Scott Gazelle’s Publications

@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 = {},

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tppubtype = {article}

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@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},

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@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}

}

@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},

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@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.},

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pubstate = {published},

tppubtype = {article}

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@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}

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@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}

}

@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.},

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pubstate = {published},

tppubtype = {article}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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.},

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pubstate = {published},

tppubtype = {article}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}

@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}

}