Siddharth Karanth

Thrombolysis for Acute Ischemic Stroke in Patients With Cancer: A Population Study

Background and Purpose— The safety of thrombolysis for acute stroke in patients with cancer is not well established. Our aim is to study the outcomes after thrombolysis in patients with stroke with cancer. Methods— Patients with acute ischemic stroke who received thrombolysis were identified from the 2009 and 2010 Nationwide Inpatient Sample. Patients with cancer-associated strokes and noncancer strokes were compared based on demographics, comorbidities, and outcomes. Results— Of the 32 576 strokes treated with thrombolysis, cancer-associated strokes had significantly higher comorbidity indices overall, but fewer vascular risk factors than noncancer strokes. There was no difference in the rates of home discharge and in-hospital mortality, after adjusting for confounders. Subgroup analysis showed that compared with liquid cancers, patients with solid tumors had worse home discharge (odds ratio, 0.178; 95% confidence interval, 0.109–0.290; P<0.001) and higher in-hospital mortality (odds ratio, 3.018; 95% confidence interval, 1.37–6.646; P=0.006) after thrombolysis. Metastatic cancers had poorest outcomes, but intracerebral hemorrhage rates were similar. Conclusions— Thrombolytic therapy for acute stroke in patients with cancer is not associated with increased risk of intracerebral hemorrhage or in-hospital mortality. However, careful consideration of the cancer subtype may help delineate the subset of patients with poor response to thrombolysis. Prospective confirmation is warranted.

Cost Effectiveness of Screening Colonoscopy Depends on Adequate Bowel Preparation Rates – A Modeling Study

Background Inadequate bowel preparation during screening colonoscopy necessitates repeating colonoscopy. Studies suggest inadequate bowel preparation rates of 20–60%. This increases the cost of colonoscopy for our society. Aim The aim of this study is to determine the impact of inadequate bowel preparation rate on the cost effectiveness of colonoscopy compared to other screening strategies for colorectal cancer (CRC). Methods A microsimulation model of CRC screening strategies for the general population at average risk for CRC. The strategies include fecal immunochemistry test (FIT) every year, colonoscopy every ten years, sigmoidoscopy every five years, or stool DNA test every 3 years. The screening could be performed at private practice offices, outpatient hospitals, and ambulatory surgical centers. Results At the current assumed inadequate bowel preparation rate of 25%, the cost of colonoscopy as a screening strategy is above society’s willingness to pay (<

The cost of implementing two small media interventions to promote HPV vaccination

50,000/QALY). Threshold analysis demonstrated that an inadequate bowel preparation rate of 13% or less is necessary before colonoscopy is considered more cost effective than FIT. At inadequate bowel preparation rates of 25%, colonoscopy is still more cost effective compared to sigmoidoscopy and stool DNA test. Sensitivity analysis of all inputs adjusted by ±10% showed incremental cost effectiveness ratio values were influenced most by the specificity, adherence, and sensitivity of FIT and colonoscopy. Conclusions Screening colonoscopy is not a cost effective strategy when compared with fecal immunochemical test, as long as the inadequate bowel preparation rate is greater than 13%.

The cost of developing a computerized tailored interactive multimedia intervention vs. a print based Photonovella intervention for HPV vaccine education

OBJECTIVE To estimate the cost of implementing lay health worker delivered print-based photonovella intervention and iPad-based tailored interactive multimedia intervention (TIMI) to promote Human Papillomavirus (HPV) vaccine uptake and completion among Hispanic parents of daughters 9-17years old. METHODS We recruited 301 participants in control, 422 in photonovella, and 239 in TIMI clinics. Intervention costs were estimated using micro-costing from the societal perspective. Cost included time spent planning, training the promotoras, recruiting study participants, and delivering the interventions. Overhead for utilities and project administration was estimated at 30% of direct costs. RESULTS The total cost per person for the photonovella and TIMI interventions were

Racial-Ethnic Disparities in End-of-Life Care Quality among Lung Cancer Patients: A SEER-Medicare–Based Study

88 and

Acute Kidney Injury Following Failed Total Hip and Knee Arthroplasty

108, respectively. Less than 10% of costs were fixed and therefore the average cost estimates were insensitive to the size of the target groups. CONCLUSION The electronic medium for HPV vaccine education was 23% more costly than the standard low-tech print based approach. The cost difference should be considered relative to the effectiveness of these methods in achieving increases in immunization rates. The cost estimates provide information for cost-effectiveness and budget impact assessments of new HPV immunization intervention programs.

The Immediate Impact of the 2009 USPSTF Screening Guideline Change on Physician Recommendation of a Screening Mammogram: Findings from a National Ambulatory and Medical Care Survey-Based Study.

Mobile technology is opening new avenues for healthcare providers to create and implement tailored and personalized health education programs. We estimate and compare the cost of developing an i-Pad based tailored interactive multimedia intervention (TIMI) and a print based (Photonovella) intervention to increase human papillomavirus (HPV) immunization. The development costs of the interventions were calculated using a societal perspective. Direct cost included the cost of planning the study, conducting focus groups, and developing the intervention materials by the research staff. Costs also included the amount paid to the vendors who produced the TIMI and Photonovella. Micro cost data on the staff time and materials were recorded in logs for tracking personnel time, meeting time, supplies and software purchases. The costs were adjusted for inflation and reported in 2015 USD. The total cost of developing the Photonovella was

Factors Affecting Racial Disparities in End-of-Life Care Costs Among Lung Cancer Patients: A SEER-Medicare–based Study

66,468 and the cost of developing the TIMI was

Clinical and Economic Burden of Respiratory Viral Infections in Hematopoietic Stem Cell Transplant Recipients: The MD Anderson Experience

135,978. The amortized annual cost for the interventions calculated at a 3% discount rate and over a 7-year period was

Abstract W P61: Treatment of Ischemic Stroke With recombinant Tissue Plasminogen-Activator in Pregnancy: A Population Study

10,669 per year for the Photonovella and