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Alan M. Garber
Journal Articles

Cost-Effectiveness of Percutaneous Closure of the Left Atrial Appendage in Atrial Fibrillation Based on Results From PROTECT AF Versus PREVAIL

James V. Freeman, David W. Hutton, Geoffrey D. Barnes, Ruo P. Zhu, Douglas K. Owens, Alan M. Garber, Alan S. Go, Mark A. Hlatky, Paul A. Heidenreich, Paul J. Wang, Amin Al-Ahmad, Mintu P. Turakhia
Circulation: Arrhythmia and Electrophysiology, 2016 June 15, 2016

Background—Randomized trials of left atrial appendage (LAA) closure with the Watchman device have shown varying results, and its cost effectiveness compared with anticoagulation has not been evaluated using all available contemporary trial data.

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Abstracts

Commitment to exercise: Nudged to Exercise? Or to reveal your true colors?

Jeremy Goldhaber-Fiebert, Blumenkranz, E, Alan M. Garber
The Society for Medical Decision Making in Chicago Illinois, 2011 December 31, 2011
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Journal Articles

Using Nudges in Exercise Commitment Contracts

Jeremy Goldhaber-Fiebert, Blumenkranz, E., Alan M. Garber
Natl Bur Econ Res Bull Aging Health, 2011 December 31, 2011
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Journal Articles

Knowing loved ones' end-of-life health care wishes: Attachment security predicts caregivers' accuracy

Turan B, Mary K. Goldstein, Alan M. Garber, Carstensen LL
Health Psychology, 2011 December 31, 2011
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Journal Articles

The Behavioural Economics of Exercise Habits

Jeremy Goldhaber-Fiebert, Alan M. Garber
VoxEU, 2011 February 22, 2011

Obesity – and its related illnesses – endangers the lives of millions across the world. While healthier, more physically active lifestyles can mitigate this, the question remains of how policymakers can get people to switch from being couch potatoes to keen runner beans. This column presents new evidence suggesting that for many even a nudge may suffice.

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Journal Articles

Committing to exercise: Contract design for virtuous habit formation

Jeremy Goldhaber-Fiebert, Blumenkranz, E, Alan M. Garber
NBER Working Paper, 2010 December 31, 2010
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Journal Articles

The Potential Impact of Comparative Effectiveness Research on U.S. Health Care Expenditures

Daniella Perlroth, Goldman DP, Alan Garber
Demography, 2010 December 31, 2010

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.

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Journal Articles

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

Daniella Perlroth, Glass RJ, Davey VJ, Cannon D, Alan Garber, Douglas Owens
Clinical Infectious Diseases, 2010 December 31, 2010

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.

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Journal Articles

Cost-Effectiveness of Dabigatran Compared With Warfarin for Stroke Prevention in Atrial Fibrillation

James Freeman, Ruo Zhu, Douglas K. Owens, Alan M. Garber, David Hutton, Alan Go, Paul Wang, Mintu Turakhia
Annals of Internal Medicine, 2010 November 1, 2010

Background: Warfarin reduces the risk for ischemic stroke in patients with atrial fibrillation (AF) but increases the risk for hemorrhage. Dabigatran is a fixed-dose, oral direct thrombin inhibitor with similar or reduced rates of ischemic stroke and intracranial hemorrhage in patients with AF compared with those of warfarin.

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Journal Articles

The role of costs in comparative effectiveness research

Alan Garber, Sox HC
Health Affairs, 2010 October 1, 2010

The major expansion of federal comparative effectiveness research launched in 2009 held the potential to supply the information needed to help slow health spending growth while improving the outcomes of care. However, when Congress passed the Patient Protection and Affordable Care Act one year later, it limited the role of cost analysis in the work sponsored by the Patient-Centered Outcomes Research Institute. Despite this restriction, cost-effectiveness analysis meets important needs and is likely to play a larger role in the future.

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Journal Articles

Incidental Extracardiac Findings at Coronary CT: Clinical and Economic Impact

Lee CI, Tsai EB, Sigal BM, Sylvia Plevritis, Alan Garber, Rubin G
American Journal of Roentgenology, 2010 June 1, 2010

OBJECTIVE. The purpose of this study was to evaluate the prevalence of incidental extracardiac findings on coronary CT, to determine the associated downstream resource utilization, and to estimate additional costs per patient related to the associated diagnostic workup.

