle and F. L. Ierino and D. H. Sachs and W. P. Lee},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11162044},
year = {2001},
date = {2001-01-01},
urldate = {2001-01-01},
journal = {J Surg Res},
volume = {95},
pages = {188-94},
abstract = {The ability to safely manipulate the immune system of the developing
fetus carries the hope of effective treatment strategies for certain
congenital disorders that can be diagnosed during gestation. One
possible intervention is the induction of specific transplantation
tolerance to an adult donor who could provide tissue after birth
without the need for immunosuppression. Although the introduction
of allogeneic stem cells to a developing immune system has been shown
to result in hematopoietic chimerism, donor-specific transplantation
tolerance has not been demonstrated in a large animal model. In previous
reports of in utero stem-cell transplantation, the cells were injected
into the fetus by an intraperitoneal route. We sought to improve
upon this technique of cell transplantation by developing a method
for the safe delivery of allogeneic stem cells directly into the
hepatic circulation of fetal swine. In the second phase of our study,
we determined if adult allogeneic bone marrow cells delivered to
the fetus by this intravascular route could result in result in hematopoietic
chimerism and donor-specific transplantation tolerance. A method
of successful intravascular injection was designed in which a laparotomy
was performed on a sow at midgestation (50-55 days) to administer
1 cc of inoculum into the portal vein of each fetus using transuterine
ultrasound guidance and a 25-gauge spinal needle. In one sow, 10
piglets were injected with saline to test safety, and 8 piglets were
born. For transplantation of stem cells to the fetuses, donor bone
marrow was harvested from a genetically defined miniature swine.
In one sow the marrow was injected without T-cell depletion resulting
in abortion. In the third sow, the marrow was depleted of T-cells
to less than 0.01% using magnetic beads conjugated to anti-CD3 monoclonal
antibodies. No chimerism was detected in these offspring. Only in
the fourth sow where the T-cell depletion was reduced to about 1%
of the cells in the inoculum did one animal demonstrate chimerism.
This piglet showed reproducible blood chimerism (0.95% donor cells)
detected by flow cytometry measurement of monoclonal antibodies to
the donor MHC. In addition, this animal demonstrated hyporesponsiveness
to donor lymphocytes in an MLR assay while reacting strongly to third-party
stimulator cells. A split-thickness skin graft from the donor was
accepted, and a third-party graft was rapidly rejected.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
fetus carries the hope of effective treatment strategies for certain
congenital disorders that can be diagnosed during gestation. One
possible intervention is the induction of specific transplantation
tolerance to an adult donor who could provide tissue after birth
without the need for immunosuppression. Although the introduction
of allogeneic stem cells to a developing immune system has been shown
to result in hematopoietic chimerism, donor-specific transplantation
tolerance has not been demonstrated in a large animal model. In previous
reports of in utero stem-cell transplantation, the cells were injected
into the fetus by an intraperitoneal route. We sought to improve
upon this technique of cell transplantation by developing a method
for the safe delivery of allogeneic stem cells directly into the
hepatic circulation of fetal swine. In the second phase of our study,
we determined if adult allogeneic bone marrow cells delivered to
the fetus by this intravascular route could result in result in hematopoietic
chimerism and donor-specific transplantation tolerance. A method
of successful intravascular injection was designed in which a laparotomy
was performed on a sow at midgestation (50-55 days) to administer
1 cc of inoculum into the portal vein of each fetus using transuterine
ultrasound guidance and a 25-gauge spinal needle. In one sow, 10
piglets were injected with saline to test safety, and 8 piglets were
born. For transplantation of stem cells to the fetuses, donor bone
marrow was harvested from a genetically defined miniature swine.
In one sow the marrow was injected without T-cell depletion resulting
in abortion. In the third sow, the marrow was depleted of T-cells
to less than 0.01% using magnetic beads conjugated to anti-CD3 monoclonal
antibodies. No chimerism was detected in these offspring. Only in
the fourth sow where the T-cell depletion was reduced to about 1%
of the cells in the inoculum did one animal demonstrate chimerism.
This piglet showed reproducible blood chimerism (0.95% donor cells)
detected by flow cytometry measurement of monoclonal antibodies to
the donor MHC. In addition, this animal demonstrated hyporesponsiveness
to donor lymphocytes in an MLR assay while reacting strongly to third-party
stimulator cells. A split-thickness skin graft from the donor was
accepted, and a third-party graft was rapidly rejected.
Goldberg, S. N.; Gazelle, G. Scott
Radiofrequency tissue ablation: physical principles and techniques for increasing coagulation necrosis Journal Article
In: Hepatogastroenterology, vol. 48, no. 38, pp. 359-67, 2001, ISSN: 0172-6390 (Print) 0172-6390 (Lin, ().
@article{Goldberg2001,
title = {Radiofrequency tissue ablation: physical principles and techniques
for increasing coagulation necrosis},
author = {S. N. Goldberg and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11379309},
issn = {0172-6390 (Print) 0172-6390 (Lin},
year = {2001},
date = {2001-00-01},
journal = {Hepatogastroenterology},
volume = {48},
number = {38},
pages = {359-67},
abstract = {Radiofrequency tumor ablation has been demonstrated as a reliable
method for creating thermally-induced coagulation necrosis using
either a percutaneous approach with image-guidance or direct surgical
placement of thin electrodes into tissues to be treated. Early clinical
trials with this technology have studied the treatment of hepatic,
cerebral, and bony malignancies. The extent of coagulation necrosis
induced with conventional monopolar radiofrequency electrodes is
dependent on overall energy deposition, the duration of radiofrequency
application, and radiofrequency electrode tip length and gauge. This
article will discuss these technical considerations with the goal
of defining optimal parameters for radiofrequency ablation. Strategies
to further increase induced coagulation necrosis including: multiprobe
and bipolar arrays, and internally-cooled radiofrequency electrodes,
with or without pulsed-radiofrequency or cluster technique will be
presented. The development and laboratory results for many of these
radiofrequency techniques and potential biophysical limitations to
radiofrequency induced coagulation, such as perfusion mediated tissue
cooling (vascular flow) will likewise be discussed.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
method for creating thermally-induced coagulation necrosis using
either a percutaneous approach with image-guidance or direct surgical
placement of thin electrodes into tissues to be treated. Early clinical
trials with this technology have studied the treatment of hepatic,
cerebral, and bony malignancies. The extent of coagulation necrosis
induced with conventional monopolar radiofrequency electrodes is
dependent on overall energy deposition, the duration of radiofrequency
application, and radiofrequency electrode tip length and gauge. This
article will discuss these technical considerations with the goal
of defining optimal parameters for radiofrequency ablation. Strategies
to further increase induced coagulation necrosis including: multiprobe
and bipolar arrays, and internally-cooled radiofrequency electrodes,
with or without pulsed-radiofrequency or cluster technique will be
presented. The development and laboratory results for many of these
radiofrequency techniques and potential biophysical limitations to
radiofrequency induced coagulation, such as perfusion mediated tissue
cooling (vascular flow) will likewise be discussed.
Mathes, D. W.; Yamada, K.; Randolph, M. A.; Utsugi, R.; Solari, M. G.; Gazelle, G. Scott; Wu, A.; Sachs, D. H.; Lee, W. P.
In utero induction of transplantation tolerance Journal Article
In: Transplant Proc, vol. 33, no. 1-2, pp. 98-100, 2001, ISSN: 0041-1345 (Print) 0041-1345 (Lin, ().
@article{Mathes2001,
title = {In utero induction of transplantation tolerance},
author = {D. W. Mathes and K. Yamada and M. A. Randolph and R. Utsugi and M. G. Solari and G. Scott Gazelle and A. Wu and D. H. Sachs and W. P. Lee},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11266726},
issn = {0041-1345 (Print) 0041-1345 (Lin},
year = {2001},
date = {2001-00-01},
urldate = {2001-00-01},
journal = {Transplant Proc},
volume = {33},
number = {1-2},
pages = {98-100},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2000
Goldberg, S. N.; Kruskal, J. B.; Oliver, B. S.; Clouse, M. E.; Gazelle, G. Scott
Percutaneous tumor ablation: increased coagulation by combining radio-frequency ablation and ethanol instillation in a rat breast tumor model Journal Article
In: Radiology, vol. 217, no. 3, pp. 827-31, 2000, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Goldberg2000b,
title = {Percutaneous tumor ablation: increased coagulation by combining radio-frequency
ablation and ethanol instillation in a rat breast tumor model},
author = {S. N. Goldberg and J. B. Kruskal and B. S. Oliver and M. E. Clouse and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11110950},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2000},
date = {2000-12-01},
journal = {Radiology},
volume = {217},
number = {3},
pages = {827-31},
abstract = {PURPOSE: To determine if percutaneously applied radio frequency (RF)
combined with percutaneous ethanol instillation (PEI) can increase
the extent of ablation in rat breast tumors. MATERIALS AND METHODS:
R3230 mammary adenocarcinoma was implanted bilaterally in the mammary
fat pads of 18 female rats. The tumor nodules measured 1. 2-1.5 cm.
Eight tumors each were treated with (a) conventional, monopolar RF
(96 mA +/- 28; 70 degrees C for 5 minutes); (b) PEI (250 microL of
ethanol infused over 1 minute); (c) combined therapy of PEI immediately
followed by RF ablation; or (d) combined therapy of RF ablation immediately
followed by PEI. Four tumors were not treated and served as controls.
Histopathologic examination included staining for mitochondrial enzyme
activity. Resultant coagulation necrosis was compared between treatment
groups. RESULTS: Coagulation necrosis was observed only within treated
tumors. Tumors treated with RF alone had 6.7 mm +/- 0.6 of coagulation
surrounding the electrode, and those treated with PEI alone had 6.4
mm +/- 0.6 of coagulation around the instillation needle (not significant).
Significantly increased coagulation of 10.1 mm +/- 0.9 (P: \<.001)
was observed with the combined therapy of PEI followed by RF. RF
followed by PEI did not increase coagulation (6.4 mm +/- 0.8 around
the needle; not significant). CONCLUSION: PEI followed by RF ablation
therapy increases the extent of induced coagulation necrosis in rat
breast tumors, as compared with either therapy alone.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
combined with percutaneous ethanol instillation (PEI) can increase
the extent of ablation in rat breast tumors. MATERIALS AND METHODS:
R3230 mammary adenocarcinoma was implanted bilaterally in the mammary
fat pads of 18 female rats. The tumor nodules measured 1. 2-1.5 cm.
Eight tumors each were treated with (a) conventional, monopolar RF
(96 mA +/- 28; 70 degrees C for 5 minutes); (b) PEI (250 microL of
ethanol infused over 1 minute); (c) combined therapy of PEI immediately
followed by RF ablation; or (d) combined therapy of RF ablation immediately
followed by PEI. Four tumors were not treated and served as controls.
Histopathologic examination included staining for mitochondrial enzyme
activity. Resultant coagulation necrosis was compared between treatment
groups. RESULTS: Coagulation necrosis was observed only within treated
tumors. Tumors treated with RF alone had 6.7 mm +/- 0.6 of coagulation
surrounding the electrode, and those treated with PEI alone had 6.4
mm +/- 0.6 of coagulation around the instillation needle (not significant).
Significantly increased coagulation of 10.1 mm +/- 0.9 (P: <.001)
was observed with the combined therapy of PEI followed by RF. RF
followed by PEI did not increase coagulation (6.4 mm +/- 0.8 around
the needle; not significant). CONCLUSION: PEI followed by RF ablation
therapy increases the extent of induced coagulation necrosis in rat
breast tumors, as compared with either therapy alone.
Gazelle, G. Scott; Goldberg, S. N.; Solbiati, L.; Livraghi, T.
Tumor ablation with radio-frequency energy Journal Article
In: Radiology, vol. 217, no. 3, pp. 633-46, 2000, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Gazelle2000a,
title = {Tumor ablation with radio-frequency energy},
author = {G. Scott Gazelle and S. N. Goldberg and L. Solbiati and T. Livraghi},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11110923},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2000},
date = {2000-12-01},
urldate = {2000-12-01},
journal = {Radiology},
volume = {217},
number = {3},
pages = {633-46},
abstract = {Tumor ablation by using radio-frequency energy has begun to receive
increased attention as an effective minimally invasive approach for
the treatment of patients with a variety of primary and secondary
malignant neoplasms. To date, these techniques have been used to
treat tumors located in the brain, musculoskeletal system, thyroid
and parathyroid glands, pancreas, kidney, lung, and breast; however,
liver tumor ablation has received the greatest attention and has
been the subject of a large number of published reports. In this
article, the authors review the technical developments and early
laboratory results obtained with radio-frequency ablation techniques,
describe some of the early clinical applications of these techniques,
and conclude with a discussion of challenges and opportunities for
the future.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
increased attention as an effective minimally invasive approach for
the treatment of patients with a variety of primary and secondary
malignant neoplasms. To date, these techniques have been used to
treat tumors located in the brain, musculoskeletal system, thyroid
and parathyroid glands, pancreas, kidney, lung, and breast; however,
liver tumor ablation has received the greatest attention and has
been the subject of a large number of published reports. In this
article, the authors review the technical developments and early
laboratory results obtained with radio-frequency ablation techniques,
describe some of the early clinical applications of these techniques,
and conclude with a discussion of challenges and opportunities for
the future.
McMahon, Pamela M.; Araki, S. S.; Neumann, P. J.; Harris, G. J.; Gazelle, G. Scott
Cost-effectiveness of functional imaging tests in the diagnosis of Alzheimer disease Journal Article
In: Radiology, vol. 217, no. 1, pp. 58-68, 2000, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{McMahon2000a,
title = {Cost-effectiveness of functional imaging tests in the diagnosis of
Alzheimer disease},
author = {Pamela M. McMahon and S. S. Araki and P. J. Neumann and G. J. Harris and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11012424},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2000},
date = {2000-10-01},
journal = {Radiology},
volume = {217},
number = {1},
pages = {58-68},
abstract = {PURPOSE: To evaluate the cost-effectiveness of functional neuroimaging
in the work-up of patients at specialized Alzheimer disease clinics.
MATERIALS AND METHODS: A decision model was used to calculate costs
and benefits (in quality-adjusted life-years [QALYs]) that accrued
to hypothetical cohorts of patients at presentation to an Alzheimer
disease center. Sensitivity analysis was performed to examine the
effects of diagnostic test characteristics, therapeutic efficacy,
disease severity, and costs on cost-effectiveness. RESULTS: The incremental
cost-effectiveness ratio of dynamic susceptibility contrast material-enhanced
magnetic resonance (MR) imaging was $479,500 per QALY (compared with
the usual diagnostic work-up), while visual or quantitative single
photon emission computed tomography (SPECT) was dominated (higher
costs, lower effectiveness) by the usual diagnostic work-up. These
results depend critically on the sensitivity and specificity of the
standard diagnostic work-up, the effectiveness of drug treatment,
and the disease severity. Varying these parameters resulted in estimates
of incremental cost-effectiveness for dynamic susceptibility contrast-enhanced
MR imaging of $24,680 to $8.6 million per QALY. SPECT either was
dominated by the usual diagnostic work-up or had cost-effectiveness
ratios of $180,200 to $6 million per QALY. CONCLUSION: The addition
of functional neuroimaging to the usual diagnostic regimen at Alzheimer
disease clinics is not cost-effective given the effectiveness of
currently available therapies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
in the work-up of patients at specialized Alzheimer disease clinics.
