Daniella Perlroth

Health Outcomes and Costs of Community Mitigation Strategies for an Influenza Pandemic in the United States

BACKGROUND The optimal community-level approach to control pandemic influenza is unknown. METHODS We estimated the health outcomes and costs of combinations of 4 social distancing strategies and 2 antiviral medication strategies to mitigate an influenza pandemic for a demographically typical US community. We used a social network, agent-based model to estimate strategy effectiveness and an economic model to estimate health resource use and costs. We used data from the literature to estimate clinical outcomes and health care utilization. RESULTS At 1% influenza mortality, moderate infectivity (R(o) of 2.1 or greater), and 60% population compliance, the preferred strategy is adult and child social distancing, school closure, and antiviral treatment and prophylaxis. This strategy reduces the prevalence of cases in the population from 35% to 10%, averts 2480 cases per 10,000 population, costs

The potential impact of comparative effectiveness research on U.S. health care expenditures.

2700 per case averted, and costs

An economic analysis of conservative management versus active treatment for men with localized prostate cancer

31,300 per quality-adjusted life-year gained, compared with the same strategy without school closure. The addition of school closure to adult and child social distancing and antiviral treatment and prophylaxis, if available, is not cost-effective for viral strains with low infectivity (R(o) of 1.6 and below) and low case fatality rates (below 1%). High population compliance lowers costs to society substantially when the pandemic strain is severe (R(o) of 2.1 or greater). CONCLUSIONS Multilayered mitigation strategies that include adult and child social distancing, use of antivirals, and school closure are cost-effective for a moderate to severe pandemic. Choice of strategy should be driven by the severity of the pandemic, as defined by the case fatality rate and infectivity.

Effects of a Community-Based Fall Management Program on Medicare Cost Savings

Comparative effectiveness research (CER) has the potential to slow health care spending growth by focusing resources on health interventions that provide the most value. In this article, we discuss issues surrounding CER and its implementation and apply these methods to a salient clinical example: treatment of prostate cancer. Physicians have several options for treating patients recently diagnosed with localized disease, including removal of the prostate (radical prostatectomy), treatment with radioactive seeds (brachytherapy), radiation therapy (IMRT), or—if none of these are pursued—active surveillance. Using a commercial health insurance claims database and after adjustment for comorbid conditions, we estimate that the additional cost of treatment with radical prostatectomy is

Can Oral Nutritional Supplements Improve Medicare Patient Outcomes in the Hospital

7,300, while other alternatives are more expensive—

Treating people right: Who goes untreated with systemic therapy for metastatic prostate cancer (mPC)?

19,000 for brachytherapy and

Time to ADT and chemotherapy initiation for treatment of metastatic prostate cancer (mPC).

46,900 for IMRT. However, a review of the clinical literature uncovers no evidence that justifies the use of these more expensive approaches. These results imply that if patient management strategies were shifted to those supported by CER-based criteria, an estimated

Effect of Oral Nutritional Supplements On Hospital Outcomes in Patients Aged 65+ With Congestive Heart Failure.

1.7 to

School Nurses' Role in Asthma Management, School Absenteeism, and Cost Savings: A Demonstration Project

3.0 billion (2009 present value) could be saved each year.

Medical Care Costs of Patients with Amyotrophic Lateral Sclerosis in the Medicare Program (P07.065)

Comparative effectiveness research suggests that conservative management (CM) strategies are no less effective than active initial treatment for many men with localized prostate cancer. We estimate longer-term costs of initial management strategies and potential US health expenditure savings by increased use of conservative management for men with localized prostate cancer. Five-year total health expenditures attributed to initial management strategies for localized prostate cancer were calculated using commercial claims data from 1998 to 2006, and savings were estimated from a US population health-care expenditure model. Our analysis finds that patients receiving combinations of active treatments have the highest additional costs over conservative management at