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Journal Articles

Diagnostic Testing for the Novel Coronavirus

Joshua M. Sharfstein, Scott J. Becker, Michelle Mello
JAMA Network , 2020

Controversies over diagnostic testing have dominated US headlines about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus responsible for coronavirus disease 2019 (COVID-19). Technical challenges with the first test developed by the Centers for Disease Control and Prevention (CDC) left the nation with minimal diagnostic capacity during the first few weeks of the epidemic. The CDC also initially limited access to testing to a narrow group of individuals with known exposure.

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Journal Articles

Response to COVID-19 in Taiwan Big Data Analytics, New Technology, and Proactive Testing

C. Jason Wang, Chun Y. Ng, Robert H. Brook
JAMA Network , 2020

Taiwan is 81 miles off the coast of mainland China and was expected to have the second highest number of cases of coronavirus disease 2019 (COVID-19) due to its proximity to and number of flights between China. The country has 23 million citizens of which 850 000 reside in and 404 000 work in China. In 2019, 2.71 million visitors from the mainland traveled to Taiwan. As such, Taiwan has been on constant alert and ready to act on epidemics arising from China ever since the severe acute respiratory syndrome (SARS) epidemic in 2003.

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Journal Articles

Cost-Effectiveness of Transitional Care Services After Hospitalization With Heart Failure

Manuel R. Blum, Henning Øien, Harris Carmichael, Paul A. Heidenreich, Douglas K. Owens, Jeremy Goldhaber-Fiebert
Annals of Internal Medicine , 2020

Background:

Patients with heart failure (HF) discharged from the hospital are at high risk for death and rehospitalization. Transitional care service interventions attempt to mitigate these risks.

Results of Base-Case Analysis:

All 3 transitional care interventions examined were more costly and effective than standard care, with NHVs dominating the other 2 interventions. Compared with standard care, NHVs increased QALYs (2.49 vs. 2.25) and costs ($81 327 vs. $76 705), resulting in an ICER of $19 570 per QALY gained.

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Journal Articles

The 2016 California Policy to Eliminate Nonmedical Vaccine Exemptions and Changes in Vaccine Coverage: An Empirical Policy Analysis

Sindiso Nyathi, Hannah C. Karpel, Kristin L. Sainani, Yvonne Maldonado, Peter J. Hotez, Eran Bendavid, Nathan C. Lo
PLOS Medicine , 2019

Vaccine hesitancy, the reluctance or refusal to receive vaccination, is a growing public health problem in the United States and globally. State policies that eliminate nonmedical (“personal belief”) exemptions to childhood vaccination requirements are controversial, and their effectiveness to improve vaccination coverage remains unclear given limited rigorous policy analysis. In 2016, a California policy (Senate Bill 277) eliminated nonmedical exemptions from school entry requirements.

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Journal Articles

Estimation of global insulin use for type 2 diabetes, 2018–30: a microsimulation analysis

Sanjay Basu, John S. Yudkin, Sylvia Kehlenbrink, Justine I. Davies, Sarah H. Wild, Kasia J. Lipska, Jeremy B. Sussman, David Beran
The Lancet , 2018

Background:

The amount of insulin needed to effectively treat type 2 diabetes worldwide is unknown. It also remains unclear how alternative treatment algorithms would affect insulin use and disability-adjusted life-years (DALYs) averted by insulin use, given that current access to insulin (availability and affordability) in many areas is low. The aim of this study was to compare alternative projections for and consequences of insulin use worldwide under varying treatment algorithms and degrees of insulin access.

Methods:

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Journal Articles

Anesthesia Care Team Composition and Surgical Outcomes

Eric Sun, Thomas R. Miller, Jasmin Moshfegh, Laurence C. Baker
The Journal of the American Society of Anesthesiologists , 2018

The adjusted mortality for care teams with anesthesiologist assistants was 1.6% (95% CI, 1.4 to 1.8) versus 1.7% for care teams with nurse anesthetists (95% CI, 1.7 to 1.7; difference −0.08; 95% CI, −0.3 to 0.1; P = 0.47). Compared to care teams with nurse anesthetists, care teams with anesthesiologist assistants were associated with non–statistically significant decreases in length of stay (−0.009 days; 95% CI, −0.1 to 0.1; P = 0.89) and medical spending (−$56; 95% CI, −334 to 223; P = 0.70).