MATERIALS AND METHODS: A decision model was used to calculate costs
and benefits (in quality-adjusted life-years [QALYs]) that accrued
to hypothetical cohorts of patients at presentation to an Alzheimer
disease center. Sensitivity analysis was performed to examine the
effects of diagnostic test characteristics, therapeutic efficacy,
disease severity, and costs on cost-effectiveness. RESULTS: The incremental
cost-effectiveness ratio of dynamic susceptibility contrast material-enhanced
magnetic resonance (MR) imaging was $479,500 per QALY (compared with
the usual diagnostic work-up), while visual or quantitative single
photon emission computed tomography (SPECT) was dominated (higher
costs, lower effectiveness) by the usual diagnostic work-up. These
results depend critically on the sensitivity and specificity of the
standard diagnostic work-up, the effectiveness of drug treatment,
and the disease severity. Varying these parameters resulted in estimates
of incremental cost-effectiveness for dynamic susceptibility contrast-enhanced
MR imaging of $24,680 to $8.6 million per QALY. SPECT either was
dominated by the usual diagnostic work-up or had cost-effectiveness
ratios of $180,200 to $6 million per QALY. CONCLUSION: The addition
of functional neuroimaging to the usual diagnostic regimen at Alzheimer
disease clinics is not cost-effective given the effectiveness of
currently available therapies.
McMahon, Pamela M.; Gazelle, G. Scott
The case for colorectal cancer screening Journal Article
In: Semin Roentgenol, vol. 35, no. 4, pp. 325-32, 2000, ISSN: 0037-198X (Print) 0037-198X (Lin, ().
@article{McMahon2000,
title = {The case for colorectal cancer screening},
author = {Pamela M. McMahon and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11060919},
issn = {0037-198X (Print) 0037-198X (Lin},
year = {2000},
date = {2000-10-01},
urldate = {2000-10-01},
journal = {Semin Roentgenol},
volume = {35},
number = {4},
pages = {325-32},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Goldberg, S. N.; Solbiati, L.; Halpern, Elkan F.; Gazelle, G. Scott
Variables affecting proper system grounding for radiofrequency ablation in an animal model Journal Article
In: J Vasc Interv Radiol, vol. 11, no. 8, pp. 1069-75, 2000, ISSN: 1051-0443 (Print) 1051-0443 (Lin, ().
@article{Goldberg2000a,
title = {Variables affecting proper system grounding for radiofrequency ablation
in an animal model},
author = {S. N. Goldberg and L. Solbiati and Elkan F. Halpern and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10997473},
issn = {1051-0443 (Print) 1051-0443 (Lin},
year = {2000},
date = {2000-09-01},
journal = {J Vasc Interv Radiol},
volume = {11},
number = {8},
pages = {1069-75},
abstract = {PURPOSE: The authors sought to determine which factors contribute
to excessive thermal deposition and burns at the grounding pad site
after high-current percutaneous, image-guided radiofrequency (RF)
ablation. MATERIALS AND METHODS: Radiofrequency (1,000-2,000 mA)
was applied for 10 minutes with use of an internally-cooled electrode placed into in vivo pig livers (n = 88). In separate experiments,
the number of pads (1, 2, or 4), orientation of pads (horizontal,
vertical, or diagonal), and distance between the pads and the electrode
(10-50 cm) of mesh or foil grounding pads (12.5 x 8 cm; 100 cm2)
were varied. Thermistors measured skin surface temperatures during
ablation. Pathologic analysis of skin changes was performed. RESULTS:
Temperature elevations at the grounding pad were observed for every trial, with a temperature elevation \> or =12 degrees C (as high as
45 degrees C) observed in 60 of 88 trials (68.2%). Temperatures at
the grounding site pad were dependent on all variables studied, including
the grounding pad surface area, the amount of current deposited in
the liver, the orientation of the pad, and the pad's distance from
the electrode. Second-degree burns were seen with temperatures exceeding
47 degrees C and third-degree burns were observed when a temperature \> or = 52 degrees C was noted. For a given set of RF parameters,
reduced heating was observed for trials in which foil grounding pads
were used (P \< .001). Grounding pad burns did not occur at 2,000
mA (maximum generator output) when four foil pads were placed horizontally \> or = 25 cm from the electrode. CONCLUSIONS: High-current RF ablation
can induce severe burns at the grounding pad site if inadequate precautions
are taken. To minimize the risk of burns, multiple large-surface-area
foil pads should be placed on well-prepared skin and oriented with
the longest surface edge facing the RF electrode.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
to excessive thermal deposition and burns at the grounding pad site
after high-current percutaneous, image-guided radiofrequency (RF)
ablation. MATERIALS AND METHODS: Radiofrequency (1,000-2,000 mA)
was applied for 10 minutes with use of an internally-cooled electrode placed into in vivo pig livers (n = 88). In separate experiments,
the number of pads (1, 2, or 4), orientation of pads (horizontal,
vertical, or diagonal), and distance between the pads and the electrode
(10-50 cm) of mesh or foil grounding pads (12.5 x 8 cm; 100 cm2)
were varied. Thermistors measured skin surface temperatures during
ablation. Pathologic analysis of skin changes was performed. RESULTS:
Temperature elevations at the grounding pad were observed for every trial, with a temperature elevation > or =12 degrees C (as high as
45 degrees C) observed in 60 of 88 trials (68.2%). Temperatures at
the grounding site pad were dependent on all variables studied, including
the grounding pad surface area, the amount of current deposited in
the liver, the orientation of the pad, and the pad's distance from
the electrode. Second-degree burns were seen with temperatures exceeding
47 degrees C and third-degree burns were observed when a temperature > or = 52 degrees C was noted. For a given set of RF parameters,
reduced heating was observed for trials in which foil grounding pads
were used (P < .001). Grounding pad burns did not occur at 2,000
mA (maximum generator output) when four foil pads were placed horizontally > or = 25 cm from the electrode. CONCLUSIONS: High-current RF ablation
can induce severe burns at the grounding pad site if inadequate precautions
are taken. To minimize the risk of burns, multiple large-surface-area
foil pads should be placed on well-prepared skin and oriented with
the longest surface edge facing the RF electrode.
O'Malley, M. E.; Halpern, Elkan F.; Mueller, P. R.; Gazelle, G. Scott
Helical CT protocols for the abdomen and pelvis: a survey Journal Article
In: AJR Am J Roentgenol, vol. 175, no. 1, pp. 109–113, 2000, ().
@article{OMalley2000,
title = {Helical CT protocols for the abdomen and pelvis: a survey},
author = {M. E. O'Malley and Elkan F. Halpern and P. R. Mueller and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10882257},
doi = {10.2214/ajr.175.1.1750109},
year = {2000},
date = {2000-07-01},
urldate = {2000-07-01},
journal = {AJR Am J Roentgenol},
volume = {175},
number = {1},
pages = {109--113},
institution = {Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston 02114, USA.},
abstract = {We surveyed members of the Society of Computed Body Tomography/Magnetic
Resonance to evaluate current techniques used for helical CT in the
abdomen and pelvis.The survey was distributed to 70 members (36 institutions)
of the Society of Computed Body Tomography/Magnetic Resonance. The
survey included general questions related to abdominal and pelvic
helical CT and also asked the members to write a protocol for 12
hypothetical requisitions.Thirty-two members (46%) responded, representing
28 institutions (78%). The number of protocols for helical CT of
the abdomen and pelvis at each institution ranges from 2 to 35 (median,
11). IV contrast material is administered for 90% (median) of abdominal
and pelvic CT examinations. Nonionic contrast material is used for
68% (median) of these examinations. IV contrast material is used
by 100% of institutions for tumor staging protocols except for one
institution that does not use IV contrast material for lymphoma staging.
Fifty percent of the institutions obtain two- or three-phases of
liver images for breast cancer staging. For all protocols, the average
collimation and reconstruction interval is 7 mm except for renal
(5 mm) and adrenal (4 mm) protocols. Rectal contrast material is
administered most commonly for colon cancer staging (39% of institutions).There
is a wide range in the number of protocols used for helical CT in
the abdomen and pelvis among the responding institutions. Most protocols
include use of nonionic IV contrast material injected at a rate of
3 ml/sec and a collimation of 7 mm.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Resonance to evaluate current techniques used for helical CT in the
abdomen and pelvis.The survey was distributed to 70 members (36 institutions)
of the Society of Computed Body Tomography/Magnetic Resonance. The
survey included general questions related to abdominal and pelvic
helical CT and also asked the members to write a protocol for 12
hypothetical requisitions.Thirty-two members (46%) responded, representing
28 institutions (78%). The number of protocols for helical CT of
the abdomen and pelvis at each institution ranges from 2 to 35 (median,
11). IV contrast material is administered for 90% (median) of abdominal
and pelvic CT examinations. Nonionic contrast material is used for
68% (median) of these examinations. IV contrast material is used
by 100% of institutions for tumor staging protocols except for one
institution that does not use IV contrast material for lymphoma staging.
Fifty percent of the institutions obtain two- or three-phases of
liver images for breast cancer staging. For all protocols, the average
collimation and reconstruction interval is 7 mm except for renal
(5 mm) and adrenal (4 mm) protocols. Rectal contrast material is
administered most commonly for colon cancer staging (39% of institutions).There
is a wide range in the number of protocols used for helical CT in
the abdomen and pelvis among the responding institutions. Most protocols
include use of nonionic IV contrast material injected at a rate of
3 ml/sec and a collimation of 7 mm.
Goldberg, S. N.; Gazelle, G. Scott; Compton, C. C.; Mueller, P. R.; Tanabe, K. K.
Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic-pathologic correlation Journal Article
In: Cancer, vol. 88, no. 11, pp. 2452-63, 2000, ISSN: 0008-543X (Print) 0008-543X (Lin, ().
@article{Goldberg2000,
title = {Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic-pathologic correlation},
author = {S. N. Goldberg and G. Scott Gazelle and C. C. Compton and P. R. Mueller and K. K. Tanabe},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10861420},
issn = {0008-543X (Print) 0008-543X (Lin},
year = {2000},
date = {2000-06-01},
urldate = {2000-06-01},
journal = {Cancer},
volume = {88},
number = {11},
pages = {2452-63},
abstract = {BACKGROUND: Radiofrequency (RF)-induced tissue coagulation represents
a new approach for the thermal destruction of tumors within the liver.
The purpose of the current study was to 1) assess technique safety;
2) determine the extent and evolution of induced cellular damage;
and 3) correlate the observed pathologic effects with radiologic studies. METHODS: Twenty-three tumors measuring \</= 8 cm (19 colorectal
metastases and 4 hepatomas) in 22 patients were treated with RF (range,
500-1550 milliamperes) using internally cooled electrodes. All treated
tumors were resected to allow pathologic analysis. Eleven tumors
were treated intraoperatively under ultrasonographic guidance and
excised immediately. Twelve tumors were treated percutaneously using
ultrasound or computed tomography (CT) guidance and subsequently were excised 3-7 days after ablation. Contrast-enhanced CT (n = 12) and magnetic resonance imaging (MRI) (n = 2) were performed after
ablation of all percutaneously treated patients. RESULTS: Tumors
treated intraoperatively did not demonstrate definitive coagulative
necrosis. However, pathologic abnormalities suggestive of tissue
injury were observed with hematoxylin and eosin staining, and absent
cytosolic and mitochondrial enzyme activity suggested irreversible
cellular damage. In contrast, specimens removed \> 3 days after ablation
showed definite, contiguous coagulative necrosis without intervening
areas of viable tumor. CT and MRI scans demonstrated circumscribed
hypodense, nonenhancing regions surrounding the electrode tract as
early as 15 minutes after ablation. These corresponded within 2 mm
to measurements of coagulation at pathology. CONCLUSIONS: RF ablation
is a minimally invasive and safe approach to the treatment of tumors
in the liver. Tumors treated with RF energy do not immediately demonstrate
coagulative necrosis, but do show evidence of irreversible cellular
damage. The extent of tumor necrosis correlates closely with findings
at contrast-enhanced imaging.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
a new approach for the thermal destruction of tumors within the liver.
The purpose of the current study was to 1) assess technique safety;
2) determine the extent and evolution of induced cellular damage;
and 3) correlate the observed pathologic effects with radiologic studies. METHODS: Twenty-three tumors measuring </= 8 cm (19 colorectal
metastases and 4 hepatomas) in 22 patients were treated with RF (range,
500-1550 milliamperes) using internally cooled electrodes. All treated
tumors were resected to allow pathologic analysis. Eleven tumors
were treated intraoperatively under ultrasonographic guidance and
excised immediately. Twelve tumors were treated percutaneously using
ultrasound or computed tomography (CT) guidance and subsequently were excised 3-7 days after ablation. Contrast-enhanced CT (n = 12) and magnetic resonance imaging (MRI) (n = 2) were performed after
ablation of all percutaneously treated patients. RESULTS: Tumors
treated intraoperatively did not demonstrate definitive coagulative
necrosis. However, pathologic abnormalities suggestive of tissue
injury were observed with hematoxylin and eosin staining, and absent
cytosolic and mitochondrial enzyme activity suggested irreversible
cellular damage. In contrast, specimens removed > 3 days after ablation
showed definite, contiguous coagulative necrosis without intervening
areas of viable tumor. CT and MRI scans demonstrated circumscribed
hypodense, nonenhancing regions surrounding the electrode tract as
early as 15 minutes after ablation. These corresponded within 2 mm
to measurements of coagulation at pathology. CONCLUSIONS: RF ablation
is a minimally invasive and safe approach to the treatment of tumors
in the liver. Tumors treated with RF energy do not immediately demonstrate
coagulative necrosis, but do show evidence of irreversible cellular
damage. The extent of tumor necrosis correlates closely with findings
at contrast-enhanced imaging.
Gazelle, G. Scott; McMahon, Pamela M.; Scholz, F. J.
Screening for colorectal cancer Journal Article
In: Radiology, vol. 215, no. 2, pp. 327-35, 2000, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Gazelle2000,
title = {Screening for colorectal cancer},
author = {G. Scott Gazelle and Pamela M. McMahon and F. J. Scholz},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10796903},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2000},
date = {2000-05-01},
journal = {Radiology},
volume = {215},
number = {2},
pages = {327-35},
abstract = {Colorectal cancer is the third most commonly diagnosed cancer and
the second leading cause of cancer deaths in the United States. Fortunately,
both the incidence and mortality associated with the disease have
declined during the past 2 decades. This is likely due, at least
in part, to improved efforts at screening and more aggressive removal
of adenomatous polyps. However, colorectal cancer screening is still
generally underutilized. This article reviews the current status
and future outlook for colorectal cancer screening, including a discussion
of risk factors for the disease, its anatomic distribution, proposed
mechanisms of development from adenomatous polyps, rationale for
screening, and screening options. Published literature concerning
the cost-effectiveness of colorectal cancer screening is also summarized.
The article concludes with a discussion of the emerging consensus
regarding the importance of and approaches to screening.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
the second leading cause of cancer deaths in the United States. Fortunately,
both the incidence and mortality associated with the disease have
declined during the past 2 decades. This is likely due, at least
in part, to improved efforts at screening and more aggressive removal
of adenomatous polyps. However, colorectal cancer screening is still
generally underutilized. This article reviews the current status
and future outlook for colorectal cancer screening, including a discussion
of risk factors for the disease, its anatomic distribution, proposed
mechanisms of development from adenomatous polyps, rationale for
screening, and screening options. Published literature concerning
the cost-effectiveness of colorectal cancer screening is also summarized.
The article concludes with a discussion of the emerging consensus
regarding the importance of and approaches to screening.
