Martin H. Gregory

A comparison of surgical intervention and stereotactic body radiation therapy for stage I lung cancer in high-risk patients: A decision analysis

OBJECTIVE We sought to compare the relative cost-effectiveness of surgical intervention and stereotactic body radiation therapy in high risk patients with clinical stage I lung cancer (non-small cell lung cancer). METHODS We compared patients chosen for surgical intervention or SBRT for clinical stage I non-small cell lung cancer. Propensity score matching was used to adjust estimated treatment hazard ratios for the confounding effects of age, comorbidity index, and clinical stage. We assumed that Medicare-allowable charges were

Modeling asthma exacerbations through lung function in children

15,034 for surgical intervention and

De-novo Inflammatory Bowel Disease After Bariatric Surgery: A Large Case Series

13,964 for stereotactic body radiation therapy. The incremental cost-effectiveness ratio was estimated as the cost per life year gained over the patients remaining lifetime by using a decision model. RESULTS Fifty-seven patients in each arm were selected by means of propensity score matching. Median survival with surgical intervention was 4.1 years, and 4-year survival was 51.4%. With stereotactic body radiation therapy, median survival was 2.9 years, and 4-year survival was 30.1%. Cause-specific survival was identical between the 2 groups, and the difference in overall survival was not statistically significant. For decision modeling, stereotactic body radiation therapy was estimated to have a mean expected survival of 2.94 years at a cost of

Development of a Decision-Analytic Model for the Application of STR- Based Provenance Testing of Transrectal Prostate Biopsy Specimens

14,153 and mean expected survival with surgical intervention was 3.39 years at a cost of

Efficacy and Safety of Digital Single-Operator Cholangioscopy for Difficult Biliary Stones

17,629, for an incremental cost-effectiveness ratio of

Anti-Tumour Necrosis Factor Therapy for Inflammatory Bowel Diseases Do Not Impact Serious Infections after Arthroplasty

7753. CONCLUSIONS In our analysis stereotactic body radiation therapy appears to be less costly than surgical intervention in high-risk patients with early stage non-small cell lung cancer. However, surgical intervention appears to meet the standards for cost-effectiveness because of a longer expected overall survival. Should this advantage not be confirmed in other studies, the cost-effectiveness decision would be likely to change. Prospective randomized studies are necessary to strengthen confidence in these results.

Ustekinumab Is Effective for the Treatment of Crohn’s Disease of the Pouch in a Multicenter Cohort

BACKGROUND Formal economic evaluation using a model-based approach is playing an increasingly important role in health care decision making. OBJECTIVE To develop a model by using an objective measure of lung function-- prebronchodilator FEV(1) as a percent of predicted (FEV(1)% predicted)--as the primary independent factor to predict the frequency of adverse events related to the exacerbation of asthma on a population level. METHODS We developed a Markov simulation model of childhood asthma by using data from the Childhood Asthma Management Program. The primary outcomes were the result of asthma exacerbations defined as hospitalizations, emergency department (ED) visits, and the need for oral corticosteroid therapy. Predicted monthly frequencies for each acute event were based on negative binomial regression equations estimated from the placebo arm of the Childhood Asthma Management Program with covariates of age, prebronchodilator FEV(1)% predicted, time in study, prior hospitalizations, and prior nocturnal awakenings. RESULTS Simulated versus observed mean number of acute events were similar within the placebo and treatment groups. While the trial demonstrated treatment effects of 48% reduction in hospitalizations, 46% reduction in ED visits, and 44% reduction in the need for oral corticosteroid therapy at 48 months, the model simulated similar reductions of 49% in hospitalizations, 41% in ED visits, and 46% in the need for oral corticosteroid therapy. CONCLUSIONS Our findings suggest that longitudinal intervention effects may be modeled through FEV(1)% predicted to estimate hospitalizations, ED visits, and need for oral corticosteroid therapy in childhood asthma for planning and evaluation purposes.

Health-related quality of life and long-term outcomes after endoscopic therapy for walled-off pancreatic necrosis

Background Case reports of inflammatory bowel diseases [IBD] have been reported in patients with a history of bariatric surgery. Our aim was to characterize patients who were diagnosed with IBD after having undergone bariatric surgery. Methods Electronic medical records were reviewed at two institutions to identify patients who developed de-novo Crohns disease or ulcerative colitis [UC] after bariatric surgery. Data on demographics, type of bariatric surgical procedure, IBD subtype, phenotype and medication usage were obtained. The incidence rate of de-novo IBD after bariatric surgery [per 100000 person-years] and standardized incidence ratio [SIR] were estimated from a prospective bariatric surgery database. Results A total of 44 patients with de-novo IBD after bariatric surgery were identified [31 Crohns disease, 12 UC, one IBD unclassified]. Most patients were female [88.6%], with median age at IBD onset of 44 years [IQR, 37-52] and median time to IBD diagnosis after bariatric surgery of 7 years [IQR, 3-10]. Sixty-eight per cent underwent Roux-en-Y gastric bypass. In the prospective database, the incidence of IBD in patients who underwent bariatric surgery was 26.7 per 100000 person-years [4.5 for UC and 22.3 for Crohns disease]. The age-adjusted SIR ranged from 3.56 in the 40-49 year age group to 4.73 in the 30-39 year age group. Conclusion We described a case series of patients developing de-novo IBD after bariatric surgery. There appears to be a numerically higher incidence of Crohns disease in this population. Confirmation of causality is required in larger patient cohorts.

Health Economic Outcome Analysis Of Stem Cell Mobilization With Granulocyte Colony-Stimulating Factor (G-CSF) Plus Plerixafor Versus G-CSF Alone In Preparation For Autologous Stem Cell Transplantation (ASCT) In Patients With Non-Hodgkin's Lymphomas (NHL)

BACKGROUND The diagnostic algorithm for most cancers includes the assessment of a tissue specimen by a surgical pathologist, but if specimen provenance is uncertain, the diagnostic and therapeutic process carries significant risk to the patient. Over the last decade, short tandem repeat (STR) analysis has emerged as a DNA-based method with clinical applicability for specimen identity testing (also known as specimen provenance testing). Although the clinical utility of identity testing using STR-based analysis has been demonstrated in many studies, its economic value has not been established. METHODS We developed a decision-analytic model of the application of STR-based provenance testing of transrectal prostate biopsy specimens obtained as part of routine clinical care to rule out the presence of adenocarcinoma of the prostate, as compared with no STR-based testing. Using parameter values drawn from the published literature, the cost-effectiveness of STR-based testing was quantified by calculating the incremental cost-effectiveness ratio per quality-adjusted life-year gained. RESULTS In comparison to the current standard practice of no identity testing, identity testing by STR-based analysis has an incremental cost-effectiveness ratio of

Mo1900 - Vedolizumab for the Treatment of Pouchitis

65,570 per quality-adjusted life-year gained at a testing cost of