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Journal Articles

Desalination of the American Diet: Population Strategies to Decrease Sodium Intake and the Burden of Cardiovascular Disease

Crystal Smith-Spangler, Jessie L. Juusola, Eva A. Enns, Douglas Owens, Alan Garber
Annals of Internal Medicine, 2010 March 1, 2010

Background: Sodium consumption raises blood pressure, increasing the risk for heart attack and stroke. Several countries, including the United States, are considering strategies to decrease population sodium intake.

Objective: To assess the cost-effectiveness of 2 population strategies to reduce sodium intake: government collaboration with food manufacturers to voluntarily cut sodium in processed foods, modeled on the United Kingdom experience, and a sodium tax.

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Journal Articles

Following Your Heart or Your Head: Focusing on Emotions versus Information Differentially Influences the Decisions of Younger and Older Adults

Joseph A. Mikels, Lockenhoff CE, Maglio SJ, Laura L. Carstensen, Mary K. Goldstein, Alan M. Garber
Journal of Experimental Psychology Applied, 2010 March 1, 2010

Research on aging has indicated that whereas deliberative cognitive processes decline with age, emotional processes are relatively spared. To examine the implications of these divergent trajectories in the context of health care choices, we investigated whether instructional manipulations emphasizing a focus on feelings or details would have differential effects on decision quality among younger and older adults. We presented 60 younger and 60 older adults with health care choices that required them to hold in mind and consider multiple pieces of information.

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Journal Articles

Population Strategies to Decrease Sodium Intake and the Burden of Cardiovascular Disease: A Cost-Effectiveness Analysis

Crystal Smith-Spangler, Juusola JL, Enns EA, Douglas Owens, Alan Garber
Annals of Internal Medicine, 2010 March 1, 2010

Background: Sodium consumption raises blood pressure, increasing the risk for heart attack and stroke. Several countries, including the United States, are considering strategies to decrease population sodium intake.

Objective: To assess the cost-effectiveness of 2 population strategies to reduce sodium intake: government collaboration with food manufacturers to voluntarily cut sodium in processed foods, modeled on the United Kingdom experience, and a sodium tax.

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Journal Articles

Health outcomes and costs of community mitigation strategies for an influenza pandemic in the United States.

Daniella Perlroth, Glass RJ, Davey VJ, Cannon D, Alan M. Garber, Douglas K. Owens
Clinical Infectious Diseases, 2010 January 15, 2010

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.

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Journal Articles

Effectiveness and Cost-Effectiveness of Vaccination Against Pandemic Influenza (H1N1) 2009

Nayer Khazeni, Hutton DW, Alan M. Garber, Hupert N, Douglas Owens
Annals of Internal Medicine, 2009 December 12, 2009

Background: Decisions on the timing and extent of vaccination against pandemic (H1N1) 2009 virus are complex.

Objective: To estimate the effectiveness and cost-effectiveness of pandemic influenza (H1N1) vaccination under different scenarios in October or November 2009.

Design: Compartmental epidemic model in conjunction with a Markov model of disease progression.

Data Sources: Literature and expert opinion.

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Journal Articles

Effectiveness and Cost-Effectiveness of Expanded Antiviral Prophylaxis and Adjuvanted Vaccination Strategies for an Influenza A (H5N1) Pandemic

Nayer Khazeni, Hutton DW, Alan M. Garber, Douglas Owens
Annals of Internal Medicine, 2009 December 12, 2009

Background: The pandemic potential of influenza A (H5N1) virus is a prominent public health concern of the 21st century.

Objective: To estimate the effectiveness and cost-effectiveness of alternative pandemic (H5N1) mitigation and response strategies.

Design: Compartmental epidemic model in conjunction with a Markov model of disease progression.

Data Sources: Literature and expert opinion.

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Journal Articles

Cost-Effectiveness of Alternative Imaging Strategies for the Diagnosis of Small-bowel Crohn's Disease

Barrett Levesque, Cipriano LE, Chang SL, Lee KK, Douglas Owens, Alan Garber
Clinical Gastroenterology and Hepatology, 2009 November 1, 2009

BACKGROUND AND AIMS:: The cost-effectiveness of alternative approaches to the diagnosis of small-bowel Crohn's disease is unknown. This study evaluates whether CT-Enterography (CTE) is a cost-effective alternative to small bowel follow-through (SBFT) and whether capsule endoscopy is a cost-effective third test in patients in whom a high suspicion of disease remains after two previous negative tests.

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Journal Articles

Laparoscopy in Women with Unexplained Infertility: A Cost-Effectiveness Analysis

Sharon E. Moayeri, Lee, HC, Lathi, RB, Westphal LM, Miliki AA, Alan Garber
Fertility and Sterility, 2009 August 1, 2009

Objective

To evaluate the cost effectiveness of laparoscopy for unexplained infertility.