Livraghi, T.; Goldberg, S. N.; Lazzaroni, S.; Meloni, F.; Ierace, T.; Solbiati, L.; Gazelle, G. Scott
Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions Journal Article
In: Radiology, vol. 214, no. 3, pp. 761-8, 2000, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Livraghi2000,
title = {Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions},
author = {T. Livraghi and S. N. Goldberg and S. Lazzaroni and F. Meloni and T. Ierace and L. Solbiati and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10715043},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2000},
date = {2000-03-01},
urldate = {2000-03-01},
journal = {Radiology},
volume = {214},
number = {3},
pages = {761-8},
abstract = {PURPOSE: To study local therapeutic efficacy, side effects, and complications
of radio-frequency (RF) ablation in the treatment of medium and large
hepatocellular carcinoma (HCC) lesions in patients with cirrhosis
or chronic hepatitis. MATERIALS AND METHODS: One-hundred fourteen
patients who were under conscious sedation or general anesthesia
had 126 HCCs greater than 3.0 cm in diameter treated with RF by using
an internally cooled electrode. Eighty tumors were medium (3.1-5.0
cm), and 46 were large (5.1-9.5 cm). The mean diameter for all tumors
was 5.4 cm. At imaging, 75 tumors were considered noninfiltrating,
and 51 were considered infiltrating. RESULTS: Complete necrosis was
attained in 60 lesions (47.6%), nearly complete (90%-99%) necrosis
in 40 lesions (31.7%), and partial (50%-89%) necrosis in the remaining
26 lesions (20.6%). Medium and/or noninfiltrating tumors were treated
successfully significantly more often than large and/or infiltrating
tumors. Two major complications (death, hemorrhage requiring laparotomy)
and five minor complications (self-limited hemorrhage, persistent
pain) were observed. The single death was due to a break in sterile
technique rather than to the RF procedure itself. CONCLUSION: RF
ablation appears to be an effective, safe, and relatively simple
procedure for the treatment of medium and large HCCs.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
of radio-frequency (RF) ablation in the treatment of medium and large
hepatocellular carcinoma (HCC) lesions in patients with cirrhosis
or chronic hepatitis. MATERIALS AND METHODS: One-hundred fourteen
patients who were under conscious sedation or general anesthesia
had 126 HCCs greater than 3.0 cm in diameter treated with RF by using
an internally cooled electrode. Eighty tumors were medium (3.1-5.0
cm), and 46 were large (5.1-9.5 cm). The mean diameter for all tumors
was 5.4 cm. At imaging, 75 tumors were considered noninfiltrating,
and 51 were considered infiltrating. RESULTS: Complete necrosis was
attained in 60 lesions (47.6%), nearly complete (90%-99%) necrosis
in 40 lesions (31.7%), and partial (50%-89%) necrosis in the remaining
26 lesions (20.6%). Medium and/or noninfiltrating tumors were treated
successfully significantly more often than large and/or infiltrating
tumors. Two major complications (death, hemorrhage requiring laparotomy)
and five minor complications (self-limited hemorrhage, persistent
pain) were observed. The single death was due to a break in sterile
technique rather than to the RF procedure itself. CONCLUSION: RF
ablation appears to be an effective, safe, and relatively simple
procedure for the treatment of medium and large HCCs.
Halpern, Elkan F.; Weinstein, M. C.; Hunink, M. G.; Gazelle, G. Scott
Representing both first- and second-order uncertainties by Monte Carlo simulation for groups of patients Journal Article
In: Med Decis Making, vol. 20, pp. 314-22, 2000, ().
@article{Halpern2000,
title = {Representing both first- and second-order uncertainties by Monte
Carlo simulation for groups of patients},
author = {Elkan F. Halpern and M. C. Weinstein and M. G. Hunink and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10929854},
year = {2000},
date = {2000-01-01},
journal = {Med Decis Making},
volume = {20},
pages = {314-22},
abstract = {Actual implementation of probabilistic sensitivity analysis may lead
to misleading or improper conclusions when it is applied to groups
of patients rather than individual patients. The practice of combining
first- and second-order simulations when modeling the outcome for
a group of more than one patient yields an erroneous marginal distribution
whenever the parameter values are randomly sampled for each patient
while the results are presented as simulated means for the group
of patients. This practice results in underrepresenting the second-order
uncertainty. It may also distort the shape (especially the symmetry
or extent of the tails) in the simulated distribution. As a result,
it may lead to premature or incorrect conclusions of superiority.
It may also result in inappropriate estimates of the value of further
research to inform parameter values.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
to misleading or improper conclusions when it is applied to groups
of patients rather than individual patients. The practice of combining
first- and second-order simulations when modeling the outcome for
a group of more than one patient yields an erroneous marginal distribution
whenever the parameter values are randomly sampled for each patient
while the results are presented as simulated means for the group
of patients. This practice results in underrepresenting the second-order
uncertainty. It may also distort the shape (especially the symmetry
or extent of the tails) in the simulated distribution. As a result,
it may lead to premature or incorrect conclusions of superiority.
It may also result in inappropriate estimates of the value of further
research to inform parameter values.
1999
Goldberg, S. N.; Mallery, S.; Gazelle, G. Scott; Brugge, W. R.
EUS-guided radiofrequency ablation in the pancreas: results in a porcine model Journal Article
In: Gastrointest Endosc, vol. 50, no. 3, pp. 392-401, 1999, ISSN: 0016-5107 (Print) 0016-5107 (Lin, ().
@article{Goldberg1999b,
title = {EUS-guided radiofrequency ablation in the pancreas: results in a
porcine model},
author = {S. N. Goldberg and S. Mallery and G. Scott Gazelle and W. R. Brugge},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10462663},
issn = {0016-5107 (Print) 0016-5107 (Lin},
year = {1999},
date = {1999-09-01},
journal = {Gastrointest Endosc},
volume = {50},
number = {3},
pages = {392-401},
abstract = {BACKGROUND: Our aim in this study was to investigate the feasibility
and safety of performing radiofrequency (RF) ablation in the pancreas
with endoscopic ultrasound (EUS). METHODS: RF was applied to normal
pancreatic tissue in 13 anesthetized Yorkshire pigs with specially
modified 19-gauge needle electrodes (1.0 to 1.5 cm tip). The pancreas
was localized with EUS and punctured through a transgastric approach.
RF current (285 +/- 120 mA) was delivered for 6 minutes. Diagnostic
imaging (EUS and CT) and serum amylase and lipase levels were obtained
at baseline, immediately after ablation, and 1 to 14 days after the procedure. Pigs were killed immediately (n = 5), 1 to 2 days after ablation (n = 2), and 2 weeks after the procedure (n = 6). Pathologic
examination was performed. RESULTS: Sixteen ablations were performed.
During ablation, round hyperechoic foci (diameter to 1.0 cm) gradually
surrounded the tip of the electrode. Immediately after the procedure
CT demonstrated 1 cm hypodense foci that did not enhance with iodinated
contrast. In pigs killed immediately and 1 to 2 days after ablation,
pathologic examination showed discrete, well-demarcated spherical
foci of coagulation necrosis measuring 8 to 12 mm in diameter surrounded
by a 1 to 2 mm rim of hemorrhage. Radiologic-pathologic correlation
was within 2 mm. In 4 of 6 (67%) pigs killed on day 14, retraction
of the coagulated focus was observed. A 1 to 3 mm fibrotic capsule
surrounded the coagulated tissue in the remaining 2 pigs. One pig
had mild hyperlipasemia, a focal zone of pancreatitis (\<1 cm), and
later a pancreatic fluid collection. Biochemical parameters were
normal in the remaining pigs. Other complications included three
gastric and one intestinal burn caused by improper electrode placement.
CONCLUSIONS: EUS-guided RF ablation can be used safely to produce
discrete zones of coagulation necrosis in the porcine pancreas. Potential
clinical uses of this technology include management of small neuroendocrine
tumors and possibly palliation of unresectable pancreatic adenocarcinoma.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
and safety of performing radiofrequency (RF) ablation in the pancreas
with endoscopic ultrasound (EUS). METHODS: RF was applied to normal
pancreatic tissue in 13 anesthetized Yorkshire pigs with specially
modified 19-gauge needle electrodes (1.0 to 1.5 cm tip). The pancreas
was localized with EUS and punctured through a transgastric approach.
RF current (285 +/- 120 mA) was delivered for 6 minutes. Diagnostic
imaging (EUS and CT) and serum amylase and lipase levels were obtained
at baseline, immediately after ablation, and 1 to 14 days after the procedure. Pigs were killed immediately (n = 5), 1 to 2 days after ablation (n = 2), and 2 weeks after the procedure (n = 6). Pathologic
examination was performed. RESULTS: Sixteen ablations were performed.
During ablation, round hyperechoic foci (diameter to 1.0 cm) gradually
surrounded the tip of the electrode. Immediately after the procedure
CT demonstrated 1 cm hypodense foci that did not enhance with iodinated
contrast. In pigs killed immediately and 1 to 2 days after ablation,
pathologic examination showed discrete, well-demarcated spherical
foci of coagulation necrosis measuring 8 to 12 mm in diameter surrounded
by a 1 to 2 mm rim of hemorrhage. Radiologic-pathologic correlation
was within 2 mm. In 4 of 6 (67%) pigs killed on day 14, retraction
of the coagulated focus was observed. A 1 to 3 mm fibrotic capsule
surrounded the coagulated tissue in the remaining 2 pigs. One pig
had mild hyperlipasemia, a focal zone of pancreatitis (<1 cm), and
later a pancreatic fluid collection. Biochemical parameters were
normal in the remaining pigs. Other complications included three
gastric and one intestinal burn caused by improper electrode placement.
CONCLUSIONS: EUS-guided RF ablation can be used safely to produce
discrete zones of coagulation necrosis in the porcine pancreas. Potential
clinical uses of this technology include management of small neuroendocrine
tumors and possibly palliation of unresectable pancreatic adenocarcinoma.
Livraghi, T.; Goldberg, S. N.; Lazzaroni, S.; Meloni, F.; Solbiati, L.; Gazelle, G. Scott
Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection Journal Article
In: Radiology, vol. 210, no. 3, pp. 655-61, 1999, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Livraghi1999,
title = {Small hepatocellular carcinoma: treatment with radio-frequency ablation
versus ethanol injection},
author = {T. Livraghi and S. N. Goldberg and S. Lazzaroni and F. Meloni and L. Solbiati and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10207464},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {1999},
date = {1999-03-01},
journal = {Radiology},
volume = {210},
number = {3},
pages = {655-61},
abstract = {PURPOSE: To compare the effectiveness of radio-frequency (RF) ablation
with that of percutaneous ethanol injection in the treatment of small
hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Eighty-six patients with 112 small (\< or = 3-cm-diameter) HCCs underwent RF
ablation (42 patients with 52 tumors) or percutaneous ethanol injection
(44 patients with 60 tumors). Therapeutic efficacy was evaluated
with dual-phase spiral computed tomography performed at least 4 months
after treatment. RESULTS: Complete necrosis was achieved in 47 of
52 tumors with RF ablation (90%) and in 48 of 60 tumors with percutaneous
ethanol injection (80%). These results were obtained with an average
of 1.2 sessions per tumor with RF ablation and 4.8 sessions per tumor
with percutaneous ethanol injection. One major complication (hemothorax
that required drainage) and four minor complications (intraperitoneal
bleeding, hemobilia, pleural effusion, cholecystitis) occurred in
patients treated with RF ablation; no complications occurred in patients
treated with percutaneous ethanol injection. CONCLUSION: RF ablation
results in a higher rate of complete necrosis and requires fewer
treatment sessions than percutaneous ethanol injection. However,
the complication rate is higher with RF ablation than with percutaneous
ethanol injection. RF ablation is the treatment of choice for most
patients with HCC.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
with that of percutaneous ethanol injection in the treatment of small
hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Eighty-six patients with 112 small (< or = 3-cm-diameter) HCCs underwent RF
ablation (42 patients with 52 tumors) or percutaneous ethanol injection
(44 patients with 60 tumors). Therapeutic efficacy was evaluated
with dual-phase spiral computed tomography performed at least 4 months
after treatment. RESULTS: Complete necrosis was achieved in 47 of
52 tumors with RF ablation (90%) and in 48 of 60 tumors with percutaneous
ethanol injection (80%). These results were obtained with an average
of 1.2 sessions per tumor with RF ablation and 4.8 sessions per tumor
with percutaneous ethanol injection. One major complication (hemothorax
that required drainage) and four minor complications (intraperitoneal
bleeding, hemobilia, pleural effusion, cholecystitis) occurred in
patients treated with RF ablation; no complications occurred in patients
treated with percutaneous ethanol injection. CONCLUSION: RF ablation
results in a higher rate of complete necrosis and requires fewer
treatment sessions than percutaneous ethanol injection. However,
the complication rate is higher with RF ablation than with percutaneous
ethanol injection. RF ablation is the treatment of choice for most
patients with HCC.
Swan, S. K.; Baker, J. F.; Free, R.; Tucker, R. M.; Barron, B.; Barr, R.; Seltzer, S.; Gazelle, G. Scott; Maravilla, K. R.; Barr, W.; Stevens, G. R.; Lambrecht, L. J.; Pierro, J. A.
In: J Magn Reson Imaging, vol. 9, no. 2, pp. 317-21, 1999, ISSN: 1053-1807 (Print) 1053-1807 (Lin, ().
@article{Swan1999,
title = {Pharmacokinetics, safety, and tolerability of gadoversetamide injection
(OptiMARK) in subjects with central nervous system or liver pathology
and varying degrees of renal function},
author = {S. K. Swan and J. F. Baker and R. Free and R. M. Tucker and B. Barron and R. Barr and S. Seltzer and G. Scott Gazelle and K. R. Maravilla and W. Barr and G. R. Stevens and L. J. Lambrecht and J. A. Pierro},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10077031},
issn = {1053-1807 (Print) 1053-1807 (Lin},
year = {1999},
date = {1999-02-01},
journal = {J Magn Reson Imaging},
volume = {9},
number = {2},
pages = {317-21},
abstract = {The pharmacokinetic parameters, safety, and tolerability of OptiMARK
(gadoversetamide injection), a gadolinium-based magnetic resonance
imaging (MRI) contrast agent, were evaluated in 163 subjects with
either central nervous system (CNS) or liver pathology with and without
renal insufficiency, for which a contrast-enhanced MRI was indicated.
A multicenter, double-blind, randomized, placebo-controlled, parallel-group
design was used in which subjects received 0.1, 0.3, or 0.5 mmol/kg
of OptiMARK or placebo intravenously. Samples were analyzed for total
gadolinium by inductively coupled plasma/mass spectrometry. Gadolinium
pharmacokinetics were affected by renal impairment: area under the
curve, half-life, and steady-state distribution volume significantly
increased with declining renal function, while total body clearance
decreased. In subjects with normal renal function, neither age, gender,
nor liver versus CNS pathology altered gadolinium pharmacokinetics.
No clinically significant changes from baseline were noted in vital
signs, laboratory measures, electrocardiograms, or physical examinations.
OptiMARK is safe and well-tolerated following a single intravenous
injection in subjects with either liver or CNS pathology despite
a prolonged elimination half-life in subjects with renal impairment.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
(gadoversetamide injection), a gadolinium-based magnetic resonance
imaging (MRI) contrast agent, were evaluated in 163 subjects with
either central nervous system (CNS) or liver pathology with and without
renal insufficiency, for which a contrast-enhanced MRI was indicated.
A multicenter, double-blind, randomized, placebo-controlled, parallel-group
design was used in which subjects received 0.1, 0.3, or 0.5 mmol/kg
of OptiMARK or placebo intravenously. Samples were analyzed for total
gadolinium by inductively coupled plasma/mass spectrometry. Gadolinium
pharmacokinetics were affected by renal impairment: area under the
curve, half-life, and steady-state distribution volume significantly
increased with declining renal function, while total body clearance
decreased. In subjects with normal renal function, neither age, gender,
nor liver versus CNS pathology altered gadolinium pharmacokinetics.
No clinically significant changes from baseline were noted in vital
signs, laboratory measures, electrocardiograms, or physical examinations.
OptiMARK is safe and well-tolerated following a single intravenous
injection in subjects with either liver or CNS pathology despite
a prolonged elimination half-life in subjects with renal impairment.
Solbiati, L.; Goldberg, S. N.; Ierace, T.; Dellanoce, M.; Livraghi, T.; Gazelle, G. Scott
Radio-frequency ablation of hepatic metastases: postprocedural assessment with a US microbubble contrast agent--early experience Journal Article
In: Radiology, vol. 211, pp. 643-9, 1999, ().
@article{Solbiati1999,
title = {Radio-frequency ablation of hepatic metastases: postprocedural assessment
with a US microbubble contrast agent--early experience},
author = {L. Solbiati and S. N. Goldberg and T. Ierace and M. Dellanoce and T. Livraghi and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10352586},
year = {1999},
date = {1999-01-01},
journal = {Radiology},
volume = {211},
pages = {643-9},
abstract = {PURPOSE: To evaluate contrast agent-enhanced ultrasonography (US)
in the detection of untreated tumor after radio-frequency (RF) ablation
of hepatic metastases. MATERIALS AND METHODS: Twenty patients with
solitary colorectal liver metastases underwent percutaneous RF tumor
ablation. Pre- and postablation imaging was performed with nonenhanced
and enhanced color and power Doppler US and contrast-enhanced helical
computed tomography (CT). Initial follow-up CT and US were performed
24 hours after ablation. The findings at US and CT were compared.
RESULTS: Nonenhanced US demonstrated intratumoral signal in 15 of
20 metastases before ablation. This signal increased after contrast
agent administration. Contrast-enhanced US performed 24 hours after
ablation demonstrated residual foci of enhancement in three tumors,
whereas no US signals were seen in any tumor on nonenhanced scans.
CT demonstrated small (textless 3-mm) persistent foci of residual
enhancement in these three tumors and in three additional lesions
that were not seen at US (US sensitivity, 50 specificity, 100 diagnostic
agreement with CT, 85. All six patients with evidence of residual
tumor underwent repeat RF ablation. CONCLUSION: Contrast-enhanced
US may depict residual tumor after RF application and thereby enable
additional directed therapy. The potential reduction in treatment
sessions and/or ancillary imaging procedures might increase the ease
and practicality of percutaneous ablation of focal hepatic metastases.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
in the detection of untreated tumor after radio-frequency (RF) ablation
of hepatic metastases. MATERIALS AND METHODS: Twenty patients with
solitary colorectal liver metastases underwent percutaneous RF tumor
ablation. Pre- and postablation imaging was performed with nonenhanced
and enhanced color and power Doppler US and contrast-enhanced helical
computed tomography (CT). Initial follow-up CT and US were performed
24 hours after ablation. The findings at US and CT were compared.
RESULTS: Nonenhanced US demonstrated intratumoral signal in 15 of
20 metastases before ablation. This signal increased after contrast
agent administration. Contrast-enhanced US performed 24 hours after
ablation demonstrated residual foci of enhancement in three tumors,
whereas no US signals were seen in any tumor on nonenhanced scans.
CT demonstrated small (textless 3-mm) persistent foci of residual
enhancement in these three tumors and in three additional lesions
that were not seen at US (US sensitivity, 50 specificity, 100 diagnostic
agreement with CT, 85. All six patients with evidence of residual
tumor underwent repeat RF ablation. CONCLUSION: Contrast-enhanced
US may depict residual tumor after RF application and thereby enable
additional directed therapy. The potential reduction in treatment
sessions and/or ancillary imaging procedures might increase the ease
and practicality of percutaneous ablation of focal hepatic metastases.
Goldberg, S. N.; Walovitch, R. C.; Straub, J. A.; Shore, M. T.; Gazelle, G. Scott
Radio-frequency-induced coagulation necrosis in rabbits: immediate detection at US with a synthetic microsphere contrast agent Journal Article
In: Radiology, vol. 213, pp. 438-44, 1999, ().
@article{Goldberg1999,
title = {Radio-frequency-induced coagulation necrosis in rabbits: immediate
detection at US with a synthetic microsphere contrast agent},
author = {S. N. Goldberg and R. C. Walovitch and J. A. Straub and M. T. Shore and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10551224},
year = {1999},
date = {1999-01-01},
journal = {Radiology},
volume = {213},
pages = {438-44},
abstract = {PURPOSE: To determine whether a synthetic ultrasonographic (US) contrast
agent can be used to differentiate coagulation necrosis from untreated
tumor immediately after radio-frequency ablative therapy. MATERIALS
AND METHODS: VX2 (adenocarcinoma) tumors (0.8-1.5-cm diameter) were
implanted into 12 rabbits. Gray-scale and color Doppler US were performed
with or without intravenous injection of a US contrast agent composed
of poly-lactide-co-glycolic acid polymeric (PLGA) microspheres (2-micron
diameter) filled with perfluorocarbon gas. Radio frequency was applied
to each nodule for 6 minutes at 127 mA +/- 33 (mean +/- SD) (tip
temperature, 92 degrees C +/- 2). Repeat US with a second dose of
the contrast agent was performed immediately after ablation. In four
animals, a third dose was administered 30-120 minutes after ablation.
Radiologic-histopathologic correlation was performed and included
in vivo staining and studies of mitochondrial function. RESULTS:
Intense contrast agent enhancement was seen throughout the tumor
prior to ablation. At gray-scale US, ablation produced hyperechoic
foci, which were within 1 mm of the foci identified at histopathologic
examination in seven of 12 animals (58. After the administration
of contrast material, foci devoid of previously visualized enhancement,
which measured 7.3-15.0 mm, were identified. These were within 1
mm of the size of the foci identified at histopathologic examination
in 11 of 12 animals (92 P textless .01). In two animals, enhancement
depicted viable tumor, which appeared hyperechoic, on nonenhanced
images. On delayed images, hyperechoic areas decreased in size, whereas
the nonenhanced region remained unchanged. CONCLUSION: A PLGA microspherical
US contrast agent enabled the immediate detection of coagulation
necrosis as a region devoid of contrast enhancement after radio-frequency
ablation in rabbit hepatic tumors. Therefore, this agent could provide
real-time guidance during complex ablative procedures and may provide
an efficient technique for postprocedural assessment.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
agent can be used to differentiate coagulation necrosis from untreated
tumor immediately after radio-frequency ablative therapy. MATERIALS
AND METHODS: VX2 (adenocarcinoma) tumors (0.8-1.5-cm diameter) were
implanted into 12 rabbits. Gray-scale and color Doppler US were performed
with or without intravenous injection of a US contrast agent composed
of poly-lactide-co-glycolic acid polymeric (PLGA) microspheres (2-micron
diameter) filled with perfluorocarbon gas. Radio frequency was applied
to each nodule for 6 minutes at 127 mA +/- 33 (mean +/- SD) (tip
temperature, 92 degrees C +/- 2). Repeat US with a second dose of
the contrast agent was performed immediately after ablation. In four
animals, a third dose was administered 30-120 minutes after ablation.
Radiologic-histopathologic correlation was performed and included
in vivo staining and studies of mitochondrial function. RESULTS:
Intense contrast agent enhancement was seen throughout the tumor
prior to ablation. At gray-scale US, ablation produced hyperechoic
foci, which were within 1 mm of the foci identified at histopathologic
examination in seven of 12 animals (58. After the administration
of contrast material, foci devoid of previously visualized enhancement,
which measured 7.3-15.0 mm, were identified. These were within 1
mm of the size of the foci identified at histopathologic examination
in 11 of 12 animals (92 P textless .01). In two animals, enhancement
depicted viable tumor, which appeared hyperechoic, on nonenhanced
images. On delayed images, hyperechoic areas decreased in size, whereas
the nonenhanced region remained unchanged. CONCLUSION: A PLGA microspherical
US contrast agent enabled the immediate detection of coagulation
necrosis as a region devoid of contrast enhancement after radio-frequency
ablation in rabbit hepatic tumors. Therefore, this agent could provide
real-time guidance during complex ablative procedures and may provide
an efficient technique for postprocedural assessment.
Goldberg, S. N.; Stein, M. C.; Gazelle, G. Scott; Sheiman, R. G.; Kruskal, J. B.; Clouse, M. E.
Percutaneous radiofrequency tissue ablation: optimization of pulsed-radiofrequency technique to increase coagulation necrosis Journal Article
In: J Vasc Interv Radiol, vol. 10, no. 7, pp. 907-16, 1999, ISSN: 1051-0443 (Print) 1051-0443 (Lin, ().
@article{Goldberg1999a,
title = {Percutaneous radiofrequency tissue ablation: optimization of pulsed-radiofrequency
technique to increase coagulation necrosis},
author = {S. N. Goldberg and M. C. Stein and G. Scott Gazelle and R. G. Sheiman and J. B. Kruskal and M. E. Clouse},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10435709},
issn = {1051-0443 (Print) 1051-0443 (Lin},
year = {1999},
date = {1999-00-01},
journal = {J Vasc Interv Radiol},
volume = {10},
number = {7},
pages = {907-16},
abstract = {PURPOSE: To develop a computerized algorithm for pulsed, high-current
percutaneous radiofrequency (RF) ablation, which maximally increases
the extent of induced coagulation necrosis. MATERIALS AND METHODS:
An automated, programmable algorithm for pulsed-RF deposition was
designed to permit high-current deposition by periodically reducing
current for 5-30 seconds during RF application. Two strategies for
pulsed-RF deposition were evaluated: (i) constant peak current (900-1,800
mA) of variable duration and (ii) variable peak current (1,200-2,000
mA) for a specified minimum duration. The extent of induced coagulation
was compared to results obtained with continuous (lower current) RF application. Trials were performed in ex vivo calf liver (n = 115) and in vivo porcine liver (n = 30) and muscle (n = 18) with
use of 2-4-cm tip, internally cooled electrodes. RESULTS: For 3-cm
electrodes in ex vivo liver, applying pulsed-RF with constant peak
current for 12 minutes produced 3.5 cm +/- 0.2 of necrosis. Greater
necrosis was produced with use of the variable current strategy,
in which 4.5 cm +/- 0.2 of coagulation was achieved with use of an initial current \> or =1,500 mA (minimum peak-RF duration of 10 sec,
with 15 sec of reduced current to 100 mA between peaks; P \< .01).
This variable peak current algorithm also produced 3.7 cm +/- 0.6
of necrosis in in vivo liver, and 6.5 cm +/- 0.9 in in vivo muscle.
Without pulsing, a maximum of 750 mA, 1,100 mA, and 1,500 mA could
be applied in ex vivo liver, in vivo liver, and in vivo muscle, respectively,
which resulted in 2.9 cm +/- 0.2, 2.4 cm +/- 0.2, and 5.1 cm +/-
0.4 of coagulation (P \< .05, all comparisons). CONCLUSIONS: A variable
peak current algorithm for pulsed-RF deposition can increase coagulation
necrosis diameter over other ablation strategies. This innovation
may ultimately enable the percutaneous treatment of larger tumors.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
percutaneous radiofrequency (RF) ablation, which maximally increases
the extent of induced coagulation necrosis. MATERIALS AND METHODS:
An automated, programmable algorithm for pulsed-RF deposition was
designed to permit high-current deposition by periodically reducing
current for 5-30 seconds during RF application. Two strategies for
pulsed-RF deposition were evaluated: (i) constant peak current (900-1,800
mA) of variable duration and (ii) variable peak current (1,200-2,000
mA) for a specified minimum duration. The extent of induced coagulation
was compared to results obtained with continuous (lower current) RF application. Trials were performed in ex vivo calf liver (n = 115) and in vivo porcine liver (n = 30) and muscle (n = 18) with
use of 2-4-cm tip, internally cooled electrodes. RESULTS: For 3-cm
electrodes in ex vivo liver, applying pulsed-RF with constant peak
current for 12 minutes produced 3.5 cm +/- 0.2 of necrosis. Greater
necrosis was produced with use of the variable current strategy,
in which 4.5 cm +/- 0.2 of coagulation was achieved with use of an initial current > or =1,500 mA (minimum peak-RF duration of 10 sec,
with 15 sec of reduced current to 100 mA between peaks; P < .01).
This variable peak current algorithm also produced 3.7 cm +/- 0.6
of necrosis in in vivo liver, and 6.5 cm +/- 0.9 in in vivo muscle.
Without pulsing, a maximum of 750 mA, 1,100 mA, and 1,500 mA could
be applied in ex vivo liver, in vivo liver, and in vivo muscle, respectively,
which resulted in 2.9 cm +/- 0.2, 2.4 cm +/- 0.2, and 5.1 cm +/-
0.4 of coagulation (P < .05, all comparisons). CONCLUSIONS: A variable
peak current algorithm for pulsed-RF deposition can increase coagulation
necrosis diameter over other ablation strategies. This innovation
may ultimately enable the percutaneous treatment of larger tumors.
1998
Goldberg, S. N.; Hahn, P. F.; Halpern, Elkan F.; Fogle, R. M.; Gazelle, G. Scott
Radio-frequency tissue ablation: effect of pharmacologic modulation of blood flow on coagulation diameter Journal Article
In: Radiology, vol. 209, no. 3, pp. 761-7, 1998, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Goldberg1998d,
title = {Radio-frequency tissue ablation: effect of pharmacologic modulation
of blood flow on coagulation diameter},
author = {S. N. Goldberg and P. F. Hahn and Elkan F. Halpern and R. M. Fogle and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9844671},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {1998},
date = {1998-12-01},
journal = {Radiology},
volume = {209},
number = {3},
pages = {761-7},
abstract = {PURPOSE: To determine whether vasoactive pharmacologic agents can
alter radio-frequency (RF)-induced coagulation necrosis by modulating
hepatic blood flow. MATERIALS AND METHODS: RF ablation was performed
in normal, in vivo porcine liver with 1.5-cm internally cooled electrodes
and a standardized RF application (i.e., 500 mA for 10 minutes). Ablation was performed without (n = 9) and with pharmacologic modulation of blood flow with halothane (n = 7), vasopressin (n = 6), or epinephrine (n = 7). Laser Doppler techniques were used to quantify changes in
hepatic blood flow. Remote thermometry was also performed. Blood
flow was correlated with both induced coagulation necrosis and tissue
temperatures. RESULTS: Halothane reduced mean blood flow (+/- SD)
to 46.1% +/- 8.5 of normal, and vasopressin increased mean blood
flow to 132.7% +/- 13.9. Epinephrine caused increased hepatic blood
flow centrally (171.1% +/- 31.7) but not peripherally (102.8% +/-
15.4). Mean coagulation diameter was 1.4 cm +/- 0.3 with vasopressin,
2.2 cm +/- 0.4 with normal blood flow, and 3.2 cm +/- 0.1 with halothane
(P \< .01). After epinephrine infusion, mean coagulation measured
2.3 cm +/- 0.3 peripherally and 1.4 cm +/- 0.5 centrally (P \< .01).