Design

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Policy Briefs

Comparative Effectiveness Research Prioritization

Institute of Medicine's Committee on Comparative Effectiveness Research Prioritization, Alan M. Garber
Institute of Medicine's Committee on Comparative Effectiveness Research Prioritization, 2009 June 30, 2009

Clinical research presents health care providers with information on the natural history and clinical presentations of disease as well as diagnostic and treatment options. Consumers, patients, and caregivers also require this information to decide how to evaluate and treat their conditions. All too often, the information necessary to inform these medical decisions is incomplete or unavailable, resulting in more than half of the treatments delivered today lacking clear evidence of effectiveness.

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Journal Articles

Toward a 21st-Century Health Care System: Recommendations for Health Care Reform

Kenneth J. Arrow, Auerbach A, Bertko J, Brownlee S, Casalino LP, Cooper J, Crosson J, Alain C. Enthoven, Falcone E, Feldman RC, Victor R. Fuchs, Alan M. Garber, Gold MR, Goldman D, Hadfield GK, Hall MA, Horwitz RI, Hooven M, Jacobson PD, Stoltzfus Jost T, Kotlikoff LJ, Levin J, Levine S, Levy R, Linscott K, Harold S. Luft, Marshal R, McFadden D, Mechanic D, Meltzer D, Newhouse JP, Noll RG, Pietzsch JB, Pizzo P, Reischauer RD, Rosenbaum S, Sage W, Schaeffer LD, Sheen E, Siilber BM, Skinner J, Stephen M. Shortell, Thier SO, Sean R. Tunis, Wulsin L, Yock P, Nun GB, Stirling Bryan, Luxenburg O, van de Ven PMM
Annals of Internal Medicine, 2009 April 7, 2009

The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspectives came together.

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Journal Articles

Simple counts of ADL dependencies do not adequately reflect older adults' preferences toward states of functional impairment.

Tamara L. Sims, Holmes TH, Dena M. Bravata, Alan Garber, Lorene Nelson, Mary Goldstein
Journal of Clinical Epidemiology, 2008 December 1, 2008

OBJECTIVE: To use unweighted counts of dependencies in activities of daily living (ADLs) to assess the impact of functional impairment requires an assumption of equal preferences for each ADL dependency. To test this assumption, we analyzed standard gamble (SG) utilities of single and combination ADL dependencies among older adults. STUDY DESIGN AND SETTING: Four hundred older adults used multimedia software (FLAIR1) to report SG utilities for their current health and hypothetical health states of dependency in each of 7 ADLs and 8 of 30

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Journal Articles

Is American Health Care Uniquely Inefficient?

Alan Garber, Skinner J
Journal of Economic Perspectives, 2008 October 1, 2008

The U.S. health system has been described as the most competitive, heterogeneous, inefficient, fragmented, and advanced system of care in the world. In this paper, we consider two questions: First, is the U.S. healthcare system productively efficient relative to other wealthy countries, in the sense of producing better health for a given bundle of hospital beds, physicians, nurses, and other factor inputs? Second, is the United States allocatively efficient relative to other countries, in the sense of providing highly valued care to consumers? For both

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Journal Articles

Management of acute kidney injury in the intensive care unit: a cost-effectiveness analysis of daily vs alternate-day hemodialysis.

Amar Desai, Baras J, Berk B, Nakajima A, Alan M. Garber, Douglas K. Owens, Glenn Chertow
Archives of Internal Medicine, 2008 September 8, 2008

BACKGROUND: Although evidence suggests that a higher hemodialysis dose and/or frequency may be associated with improved outcomes, the cost-effectiveness of a daily hemodialysis strategy for critically ill patients with acute kidney injury (AKI) is unknown. METHODS: We developed a Markov model of the cost, quality of life, survival, and incremental cost-effectiveness of daily hemodialysis, compared with alternate-day hemodialysis, for patients with AKI in the intensive care unit (ICU). We employed a societal perspective with a lifetime analytic

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Journal Articles

Is Having More Preapproval Data the Best Way to Assure Drug Safety?

Alan Garber
Health Affairs, 2008 September 1, 2008

An intensified focus on drug safety often leads to demands for more data collection prior to drug approval. Other approaches can be used, such as enhanced postmarketing surveillance. Many drug benefits and adverse effects are unlikely to become apparent before wide distribution among diverse patients. The best balance of pre- and postapproval data collection may vary by drug. The consequences of alternative strategies are complex and not always immediately apparent, so formal modeling offers the best approach to determine which strategy is optimal in each case.

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