A linear correlation between coagulation diameter and blood flow was demonstrated (r2 = 0.78). Temperatures 10 and 15 mm from the
electrode correlated with both blood flow and coagulation diameter (r2 = 0.65 and 0.60, respectively). CONCLUSION: The coagulation necrosis
achieved for a standardized RF application correlates with relative
tissue perfusion. Pharmacologic reduction of blood flow during thermally
mediated percutaneous ablation may induce greater coagulation necrosis.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
alter radio-frequency (RF)-induced coagulation necrosis by modulating
hepatic blood flow. MATERIALS AND METHODS: RF ablation was performed
in normal, in vivo porcine liver with 1.5-cm internally cooled electrodes
and a standardized RF application (i.e., 500 mA for 10 minutes). Ablation was performed without (n = 9) and with pharmacologic modulation of blood flow with halothane (n = 7), vasopressin (n = 6), or epinephrine (n = 7). Laser Doppler techniques were used to quantify changes in
hepatic blood flow. Remote thermometry was also performed. Blood
flow was correlated with both induced coagulation necrosis and tissue
temperatures. RESULTS: Halothane reduced mean blood flow (+/- SD)
to 46.1% +/- 8.5 of normal, and vasopressin increased mean blood
flow to 132.7% +/- 13.9. Epinephrine caused increased hepatic blood
flow centrally (171.1% +/- 31.7) but not peripherally (102.8% +/-
15.4). Mean coagulation diameter was 1.4 cm +/- 0.3 with vasopressin,
2.2 cm +/- 0.4 with normal blood flow, and 3.2 cm +/- 0.1 with halothane
(P < .01). After epinephrine infusion, mean coagulation measured
2.3 cm +/- 0.3 peripherally and 1.4 cm +/- 0.5 centrally (P < .01).
A linear correlation between coagulation diameter and blood flow was demonstrated (r2 = 0.78). Temperatures 10 and 15 mm from the
electrode correlated with both blood flow and coagulation diameter (r2 = 0.65 and 0.60, respectively). CONCLUSION: The coagulation necrosis
achieved for a standardized RF application correlates with relative
tissue perfusion. Pharmacologic reduction of blood flow during thermally
mediated percutaneous ablation may induce greater coagulation necrosis.
Boland, G. W.; Gazelle, G. Scott; Girard, M. J.; Mueller, P. R.
Asymptomatic hydropneumothorax after therapeutic thoracentesis for malignant pleural effusions Journal Article
In: AJR Am J Roentgenol, vol. 170, no. 4, pp. 943-6, 1998, ISSN: 0361-803X (Print) 0361-803X (Lin, ().
@article{Boland1998a,
title = {Asymptomatic hydropneumothorax after therapeutic thoracentesis for malignant pleural effusions},
author = {G. W. Boland and G. Scott Gazelle and M. J. Girard and P. R. Mueller},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9530040},
issn = {0361-803X (Print) 0361-803X (Lin},
year = {1998},
date = {1998-04-01},
urldate = {1998-04-01},
journal = {AJR Am J Roentgenol},
volume = {170},
number = {4},
pages = {943-6},
abstract = {OBJECTIVE: The purpose of this study was to document in a historical
cohort the incidence and clinical observations of pneumothorax ex
vacuo after therapeutic thoracentesis for malignant pleural effusions
in patients with underlying parenchymal lung disease. MATERIALS AND
METHODS: Forty pneumothoraces resulted from 512 therapeutic thoracentesis
performed for malignant pleural effusions over a 3-year period. Twenty-nine
patients with pneumothoraces underwent catheter placement in the
pleural space for treatment. Of these, 12 pneumothoraces resolved
and 17 remained unchanged. We reviewed the charts of these 17 patients
to document the cause of malignant pleural effusion, presence of
underlying malignant parenchymal disease, volume of fluid aspirated,
and improvement in symptoms. Clinical outcome was then evaluated,
including size of residual pneumothorax, duration of catheter drainage,
and reaccumulation of effusion. RESULTS: No patients' lungs reexpanded
despite insertion of large-bore (16- to 35-French) chest tubes. All
had pneumothoraces that occupied at least 30% of the hemithorax;
all were asymptomatic; all had underlying parenchymal disease and
noncompliant lungs. Pleural effusion reaccumulated in all 17 after
removal of the chest tube. CONCLUSION: A subgroup of patients with
malignant lung parenchymal disease who undergo therapeutic thoracentesis
will develop asymptomatic hydropneumothoraces due to poor lung compliance.
These patients do not require further catheter drainage. Pleural
effusion will reaccumulate in the residual space over a variable
period of time.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
cohort the incidence and clinical observations of pneumothorax ex
vacuo after therapeutic thoracentesis for malignant pleural effusions
in patients with underlying parenchymal lung disease. MATERIALS AND
METHODS: Forty pneumothoraces resulted from 512 therapeutic thoracentesis
performed for malignant pleural effusions over a 3-year period. Twenty-nine
patients with pneumothoraces underwent catheter placement in the
pleural space for treatment. Of these, 12 pneumothoraces resolved
and 17 remained unchanged. We reviewed the charts of these 17 patients
to document the cause of malignant pleural effusion, presence of
underlying malignant parenchymal disease, volume of fluid aspirated,
and improvement in symptoms. Clinical outcome was then evaluated,
including size of residual pneumothorax, duration of catheter drainage,
and reaccumulation of effusion. RESULTS: No patients' lungs reexpanded
despite insertion of large-bore (16- to 35-French) chest tubes. All
had pneumothoraces that occupied at least 30% of the hemithorax;
all were asymptomatic; all had underlying parenchymal disease and
noncompliant lungs. Pleural effusion reaccumulated in all 17 after
removal of the chest tube. CONCLUSION: A subgroup of patients with
malignant lung parenchymal disease who undergo therapeutic thoracentesis
will develop asymptomatic hydropneumothoraces due to poor lung compliance.
These patients do not require further catheter drainage. Pleural
effusion will reaccumulate in the residual space over a variable
period of time.
Steiner, P.; Botnar, R.; Dubno, B.; Zimmermann, G. G.; Gazelle, G. Scott; Debatin, J. F.
Radio-frequency-induced thermoablation: monitoring with T1-weighted and proton-frequency-shift MR imaging in an interventional 0.5-T environment Journal Article
In: Radiology, vol. 206, no. 3, pp. 803-10, 1998, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Steiner1998,
title = {Radio-frequency-induced thermoablation: monitoring with T1-weighted and proton-frequency-shift MR imaging in an interventional 0.5-T environment},
author = {P. Steiner and R. Botnar and B. Dubno and G. G. Zimmermann and G. Scott Gazelle and J. F. Debatin},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9494505},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {1998},
date = {1998-03-01},
urldate = {1998-03-01},
journal = {Radiology},
volume = {206},
number = {3},
pages = {803-10},
abstract = {PURPOSE: To evaluate the feasibility and accuracy of monitoring radio-frequency
(RF) ablation with an open-configuration, 0.5-T magnetic resonance
(MR) imager. MATERIALS AND METHODS: Thirty-six in vivo RF ablation experiments were performed in porcine paravertebral muscle (n = 24) and liver (n = 12). A 90 degrees C tip temperature was applied for
3-9 minutes. MR images were acquired after continuous or during intermittent
RF application. Temperature changes were monitored as signal intensity
and proton-frequency-shift (PFS) alterations in two T1-weighted gradient-echo
sequences. An update image was obtained every 2.5 seconds (20/10
[repetition time msec/echo time [TE] msec]) or every 5.0 seconds
(40/20). A color-coded subtraction technique enhanced the signal
intensity and PFS changes. Macroscopic coagulation size was compared
with MR image lesion size. RESULTS: The RF application mode had no
significant effect on coagulation size in muscle or liver (P \> .05).
Twenty-two of 24 coagulative lesions in muscle and nine of 12 in
liver were demonstrated with the PFS technique. Accuracy of lesion size determination depended on TE (TE = 20 mse},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
(RF) ablation with an open-configuration, 0.5-T magnetic resonance
(MR) imager. MATERIALS AND METHODS: Thirty-six in vivo RF ablation experiments were performed in porcine paravertebral muscle (n = 24) and liver (n = 12). A 90 degrees C tip temperature was applied for
3-9 minutes. MR images were acquired after continuous or during intermittent
RF application. Temperature changes were monitored as signal intensity
and proton-frequency-shift (PFS) alterations in two T1-weighted gradient-echo
sequences. An update image was obtained every 2.5 seconds (20/10
[repetition time msec/echo time [TE] msec]) or every 5.0 seconds
(40/20). A color-coded subtraction technique enhanced the signal
intensity and PFS changes. Macroscopic coagulation size was compared
with MR image lesion size. RESULTS: The RF application mode had no
significant effect on coagulation size in muscle or liver (P > .05).
Twenty-two of 24 coagulative lesions in muscle and nine of 12 in
liver were demonstrated with the PFS technique. Accuracy of lesion size determination depended on TE (TE = 20 mse
Goldberg, S. N.; Hahn, P. F.; McGovern, F. J.; Fogle, R. M.; Mueller, P. R.; Gazelle, G. Scott
Benign prostatic hyperplasia: US-guided transrectal urethral enlargement with radio frequency--initial results in a canine model Journal Article
In: Radiology, vol. 208, pp. 491-8, 1998, ().
@article{Goldberg1998c,
title = {Benign prostatic hyperplasia: US-guided transrectal urethral enlargement
with radio frequency--initial results in a canine model},
author = {S. N. Goldberg and P. F. Hahn and F. J. McGovern and R. M. Fogle and P. R. Mueller and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9680581},
year = {1998},
date = {1998-01-01},
journal = {Radiology},
volume = {208},
pages = {491-8},
abstract = {PURPOSE: To enlarge the prostatic urethra with thermal coagulation
with transrectal radio-frequency (RF) application in dogs. MATERIALS
AND METHODS: Eight aged dogs underwent RF ablation of periurethral
prostatic tissue for 6 minutes. Eighteen-gauge electrodes were placed
into the periurethral tissues with a transrectal approach and ultrasound
(US) guidance. Prostatic and rectal temperatures were measured during
RF application. US, conventional and computed tomographic (CT) retrograde urethrography (RUG), and CT were performed immediately (n = 8) and at 3-96 days (n = 6) after ablation. Histopathologic analysis was performed at sacrifice immediately (n = 2), at 28 days (n = 2), or at 3 months (n = 4) after treatment. RESULTS: All procedures were
successful with no complications and were performed in less than
30 minutes. Rectal mucosal temperature did not exceed 38 degrees
C. Immediately after treatment, CT and US demonstrated 1.2-cm foci
of altered periurethral tissue that corresponded to solid coagulated
tissue at histopathologic analysis. By day 3, CT, RUG, and US demonstrated
that these foci had begun to cavitate, resulting in enlargement of
the urethra. Complete cavitation was demonstrated by day 28. Minimal
reduction in the degree of urethral enlargement was noted by day
60, but narrowing, urethral strictures, or fistulas were not observed
at 3 months. At histopathologic analysis, focal cavitary enlargement
with at least doubling of the urethral diameter and with normal urothelium
was noted in all dogs surviving at least 28 days. CONCLUSION: Transrectal
RF urethral enlargement is feasible and safe in animals and merits
investigation for alleviating urethral obstruction due to benign
prostatic hyperplasia.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
with transrectal radio-frequency (RF) application in dogs. MATERIALS
AND METHODS: Eight aged dogs underwent RF ablation of periurethral
prostatic tissue for 6 minutes. Eighteen-gauge electrodes were placed
into the periurethral tissues with a transrectal approach and ultrasound
(US) guidance. Prostatic and rectal temperatures were measured during
RF application. US, conventional and computed tomographic (CT) retrograde urethrography (RUG), and CT were performed immediately (n = 8) and at 3-96 days (n = 6) after ablation. Histopathologic analysis was performed at sacrifice immediately (n = 2), at 28 days (n = 2), or at 3 months (n = 4) after treatment. RESULTS: All procedures were
successful with no complications and were performed in less than
30 minutes. Rectal mucosal temperature did not exceed 38 degrees
C. Immediately after treatment, CT and US demonstrated 1.2-cm foci
of altered periurethral tissue that corresponded to solid coagulated
tissue at histopathologic analysis. By day 3, CT, RUG, and US demonstrated
that these foci had begun to cavitate, resulting in enlargement of
the urethra. Complete cavitation was demonstrated by day 28. Minimal
reduction in the degree of urethral enlargement was noted by day
60, but narrowing, urethral strictures, or fistulas were not observed
at 3 months. At histopathologic analysis, focal cavitary enlargement
with at least doubling of the urethral diameter and with normal urothelium
was noted in all dogs surviving at least 28 days. CONCLUSION: Transrectal
RF urethral enlargement is feasible and safe in animals and merits
investigation for alleviating urethral obstruction due to benign
prostatic hyperplasia.
Goldberg, S. N.; Hahn, P. F.; Tanabe, K. K.; Mueller, P. R.; Schima, W.; Athanasoulis, C. A.; Compton, C. C.; Solbiati, L.; Gazelle, G. Scott
Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis? Journal Article
In: J Vasc Interv Radiol, vol. 9, pp. 101-11, 1998, ().
@article{Goldberg1998b,
title = {Percutaneous radiofrequency tissue ablation: does perfusion-mediated
tissue cooling limit coagulation necrosis?},
author = {S. N. Goldberg and P. F. Hahn and K. K. Tanabe and P. R. Mueller and W. Schima and C. A. Athanasoulis and C. C. Compton and L. Solbiati and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9468403},
year = {1998},
date = {1998-01-01},
journal = {J Vasc Interv Radiol},
volume = {9},
pages = {101-11},
abstract = {PURPOSE: To determine, by decreasing hepatic perfusion during radiofrequency
(RF) ablation, whether perfusion-mediated tissue cooling can explain
the reduced coagulation observed in in vivo studies compared to that
seen with RF application in ex vivo tissue. MATERIALS AND METHODS:
RF was applied in vivo with use of cooled-tip electrodes to normal porcine liver without (n = 8) and with balloon occlusion of the portal vein (n = 8), celiac artery (n = 3), or hepatic artery (n = 2), and to ex vivo calf liver (n = 10). In vivo trials of vasopressin (0.3-0.6 U/min) infusion during RF application with (n = 10) and without (n = 2) arterial balloon occlusion were also performed. Intraoperative
RF was subsequently performed in seven patients with hepatic colorectal
metastases with and without portal inflow occlusion. Remote thermometry
was performed in four patients. RESULTS: RF application (12 minutes)
during portal venous occlusion produced larger areas of coagulation
necrosis than RF with unaltered blood flow (2.9 cm +/- 0.1 vs 2.4
cm +/- 0.2 diameter; P textless .01). With celiac and hepatic artery
occlusion, coagulation diameter measured 2.7 cm +/- 0.2 and 2.5 cm
+/- 0.1, respectively. Infusion of vasopressin without vascular occlusion
reduced coagulation diameter to 1.1 cm. However, different methods
of hepatic or celiac arterial balloon occlusion with simultaneous
vasopressin infusion produced a mean 3.4 cm +/- 0.2 of necrosis.
Coagulation in ex vivo liver was 2.9 cm +/- 0.1 in diameter. Clinical
studies demonstrated greater coagulation diameter for metastases
treated during portal inflow occlusion (4.0 cm +/- 1.3) than for
tumors treated with normal blood flow (2.5 cm +/- 0.8; P textless
.05). Thermometry documented a 10 degrees C increase compared to
baseline at 10 mm and 20 mm from the electrode after 5 minutes of
portal inflow occlusion during constant RF application. CONCLUSIONS:
Perfusion-mediated tissue cooling reduces coagulation necrosis achievable
with RF ablation. Reduction of blood flow during RF application increases
coagulation in both an animal model and human liver metastases.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
(RF) ablation, whether perfusion-mediated tissue cooling can explain
the reduced coagulation observed in in vivo studies compared to that
seen with RF application in ex vivo tissue. MATERIALS AND METHODS:
RF was applied in vivo with use of cooled-tip electrodes to normal porcine liver without (n = 8) and with balloon occlusion of the portal vein (n = 8), celiac artery (n = 3), or hepatic artery (n = 2), and to ex vivo calf liver (n = 10). In vivo trials of vasopressin (0.3-0.6 U/min) infusion during RF application with (n = 10) and without (n = 2) arterial balloon occlusion were also performed. Intraoperative
RF was subsequently performed in seven patients with hepatic colorectal
metastases with and without portal inflow occlusion. Remote thermometry
was performed in four patients. RESULTS: RF application (12 minutes)
during portal venous occlusion produced larger areas of coagulation
necrosis than RF with unaltered blood flow (2.9 cm +/- 0.1 vs 2.4
cm +/- 0.2 diameter; P textless .01). With celiac and hepatic artery
occlusion, coagulation diameter measured 2.7 cm +/- 0.2 and 2.5 cm
+/- 0.1, respectively. Infusion of vasopressin without vascular occlusion
reduced coagulation diameter to 1.1 cm. However, different methods
of hepatic or celiac arterial balloon occlusion with simultaneous
vasopressin infusion produced a mean 3.4 cm +/- 0.2 of necrosis.
Coagulation in ex vivo liver was 2.9 cm +/- 0.1 in diameter. Clinical
studies demonstrated greater coagulation diameter for metastases
treated during portal inflow occlusion (4.0 cm +/- 1.3) than for
tumors treated with normal blood flow (2.5 cm +/- 0.8; P textless
.05). Thermometry documented a 10 degrees C increase compared to
baseline at 10 mm and 20 mm from the electrode after 5 minutes of
portal inflow occlusion during constant RF application. CONCLUSIONS:
Perfusion-mediated tissue cooling reduces coagulation necrosis achievable
with RF ablation. Reduction of blood flow during RF application increases
coagulation in both an animal model and human liver metastases.
Goldberg, S. N.; Solbiati, L.; Hahn, P. F.; Cosman, E.; Conrad, J. E.; Fogle, R.; Gazelle, G. Scott
In: Radiology, vol. 209, pp. 371-9, 1998, ().
@article{Goldberg1998a,
title = {Large-volume tissue ablation with radio frequency by using a clustered,
internally cooled electrode technique: laboratory and clinical experience
in liver metastases},
author = {S. N. Goldberg and L. Solbiati and P. F. Hahn and E. Cosman and J. E. Conrad and R. Fogle and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9807561},
year = {1998},
date = {1998-01-01},
journal = {Radiology},
volume = {209},
pages = {371-9},
abstract = {PURPOSE: To evaluate whether coagulation necrosis achievable with
radio-frequency (RF) ablation can be increased by using a cluster
of closely spaced electrodes. MATERIALS AND METHODS: RF was applied to ex vivo liver (n = 68), in vivo liver (n = 12), and in vivo muscle (n = 15) by using a cluster array of three separate internally cooled
electrodes spaced 0.5 cm apart. The diameter of coagulation necrosis
achieved with optimal RF deposition (1,400-2,150 peak mA) for 5-60
minutes of RF application was determined for electrode tip lengths
of 1.5-3.0 cm and compared with that obtained by using a single electrode
and otherwise similar technique. Ten patients with solitary intrahepatic
colorectal metastases were also treated by using cluster electrode
RF ablation. RESULTS: In ex vivo liver, simultaneous RF application
to electrode clusters for 15, 30, and 45 minutes produced 4.7 cm
+/- 0.1, 6.2 cm +/- 0.1, and 7.0 cm +/- 0.2 of coagulation necrosis,
respectively. In in vivo liver and muscle, RF applied to electrode
clusters for 12 minutes yielded 3.1 cm +/- 0.2 and 7.6 cm +/- 0.4
of coagulation, respectively. RF application to a single electrode
produced maximal coagulation of 2.9 cm in ex vivo liver, 1.8 cm in
in vivo liver, and 4.3 cm in muscle (P textless .01, all tissues).
In colorectal metastases, a single 12-15-minute application of RF
to an electrode cluster induced 4.5-7.0 cm of coagulation necrosis.
CONCLUSION: Simultaneous RF application to a cluster of three closely
spaced internally cooled electrodes enables a larger volume of coagulation
in ex vivo liver, in vivo tissues, and hepatic colorectal metastases
than previously reported.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
radio-frequency (RF) ablation can be increased by using a cluster
of closely spaced electrodes. MATERIALS AND METHODS: RF was applied to ex vivo liver (n = 68), in vivo liver (n = 12), and in vivo muscle (n = 15) by using a cluster array of three separate internally cooled
electrodes spaced 0.5 cm apart. The diameter of coagulation necrosis
achieved with optimal RF deposition (1,400-2,150 peak mA) for 5-60
minutes of RF application was determined for electrode tip lengths
of 1.5-3.0 cm and compared with that obtained by using a single electrode
and otherwise similar technique. Ten patients with solitary intrahepatic
colorectal metastases were also treated by using cluster electrode
RF ablation. RESULTS: In ex vivo liver, simultaneous RF application
to electrode clusters for 15, 30, and 45 minutes produced 4.7 cm
+/- 0.1, 6.2 cm +/- 0.1, and 7.0 cm +/- 0.2 of coagulation necrosis,
respectively. In in vivo liver and muscle, RF applied to electrode
clusters for 12 minutes yielded 3.1 cm +/- 0.2 and 7.6 cm +/- 0.4
of coagulation, respectively. RF application to a single electrode
produced maximal coagulation of 2.9 cm in ex vivo liver, 1.8 cm in
in vivo liver, and 4.3 cm in muscle (P textless .01, all tissues).
In colorectal metastases, a single 12-15-minute application of RF
to an electrode cluster induced 4.5-7.0 cm of coagulation necrosis.
CONCLUSION: Simultaneous RF application to a cluster of three closely
spaced internally cooled electrodes enables a larger volume of coagulation
in ex vivo liver, in vivo tissues, and hepatic colorectal metastases
than previously reported.
Boland, G. W.; Lee, M. J.; Gazelle, G. Scott; Halpern, Elkan F.; McNicholas, M. M.; Mueller, P. R.
Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature Journal Article
In: AJR Am J Roentgenol, vol. 171, pp. 201-4, 1998, ().
@article{Boland1998,
title = {Characterization of adrenal masses using unenhanced CT: an analysis
of the CT literature},
author = {G. W. Boland and M. J. Lee and G. Scott Gazelle and Elkan F. Halpern and M. M. McNicholas and P. R. Mueller},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9648789},
year = {1998},
date = {1998-01-01},
journal = {AJR Am J Roentgenol},
volume = {171},
pages = {201-4},
abstract = {OBJECTIVE: Unenhanced CT scanning can reliably characterize incidentally
detected adrenal masses when observers use density measurements of
the adrenal gland. However, controversy exists as to the optimal
density threshold required to differentiate benign from malignant
lesions. This study attempts to establish a consensus by performing
a pooled analysis of data found in the CT literature. MATERIALS AND
METHODS: Ten CT reports were analyzed, from which individual adrenal
lesion density measurements were obtained for 495 adrenal lesions
(272 benign lesions and 223 malignant lesions). Threshold analysis
generated a range of sensitivities and specificities for lesion characterization
at different density thresholds. RESULTS: Sensitivity for characterizing
a lesion as benign ranged from 47% at a threshold of 2 H to 88% at
a threshold of 20 H. Similarly, specificity varied from 100% at a
threshold of 2 H to 84% at a threshold of 20 H. CONCLUSION: The attempt
to be absolutely certain that an adrenal lesion is benign may lead
to an unacceptably low sensitivity for lesion characterization. The
threshold chosen will depend on the patient population and the cost-benefit
approach to patient care.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
detected adrenal masses when observers use density measurements of
the adrenal gland. However, controversy exists as to the optimal
density threshold required to differentiate benign from malignant
lesions. This study attempts to establish a consensus by performing
a pooled analysis of data found in the CT literature. MATERIALS AND
METHODS: Ten CT reports were analyzed, from which individual adrenal
lesion density measurements were obtained for 495 adrenal lesions
(272 benign lesions and 223 malignant lesions). Threshold analysis
generated a range of sensitivities and specificities for lesion characterization
at different density thresholds. RESULTS: Sensitivity for characterizing
a lesion as benign ranged from 47% at a threshold of 2 H to 88% at
a threshold of 20 H. Similarly, specificity varied from 100% at a
threshold of 2 H to 84% at a threshold of 20 H. CONCLUSION: The attempt
to be absolutely certain that an adrenal lesion is benign may lead
to an unacceptably low sensitivity for lesion characterization. The
threshold chosen will depend on the patient population and the cost-benefit
approach to patient care.
Goldberg, S. N.; Gazelle, G. Scott; Solbiati, L.; Livraghi, T.; Tanabe, K. K.; Hahn, P. F.; Mueller, P. R.
Ablation of liver tumors using percutaneous RF therapy Journal Article
In: AJR Am J Roentgenol, vol. 170, pp. 1023-8, 1998, ().
@article{Goldberg1998,
title = {Ablation of liver tumors using percutaneous RF therapy},
author = {S. N. Goldberg and G. Scott Gazelle and L. Solbiati and T. Livraghi and K. K. Tanabe and P. F. Hahn and P. R. Mueller},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9530053},
year = {1998},
date = {1998-01-01},
urldate = {1998-01-01},
journal = {AJR Am J Roentgenol},
volume = {170},
pages = {1023-8},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Lewin, J. S.; Connell, C. F.; Duerk, J. L.; Chung, Y. C.; Clampitt, M. E.; Spisak, J.; Gazelle, G. Scott; Haaga, J. R.
Interactive MRI-guided radiofrequency interstitial thermal ablation of abdominal tumors: clinical trial for evaluation of safety and feasibility Journal Article
In: J Magn Reson Imaging, vol. 8, no. 1, pp. 40-7, 1998, ISSN: 1053-1807 (Print) 1053-1807 (Lin, ().
@article{Lewin1998,
title = {Interactive MRI-guided radiofrequency interstitial thermal ablation of abdominal tumors: clinical trial for evaluation of safety and feasibility},
author = {J. S. Lewin and C. F. Connell and J. L. Duerk and Y. C. Chung and M. E. Clampitt and J. Spisak and G. Scott Gazelle and J. R. Haaga},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9500259},
issn = {1053-1807 (Print) 1053-1807 (Lin},
year = {1998},
date = {1998-00-01},
urldate = {1998-00-01},
journal = {J Magn Reson Imaging},
volume = {8},
number = {1},
pages = {40-7},
abstract = {This clinical trial was performed to evaluate the safety and feasibility
of interactive MR-guided radiofrequency (RF) interstitial thermal
ablation (ITA) performed entirely within the MR imager. RF-ITA was
performed on 11 intra-abdominal metastatic tumors during 13 sessions.
The RF electrode was placed under MR guidance on a .2-T system using
rapid fast imaging with steady state precession (FISP) and true FISP
images. A custom 17-gauge electrode was used and was modified in
four sessions to allow circulation of iced saline for cooling during
ablation. Tissue necrosis monitoring and electrode repositioning
were based on rapid T2-weighted and short-inversion-time inversion
recovery (STIR) sequences. Morbidity and toxicity were assessed by
clinical and imaging criteria. The region of tissue destruction was
visible in all 11 tumors treated, as confirmed on subsequent contrast-enhanced
images. No significant morbidity was noted, and patient discomfort
was minimal. In conclusion, interactive MR-guided RF-ITA is feasible
on a clinical .2-T C-arm system with supplemental interventional
accessories with only minor patient morbidity. The ability to completely
ablate tumors with RF-ITA depends on tumor size and vascularity.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
of interactive MR-guided radiofrequency (RF) interstitial thermal
ablation (ITA) performed entirely within the MR imager. RF-ITA was
performed on 11 intra-abdominal metastatic tumors during 13 sessions.
The RF electrode was placed under MR guidance on a .2-T system using
rapid fast imaging with steady state precession (FISP) and true FISP
images. A custom 17-gauge electrode was used and was modified in
four sessions to allow circulation of iced saline for cooling during
ablation. Tissue necrosis monitoring and electrode repositioning
were based on rapid T2-weighted and short-inversion-time inversion
recovery (STIR) sequences. Morbidity and toxicity were assessed by
clinical and imaging criteria. The region of tissue destruction was
visible in all 11 tumors treated, as confirmed on subsequent contrast-enhanced
images. No significant morbidity was noted, and patient discomfort
was minimal. In conclusion, interactive MR-guided RF-ITA is feasible
on a clinical .2-T C-arm system with supplemental interventional
accessories with only minor patient morbidity. The ability to completely
ablate tumors with RF-ITA depends on tumor size and vascularity.
1997
Solbiati, L.; Goldberg, S. N.; Ierace, T.; Livraghi, T.; Meloni, F.; Dellanoce, M.; Sironi, S.; Gazelle, G. Scott
Hepatic metastases: percutaneous radio-frequency ablation with cooled-tip electrodes Journal Article
In: Radiology, vol. 205, no. 2, pp. 367-73, 1997, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Solbiati1997a,
title = {Hepatic metastases: percutaneous radio-frequency ablation with cooled-tip
electrodes},
author = {L. Solbiati and S. N. Goldberg and T. Ierace and T. Livraghi and F. Meloni and M. Dellanoce and S. Sironi and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9356616},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {1997},
date = {1997-11-01},
journal = {Radiology},
volume = {205},
number = {2},
pages = {367-73},
abstract = {PURPOSE: To assess the feasibility and safety of using cooled-tip
electrodes to increase the volume of coagulation necrosis obtained
or reduce the number of treatment sessions necessary with percutaneous
tumor radio-frequency (RF) ablation. MATERIALS AND METHODS: Twenty-nine
patients with 44 hepatic metastases (1.3-5.1 cm diameter) from colorectal (n = 22), gastric (n = 5), pancreatic (n = 1), or breast (n = 1)
carcinoma were treated with RF ablation using cooled-tip, 18-gauge
electrodes with 2-3 cm tip exposure. Each tumor was treated in one
or two treatment sessions. RESULTS: Technical success, ablation of
all visualized tumor, was achieved in 40 (91%) metastases. Findings
at computed tomography (CT) and magnetic resonance (MR) imaging performed
3-6 months after treatment confirmed complete necrosis of the entire
metastasis in 66%. Disease-free survival was 50% at 12 months and
33% at 18 months, with localized progression of disease in 34% of
treated lesions. Overall survival was 100%, 94%, and 89% at 6, 12,
and 18 months, respectively. Only one complication, self-limited
hemorrhage, was seen. CONCLUSION: Use of cooled-tip electrodes was
a safe and feasible adjunct for tumor RF ablation therapy that produced
larger volumes of coagulation necrosis with fewer electrode insertions
than is produced with other RF ablation techniques.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
electrodes to increase the volume of coagulation necrosis obtained
or reduce the number of treatment sessions necessary with percutaneous
tumor radio-frequency (RF) ablation. MATERIALS AND METHODS: Twenty-nine
patients with 44 hepatic metastases (1.3-5.1 cm diameter) from colorectal (n = 22), gastric (n = 5), pancreatic (n = 1), or breast (n = 1)
carcinoma were treated with RF ablation using cooled-tip, 18-gauge
electrodes with 2-3 cm tip exposure. Each tumor was treated in one
or two treatment sessions. RESULTS: Technical success, ablation of
all visualized tumor, was achieved in 40 (91%) metastases. Findings
at computed tomography (CT) and magnetic resonance (MR) imaging performed
3-6 months after treatment confirmed complete necrosis of the entire
metastasis in 66%. Disease-free survival was 50% at 12 months and
33% at 18 months, with localized progression of disease in 34% of
treated lesions. Overall survival was 100%, 94%, and 89% at 6, 12,
and 18 months, respectively. Only one complication, self-limited
hemorrhage, was seen. CONCLUSION: Use of cooled-tip electrodes was
a safe and feasible adjunct for tumor RF ablation therapy that produced
larger volumes of coagulation necrosis with fewer electrode insertions
than is produced with other RF ablation techniques.
Steiner, P.; Botnar, R.; Goldberg, S. N.; Gazelle, G. Scott; Debatin, J. F.
Monitoring of radio frequency tissue ablation in an interventional magnetic resonance environment. Preliminary ex vivo and in vivo results Journal Article
In: Invest Radiol, vol. 32, no. 11, pp. 671-8, 1997, ISSN: 0020-9996 (Print) 0020-9996 (Lin, ().
@article{Steiner1997,
title = {Monitoring of radio frequency tissue ablation in an interventional
magnetic resonance environment. Preliminary ex vivo and in vivo results},
author = {P. Steiner and R. Botnar and S. N. Goldberg and G. Scott Gazelle and J. F. Debatin},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9387054},
issn = {0020-9996 (Print) 0020-9996 (Lin},
year = {1997},
date = {1997-11-01},
journal = {Invest Radiol},
volume = {32},
number = {11},
pages = {671-8},
abstract = {RATIONALE AND OBJECTIVES: The authors evaluate the feasibility of
monitoring radio frequency (RF) ablation in an interventional, open-configuration,
0.5-tesla magnetic resonance (MR) environment. METHODS: Ex vivo and
in vivo RF coagulation necrosis were induced in porcine paraspinal
muscle tissue using a 300 kHz monopolar RF generator applying 5 to
20 W over 3 to 9 minutes. Images were acquired simultaneous to RF
application, after RF application, and in an intermittent mode (60
seconds of RF followed by 15 seconds of MR imaging). Temperature
changes were monitored based on amplitude (ex vivo) and phase alterations
(in vivo) of a T1-weighted graded refocused echo (GRE) sequence enabling
an update every 2.5 seconds. A standardized color-coded subtraction
technique enhanced signal changes. Additionally, T2- and T1-weighted
spin echo (SE) images were acquired with and without intravenous
contrast. Macroscopic coagulation size was compared with lesion size
seen on MR images. RESULTS: Although lesion diameters were related
directly to applied RF power, the application mode had no significant
impact on coagulation size (P \> 0.05). As could be expected, MR imaging
during RF ablation resulted in major image distortion. Radio frequency
effects were seen on images acquired in the continuous and intermittent
modes. Coagulation size seen on GRE images correlated well with macroscopy both ex vivo (r = 0.89) and in vivo (r = 0.92). Poorer correlation was found with postinterventional SE sequences (r = 0.78-0.84). CONCLUSIONS:
Magnetic resonance monitoring of RF effects is feasible both ex vivo
as well as in vivo using temperature-sensitive sequences in an open-configuration
MR environment.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
monitoring radio frequency (RF) ablation in an interventional, open-configuration,
0.5-tesla magnetic resonance (MR) environment. METHODS: Ex vivo and
in vivo RF coagulation necrosis were induced in porcine paraspinal
muscle tissue using a 300 kHz monopolar RF generator applying 5 to
20 W over 3 to 9 minutes. Images were acquired simultaneous to RF
application, after RF application, and in an intermittent mode (60
seconds of RF followed by 15 seconds of MR imaging). Temperature
changes were monitored based on amplitude (ex vivo) and phase alterations
(in vivo) of a T1-weighted graded refocused echo (GRE) sequence enabling
an update every 2.5 seconds. A standardized color-coded subtraction
technique enhanced signal changes. Additionally, T2- and T1-weighted
spin echo (SE) images were acquired with and without intravenous
contrast. Macroscopic coagulation size was compared with lesion size
seen on MR images. RESULTS: Although lesion diameters were related
directly to applied RF power, the application mode had no significant
impact on coagulation size (P > 0.05). As could be expected, MR imaging
during RF ablation resulted in major image distortion. Radio frequency
effects were seen on images acquired in the continuous and intermittent
modes. Coagulation size seen on GRE images correlated well with macroscopy both ex vivo (r = 0.89) and in vivo (r = 0.92). Poorer correlation was found with postinterventional SE sequences (r = 0.78-0.84). CONCLUSIONS:
Magnetic resonance monitoring of RF effects is feasible both ex vivo
as well as in vivo using temperature-sensitive sequences in an open-configuration
MR environment.
Hahn, P. F.; Gazelle, G. Scott; Jiang, D. Y.; Compton, C. C.; Goldberg, S. N.; Mueller, P. R.
Liver tumor ablation: real-time monitoring with dynamic CT Journal Article
In: Acad Radiol, vol. 4, no. 9, pp. 634-8, 1997, ISSN: 1076-6332 (Print) 1076-6332 (Lin, ().
@article{Hahn1997,
title = {Liver tumor ablation: real-time monitoring with dynamic CT},
author = {P. F. Hahn and G. Scott Gazelle and D. Y. Jiang and C. C. Compton and S. N. Goldberg and P. R. Mueller},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9288191},
issn = {1076-6332 (Print) 1076-6332 (Lin},
year = {1997},
date = {1997-09-01},
journal = {Acad Radiol},
volume = {4},
number = {9},
pages = {634-8},
abstract = {RATIONALE AND OBJECTIVES: To determine whether incomplete contact
of ethanol with tumor limits the success of percutaneous ethanol
injection therapy. MATERIALS AND METHODS: Percutaneous ethanol injection
was performed in seven normal New Zealand white rabbits and 18 rabbits
with 1-3-cm liver tumors 10-14 days after percutaneous implantation
of suspended tumor cells. A 3-5 mL dose of ethanol was injected at
a rate of 0.2 mL/sec either into normal liver remote from large vessels
or directly into tumor. During and immediately after injection, axial,
2-mm-thick, contrast material-enhanced computed tomography scans
were obtained at reach of three levels every 9 seconds. RESULTS:
In normal animals, virtually all injected ethanol tracked to the
hepatic capsule. As ethanol was injected into tumors, peripheral
tracking, similar to that seen in normal livers, or extratumoral
puddling was observed. Ethanol-tumor contact was incomplete in 16
of 18 animals (89%). Histopathologic analysis showed incomplete tumor
necrosis. CONCLUSION: In this model of hepatic carcinoma metastasis,
the tumor failed to hold sufficient ethanol for successful ablation
by means of percutaneous ethanol injection therapy.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
of ethanol with tumor limits the success of percutaneous ethanol
injection therapy. MATERIALS AND METHODS: Percutaneous ethanol injection
was performed in seven normal New Zealand white rabbits and 18 rabbits
with 1-3-cm liver tumors 10-14 days after percutaneous implantation
of suspended tumor cells. A 3-5 mL dose of ethanol was injected at
a rate of 0.2 mL/sec either into normal liver remote from large vessels
or directly into tumor. During and immediately after injection, axial,
2-mm-thick, contrast material-enhanced computed tomography scans
were obtained at reach of three levels every 9 seconds. RESULTS:
In normal animals, virtually all injected ethanol tracked to the
hepatic capsule. As ethanol was injected into tumors, peripheral
tracking, similar to that seen in normal livers, or extratumoral
puddling was observed. Ethanol-tumor contact was incomplete in 16
of 18 animals (89%). Histopathologic analysis showed incomplete tumor
necrosis. CONCLUSION: In this model of hepatic carcinoma metastasis,
the tumor failed to hold sufficient ethanol for successful ablation
by means of percutaneous ethanol injection therapy.
Solbiati, L.; Ierace, T.; Goldberg, S. N.; Sironi, S.; Livraghi, T.; Fiocca, R.; Servadio, G.; Rizzatto, G.; Mueller, P. R.; Maschio, A. Del; Gazelle, G. Scott
Percutaneous US-guided radio-frequency tissue ablation of liver metastases: treatment and follow-up in 16 patients Journal Article
In: Radiology, vol. 202, no. 1, pp. 195-203, 1997, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Solbiati1997,
title = {Percutaneous US-guided radio-frequency tissue ablation of liver metastases:
treatment and follow-up in 16 patients},
author = {L. Solbiati and T. Ierace and S. N. Goldberg and S. Sironi and T. Livraghi and R. Fiocca and G. Servadio and G. Rizzatto and P. R. Mueller and A. Del Maschio and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/8988211},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {1997},
date = {1997-01-01},
journal = {Radiology},
volume = {202},
number = {1},
pages = {195-203},
abstract = {PURPOSE: To determine the potential efficacy of radio-frequency (RF)
ablation of liver metastases during long-term follow-up. MATERIALS
AND METHODS: Sixteen patients with 31 hepatic metastases were treated
with percutaneous, ultrasound-guided RF ablation. RF was applied
to monopolar electrodes (2-3-cm tip exposure) either individually
or within a multiprobe array (two to four probes) for 6 minutes at
90 degrees C over one to four treatment sessions per metastasis.
RESULTS: In only one of 75 sessions, a moderate complication, self-limited
intraperitoneal hemorrhage, was observed. Four patients (four lesions)
underwent surgical resection 15-60 days after RF treatment. Residual,
viable tumor was seen in all of these patients. The remaining 12
patients were followed up for 9-29 months (mean, 18.1 months). In
these patients, 18 of 27 lesions remained stable or decreased in
size and showed no enhancement at computed tomography and/or magnetic
resonance imaging for at least 9 months. Two patients died of disseminated
disease at 13 months and one at 16 months. Disease-free survival
was achieved in eight patients. CONCLUSIONS: RF ablation appears
to be a simple, safe, and potentially effective treatment for selected
patients with liver metastases and may become a less invasive alternative
to surgical therapy.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
ablation of liver metastases during long-term follow-up. MATERIALS
AND METHODS: Sixteen patients with 31 hepatic metastases were treated
with percutaneous, ultrasound-guided RF ablation. RF was applied
to monopolar electrodes (2-3-cm tip exposure) either individually
or within a multiprobe array (two to four probes) for 6 minutes at
90 degrees C over one to four treatment sessions per metastasis.
RESULTS: In only one of 75 sessions, a moderate complication, self-limited
intraperitoneal hemorrhage, was observed. Four patients (four lesions)
underwent surgical resection 15-60 days after RF treatment. Residual,
viable tumor was seen in all of these patients. The remaining 12
patients were followed up for 9-29 months (mean, 18.1 months). In
these patients, 18 of 27 lesions remained stable or decreased in
size and showed no enhancement at computed tomography and/or magnetic
resonance imaging for at least 9 months. Two patients died of disseminated
disease at 13 months and one at 16 months. Disease-free survival
was achieved in eight patients. CONCLUSIONS: RF ablation appears
to be a simple, safe, and potentially effective treatment for selected
patients with liver metastases and may become a less invasive alternative
to surgical therapy.
Trubetskoy, V. S.; Gazelle, G. Scott; Wolf, G. L.; Torchilin, V. P.
In: J Drug Target, vol. 4, pp. 381-8, 1997, ().
@article{Trubetskoy1997,
title = {Block-copolymer of polyethylene glycol and polylysine as a carrier
of organic iodine: design of long-circulating particulate contrast
medium for X-ray computed tomography},
author = {V. S. Trubetskoy and G. Scott Gazelle and G. L. Wolf and V. P. Torchilin},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9239578},
year = {1997},
date = {1997-01-01},
journal = {J Drug Target},
volume = {4},
pages = {381-8},
abstract = {In order to obtain small, polymer-stabilized particulate carriers
for organic iodine to serve as a contrast agent for X-ray computed
tomography (CT) an attempt was made to design a carrier based on
polymeric micelles. Here we describe the synthesis of an iodine-containing
amphiphilic block-copolymer which can micellize in aqueous solutions.
The two blocks of the copolymer consisted of methoxypoly(ethyleneglycol)
and poly[epsilon,N-(triiodobenzoyl)-L-lysine]. Upon dispersion in
water, the block copolymer formed particles with average diameter
80 nm and iodine content up to 44.7 The particles start to dissociate
to the individual polymeric chains in the concentration range of
0.05-0.5 microM in water at 23 degrees C. Upon intravenous injection
at 250 mg of iodine/kg (570 mg of the agent/kg) in rabbits the medium
demonstrated exceptional 24 hr half-life in the blood substantiating
corona/core structure of the particles with PEG chains protecting
the iodine-containing core. The possible use of these particulates
as contrast medium for X-ray computed tomography is discussed.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
for organic iodine to serve as a contrast agent for X-ray computed
tomography (CT) an attempt was made to design a carrier based on
polymeric micelles. Here we describe the synthesis of an iodine-containing
amphiphilic block-copolymer which can micellize in aqueous solutions.
The two blocks of the copolymer consisted of methoxypoly(ethyleneglycol)
and poly[epsilon,N-(triiodobenzoyl)-L-lysine]. Upon dispersion in
water, the block copolymer formed particles with average diameter
80 nm and iodine content up to 44.7 The particles start to dissociate
to the individual polymeric chains in the concentration range of
0.05-0.5 microM in water at 23 degrees C. Upon intravenous injection
at 250 mg of iodine/kg (570 mg of the agent/kg) in rabbits the medium
demonstrated exceptional 24 hr half-life in the blood substantiating
corona/core structure of the particles with PEG chains protecting
the iodine-containing core. The possible use of these particulates
as contrast medium for X-ray computed tomography is discussed.
Livraghi, T.; Goldberg, S. N.; Monti, F.; Bizzini, A.; Lazzaroni, S.; Meloni, F.; Pellicano, S.; Solbiati, L.; Gazelle, G. Scott
Saline-enhanced radio-frequency tissue ablation in the treatment of liver metastases Journal Article
In: Radiology, vol. 202, no. 1, pp. 205-10, 1997, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Livraghi1997,
title = {Saline-enhanced radio-frequency tissue ablation in the treatment
of liver metastases},
author = {T. Livraghi and S. N. Goldberg and F. Monti and A. Bizzini and S. Lazzaroni and F. Meloni and S. Pellicano and L. Solbiati and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/8988212},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {1997},
date = {1997-01-01},
journal = {Radiology},
volume = {202},
number = {1},
pages = {205-10},
abstract = {PURPOSE: To assess the effect of intraparenchymal saline injection
on the results of radio-frequency (RF) tissue ablation. MATERIALS
AND METHODS: Ex vivo and in vivo animal RF ablation was performed
with and without intraparenchymal saline injection. Initially, saline
was injected as a bolus (1-20 mL) before RF application. For subsequent
in vivo studies, saline was injected as a bolus before RF application
or continuously (1 mL/min) during RF application. Finally, 14 patients
with liver metastases and one patient with primary cholangiocarcinoma
were treated with the continuous infusion technique. A single RF
electrode (tip exposure, 1-3 cm) was used with various ablation parameters.
RESULTS: With pretreatment bolus injection of saline, lesions measured
1.4 cm +/- 0.1, 1.6 cm +/- 0.2, and 1.2 cm +/- 0.1 in ex vivo liver,
in vivo animal muscle, and in vivo animal liver, respectively. Without
saline enhancement, lesion sizes were 1.0 +/- 0.2, 1.2 +/- 0.2, and
0.8 +/- 0.1 cm, respectively. With continuous saline injection in
in vivo pig liver, lesion size was 1.8 - 4.1 cm in diameter. In human
tumors, necrosis volume was variable, but complete necrosis was seen
in 13 of 25 lesions (diameter, 1.2-3.9 cm). Partial necrosis greater
than 50% was seen in 12 lesions (diameter, 1.5-4.5 cm). CONCLUSION:
Saline-enhanced RF ablation might permit percutaneous destruction
of large liver lesions.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
on the results of radio-frequency (RF) tissue ablation. MATERIALS
AND METHODS: Ex vivo and in vivo animal RF ablation was performed
with and without intraparenchymal saline injection. Initially, saline
was injected as a bolus (1-20 mL) before RF application. For subsequent
in vivo studies, saline was injected as a bolus before RF application
or continuously (1 mL/min) during RF application. Finally, 14 patients
with liver metastases and one patient with primary cholangiocarcinoma
were treated with the continuous infusion technique. A single RF
electrode (tip exposure, 1-3 cm) was used with various ablation parameters.
RESULTS: With pretreatment bolus injection of saline, lesions measured
1.4 cm +/- 0.1, 1.6 cm +/- 0.2, and 1.2 cm +/- 0.1 in ex vivo liver,
in vivo animal muscle, and in vivo animal liver, respectively. Without
saline enhancement, lesion sizes were 1.0 +/- 0.2, 1.2 +/- 0.2, and
0.8 +/- 0.1 cm, respectively. With continuous saline injection in
in vivo pig liver, lesion size was 1.8 - 4.1 cm in diameter. In human
tumors, necrosis volume was variable, but complete necrosis was seen
in 13 of 25 lesions (diameter, 1.2-3.9 cm). Partial necrosis greater
than 50% was seen in 12 lesions (diameter, 1.5-4.5 cm). CONCLUSION:
Saline-enhanced RF ablation might permit percutaneous destruction
of large liver lesions.
Goldberg, S. N.; Ryan, T. P.; Hahn, P. F.; Schima, W.; Dawson, S. L.; Lawes, K. R.; Mueller, P. R.; Gazelle, G. Scott
Transluminal radiofrequency tissue ablation with use of metallic stents Journal Article
In: J Vasc Interv Radiol, vol. 8, pp. 835-43, 1997, ().
@article{Goldberg1997a,
title = {Transluminal radiofrequency tissue ablation with use of metallic
stents},
author = {S. N. Goldberg and T. P. Ryan and P. F. Hahn and W. Schima and S. L. Dawson and K. R. Lawes and P. R. Mueller and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9314376},
year = {1997},
date = {1997-01-01},
journal = {J Vasc Interv Radiol},
volume = {8},
pages = {835-43},
abstract = {PURPOSE: To determine if transluminal coagulative necrosis can be
induced by applying radiofrequency (RF) energy to indwelling metallic
stents. MATERIALS AND METHODS: RF energy was applied to metallic
alloy stents (20-68 mm length, 5-16 mm diameter) in tissue phantom (n = 31), ex vivo bovine liver (n = 10), and in vivo porcine hepatic veins (n = 4). For ex vivo and in vivo liver experiments, RF was
applied for 5-6 minutes, titrating generator output to produce 85
degrees-95 degrees C temperatures at the stent surface. Local and
remote temperature sensing was performed. Imaging and pathologic
studies documented the extent of coagulation necrosis. RESULTS: Phantom
studies demonstrated uniform temperature distribution along the entire
stent length for all Elgiloy stents powered for 2 minutes with a
minimum of 120 watts. Shorter stents required less power or reduced
time to achieve uniform temperature. In ex vivo liver, 25-mm stents (n = 5) showed 8-10 mm of uniform circumferential coagulation necrosis
along the entire stent length. Fifty-millimeter stents showed less
uniform coagulation necrosis. For the in vivo stents (20 mm), 8-10
mm of uniform circumferential coagulation necrosis surrounded the
stent along its entire length. CONCLUSION: Metallic stents can be
used to deliver transluminal RF energy from an external source, inducing
heat deposition with resultant circumferential tissue coagulation.
Clinical applications might include reduction of intimal proliferation
in vascular diseases and/or treatment of periluminal tumors compressing
the bile ducts, the urethra, or other luminal structures.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
induced by applying radiofrequency (RF) energy to indwelling metallic
stents. MATERIALS AND METHODS: RF energy was applied to metallic
alloy stents (20-68 mm length, 5-16 mm diameter) in tissue phantom (n = 31), ex vivo bovine liver (n = 10), and in vivo porcine hepatic veins (n = 4). For ex vivo and in vivo liver experiments, RF was
applied for 5-6 minutes, titrating generator output to produce 85
degrees-95 degrees C temperatures at the stent surface. Local and
remote temperature sensing was performed. Imaging and pathologic
studies documented the extent of coagulation necrosis. RESULTS: Phantom
studies demonstrated uniform temperature distribution along the entire
stent length for all Elgiloy stents powered for 2 minutes with a
minimum of 120 watts. Shorter stents required less power or reduced
time to achieve uniform temperature. In ex vivo liver, 25-mm stents (n = 5) showed 8-10 mm of uniform circumferential coagulation necrosis
along the entire stent length. Fifty-millimeter stents showed less
uniform coagulation necrosis. For the in vivo stents (20 mm), 8-10
mm of uniform circumferential coagulation necrosis surrounded the
stent along its entire length. CONCLUSION: Metallic stents can be
used to deliver transluminal RF energy from an external source, inducing
heat deposition with resultant circumferential tissue coagulation.
Clinical applications might include reduction of intimal proliferation
in vascular diseases and/or treatment of periluminal tumors compressing
the bile ducts, the urethra, or other luminal structures.
Graf, O.; Gazelle, G. Scott; Kreuzer, S.; Halpern, Elkan F.; Boehm, P.; Lechner, G.; Mueller, P. R.
Enhancement of hepatic parenchyma, aorta, and portal vein in helical CT: comparison of iodixanol and iopromide Journal Article
In: AJR Am J Roentgenol, vol. 168, no. 1, pp. 213-7, 1997, ISSN: 0361-803X (Print) 0361-803X (Lin, ().
@article{Graf1997,
title = {Enhancement of hepatic parenchyma, aorta, and portal vein in helical
CT: comparison of iodixanol and iopromide},
author = {O. Graf and G. Scott Gazelle and S. Kreuzer and Elkan F. Halpern and P. Boehm and G. Lechner and P. R. Mueller},
url = {http://www.ncbi.nlm.nih.gov/pubmed/8976948},
issn = {0361-803X (Print) 0361-803X (Lin},
year = {1997},
date = {1997-01-01},
journal = {AJR Am J Roentgenol},
volume = {168},
number = {1},
pages = {213-7},
abstract = {OBJECTIVE: The purpose of this study was to determine hepatic, aortic,
and portal vein enhancement with a new dimeric, nonionic, isotonic
contrast medium (iodixanol) in a routinely performed helical CT protocol
and compare enhancement characteristics with those of a monomeric,
nonionic, low-osmolality contrast medium (iopromide). SUBJECTS AND
METHODS: In 81 patients, we injected 150 ml of iodixanol (320 mg
I/ml), iodixanol (300 mg I/ml), or iopromide (300 mg I/ml). Injection
rate was 5 ml/sec. A dual-phase helical CT scan was obtained (first
helical scan began at 30 sec. second helical scan began at 70 sec),
and enhancement characteristics were assessed. Results were analyzed
taking into account various intrinsic parameters of patients. RESULTS:
During the second imaging phase, iodixanol at 320 mg I/ml and iodixanol
at 300 mg I/ml provided significantly higher enhancement of the liver
(75 H, 69 H, 62 H), aorta (144 H, 140 H, 122 H), and portal vein
(147 H, 147 H, 118 H) than did iopromide at 300 mg I/ml. No significant
differences were observed during the first imaging phase. CONCLUSION:
The combination of higher vascular and parenchymal enhancement levels
after injection of the isotonic agent may represent a different quality
of tissue enhancement. Such an enhancement would be characterized
more by a higher contribution of the blood pool compartment to absolute
enhancement levels than by a contribution of the interstitial compartment.
Further studies are needed to determine whether the use of isotonic
agents effects lesion conspicuity.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
and portal vein enhancement with a new dimeric, nonionic, isotonic
contrast medium (iodixanol) in a routinely performed helical CT protocol
and compare enhancement characteristics with those of a monomeric,
nonionic, low-osmolality contrast medium (iopromide). SUBJECTS AND
METHODS: In 81 patients, we injected 150 ml of iodixanol (320 mg
I/ml), iodixanol (300 mg I/ml), or iopromide (300 mg I/ml). Injection
rate was 5 ml/sec. A dual-phase helical CT scan was obtained (first
helical scan began at 30 sec. second helical scan began at 70 sec),
and enhancement characteristics were assessed. Results were analyzed
taking into account various intrinsic parameters of patients. RESULTS:
During the second imaging phase, iodixanol at 320 mg I/ml and iodixanol
at 300 mg I/ml provided significantly higher enhancement of the liver
(75 H, 69 H, 62 H), aorta (144 H, 140 H, 122 H), and portal vein
(147 H, 147 H, 118 H) than did iopromide at 300 mg I/ml. No significant
differences were observed during the first imaging phase. CONCLUSION:
The combination of higher vascular and parenchymal enhancement levels
after injection of the isotonic agent may represent a different quality
of tissue enhancement. Such an enhancement would be characterized
more by a higher contribution of the blood pool compartment to absolute
enhancement levels than by a contribution of the interstitial compartment.
Further studies are needed to determine whether the use of isotonic
agents effects lesion conspicuity.
Goldberg, M. A.; Gazelle, G. Scott; Boland, G. W.; Hahn, P. F.; Mayo-Smith, W. W.; Pivovarov, M.; Halpern, Elkan F.; Wittenberg, J.
Focal hepatic lesions: effect of three-dimensional wavelet compression on detection at CT Journal Article
In: Radiology, vol. 202, pp. 159-65, 1997, ().
@article{Goldberg1997,
title = {Focal hepatic lesions: effect of three-dimensional wavelet compression on detection at CT},
author = {M. A. Goldberg and G. Scott Gazelle and G. W. Boland and P. F. Hahn and W. W. Mayo-Smith and M. Pivovarov and Elkan F. Halpern and J. Wittenberg},
url = {http://www.ncbi.nlm.nih.gov/pubmed/8988206},
year = {1997},
date = {1997-01-01},
journal = {Radiology},
volume = {202},
pages = {159-65},
abstract = {PURPOSE: To evaluate the effect of three-dimensional, wavelet-based
compression on the detection of focal hepatic lesions at computed
tomography (CT). MATERIALS AND METHODS: CT images obtained in 69
patients with focal hepatic lesions were studied (35 consecutive
cases and 34 cases selected to be difficult on the basis of lesion
size or contrast). Image data were compressed by means of a three-dimensional,
wavelet-based algorIthm at ratios of 10:1, 15:1, and 20:1. Normal
and abnormal sections (on original and compressed images) were reviewed
by using an interactive workstation. Four readers rated the presence
or absence of a lesion with a five-point scale. RESULTS: At receiver
operating characteristic analysis, no statistically significant difference
was detected for all cases considered together. Differences approached
but did not reach statistical significance for the diagnostic performance of one reader with compressed images (15:},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
compression on the detection of focal hepatic lesions at computed
tomography (CT). MATERIALS AND METHODS: CT images obtained in 69
patients with focal hepatic lesions were studied (35 consecutive
cases and 34 cases selected to be difficult on the basis of lesion
size or contrast). Image data were compressed by means of a three-dimensional,
wavelet-based algorIthm at ratios of 10:1, 15:1, and 20:1. Normal
and abnormal sections (on original and compressed images) were reviewed
by using an interactive workstation. Four readers rated the presence
or absence of a lesion with a five-point scale. RESULTS: At receiver
operating characteristic analysis, no statistically significant difference
was detected for all cases considered together. Differences approached
but did not reach statistical significance for the diagnostic performance of one reader with compressed images (15:
McDowell, R. K.; Gazelle, G. Scott; Murphy, B. L.; Boland, G. W.; Mayo-Smith, W. W.; Warshaw, A. L.; Mueller, P. R.
Mucinous ductal ectasia of the pancreas Journal Article
In: J Comput Assist Tomogr, vol. 21, no. 3, pp. 383-8, 1997, ISSN: 0363-8715 (Print) 0363-8715 (Lin, ().
@article{McDowell1997,
title = {Mucinous ductal ectasia of the pancreas},
author = {R. K. McDowell and G. Scott Gazelle and B. L. Murphy and G. W. Boland and W. W. Mayo-Smith and A. L. Warshaw and P. R. Mueller},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9135644},
issn = {0363-8715 (Print) 0363-8715 (Lin},
year = {1997},
date = {1997-00-01},
journal = {J Comput Assist Tomogr},
volume = {21},
number = {3},
pages = {383-8},
abstract = {PURPOSE: Pancreatic mucinous ductal ectasia (MDE) is a recently described
and poorly understood disorder, with few cases reported in the imaging
literature. We undertook this study to describe the spectrum of CT
and pancreatographic findings of MDE and to investigate the incidence
of associated pancreatic malignancy. METHOD: The medical records,
CT scans, and pancreatograms of 12 consecutive patients with pathologically
proven MDE were retrospectively reviewed. There were nine men and
three women, ranging in age from 37 to 72 years (mean 59 years).
RESULTS: Focal lesions involved primarily the uncinate (two patients)
and head (eight patients) by CT imaging. The entire gland was involved
in two patients. CT findings were variable and included focal pancreatic
enlargement, a low attenuation or cystic mass, low attenuation of
the entire gland, or marked ductal dilatation. Pancreatographic findings
were more consistent, showing ductal dilatation with or without intraluminal
filling defects, obstruction, or displacement. In all cases, findings
at endoscopy were felt to be characteristic, with ductal dilatation,
filling defects, or abundant mucus seen upon cannulation of the pancreatic
duct. Carcinoma-in-situ was present in six cases, cellular atypia
without malignancy in two, and in three cases the lesions were histologically
benign. One case demonstrated invasive adenocarcinoma. No finding
or group of findings on CT or pancreatography permitted differentiation
between benign and malignant lesions. CONCLUSION: MDE can present
with a variety of appearances on CT, none of which is diagnostic.
Pancreatography can be diagnostic if dilatation and intraluminal
filling defects are seen. Carcinoma-in-situ, invasive adenocarcinoma,
or cellular atypia is present in approximately 75%, but cannot be
accurately diagnosed prospectively.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
and poorly understood disorder, with few cases reported in the imaging
literature. We undertook this study to describe the spectrum of CT
and pancreatographic findings of MDE and to investigate the incidence
of associated pancreatic malignancy. METHOD: The medical records,
CT scans, and pancreatograms of 12 consecutive patients with pathologically
proven MDE were retrospectively reviewed. There were nine men and
three women, ranging in age from 37 to 72 years (mean 59 years).
RESULTS: Focal lesions involved primarily the uncinate (two patients)
and head (eight patients) by CT imaging. The entire gland was involved
in two patients. CT findings were variable and included focal pancreatic
enlargement, a low attenuation or cystic mass, low attenuation of
the entire gland, or marked ductal dilatation. Pancreatographic findings
were more consistent, showing ductal dilatation with or without intraluminal
filling defects, obstruction, or displacement. In all cases, findings
at endoscopy were felt to be characteristic, with ductal dilatation,
filling defects, or abundant mucus seen upon cannulation of the pancreatic
duct. Carcinoma-in-situ was present in six cases, cellular atypia
without malignancy in two, and in three cases the lesions were histologically
benign. One case demonstrated invasive adenocarcinoma. No finding
or group of findings on CT or pancreatography permitted differentiation
between benign and malignant lesions. CONCLUSION: MDE can present
with a variety of appearances on CT, none of which is diagnostic.
Pancreatography can be diagnostic if dilatation and intraluminal
filling defects are seen. Carcinoma-in-situ, invasive adenocarcinoma,
or cellular atypia is present in approximately 75%, but cannot be
accurately diagnosed prospectively.