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Journal Articles

Cost Effectiveness of Radiation and Chemotherapy for High-Risk Low Grade Glioma

Eran Bendavid, Eran Bendavid, Douglas K. Owens, Yushen Qian, Satoshi Muruyama
2018

The standard of care treatment for maximally resected, high risk (≥ 40 years old or sub-totally resected) low grade glioma (LGG) patients was established by RTOG 9802, which showed an overall survival (OS) of 13.3 years for patients treated with radiotherapy (RT) + PCV (procarbazine, lomustine [CCNU], vincristine) chemotherapy compared to 7.8 years for RT alone. In the era of value-based health care, cost-effectiveness analyses (CEA) have the potential to inform coverage decisions and patient care.

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Journal Articles

Poverty and Community-Acquired Antimicrobial Resistance with Extended-Spectrum β-Lactamase–Producing Organisms, Hyderabad, India

Nagamani Kammili, Jyothi Lakshmi, Anlu Xing, Afia Khan, Manisha Rani, Prasanthi Kolli, Anlu Xing, Douglas K. Owens
Emerging Infectious Diseases Journal , 2018

The decreasing effectiveness of antimicrobial agents is a global public health threat, yet risk factors for community-acquired antimicrobial resistance (CA-AMR) in low-income settings have not been clearly elucidated. Our aim was to identify risk factors for CA-AMR with extended-spectrum β-lactamase (ESBL)–producing organisms among urban-dwelling women in India. We collected microbiological and survey data in an observational study of primigravidae women in a public hospital in Hyderabad, India.

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Journal Articles

ACA Marketplace Premiums and Competition Among Hospitals and Physician Practices

Maria Polyakova, M. Kate Bundorf, Daniel P. Kessler, Laurence C. Baker
The American Journal of Managed Care , 2018

In this study published in the American Journal of Managed Care, the authors found that premiums for ACA Marketplace plans were higher in rating areas in which physician, hospital, and insurance markets were less competitive.

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Journal Articles

Robust relationship between air quality and infant mortality in Africa

Eran Bendavid, Jennifer Burney, Marshall Burke
Nature , 2018

Poor air quality is thought to be an important mortality risk factor globally, but there is little direct evidence from the developing world on how mortality risk varies with changing exposure to ambient particulate matter. Current global estimates apply exposure-response relationships that have been derived mostly from wealthy, mid-latitude countries to spatial population data, and these estimates remain unvalidated across large portions of the globe.

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Working Papers

Learning on the Job: Evidence from Physicians in Training

David C. Chan
Stanford University , 2018

Abstract: Learning on the job creates a tradeoff in team decisions: Workers with less knowledge have less to contribute to team decisions, but experiential learning may require that trainees also have a stake in decisions to learn. This paper studies learning and influence in team decisions among physicians trainees. Exploiting a discontinuity in relative experience, I find reduced-form evidence of influence due to seniority between trainees.

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Working Papers

Industry Input in Policymaking: Evidence from Medicare

David Chan, David C. Chan, Michael J. Dickstein
Stanford University , 2018

Abstract: In setting prices for physician services, Medicare solicits input from a committee that evaluates proposals from industry. We investigate whether this arrangement leads to prices biased toward the interests of committee members. We find that increasing a measure of affiliation between the committee and proposers by one standard deviation increases prices by 10%, demonstrating a pathway for regulatory capture. We then evaluate the effect of affiliation on the quality of information used in price-setting.

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Journal Articles

Is Single Payer the Answer for the US Health Care System?

Victor R. Fuchs
JAMA , 2018

The recent challenges to the Affordable Care Act (ACA), which has increased the number of individuals with health insurance in the United States but has had little effect on cost, has revived the debate about a single-payer health care system.

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Journal Articles

Drug Companies’ Liability for the Opioid Epidemic

Rebecca L. Haffejee, Michelle Mello
The New England Journal of Medicine , 2017

The opioid epidemic has claimed more than 300,000 lives in the United States since 20001

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Working Papers

Family Planning and Fertility Behavior: Evidence from Twentieth Century Malaysia

Kim Babiarz, Jiwon Lee, Grant Miller, Tey Nai Peng, Christine Valente
Center for Global Development , 2017

There is longstanding debate about the contribution of family planning programs to fertility decline. Studying the staggered introduction of family planning across Malaysia during the 1960s and 1970s, we find modest responses in fertility behavior. Higher (but not lower) parity birth hazards declined by one-quarter—but imply only a 5 percent decline in the overall annual probability of birth. Age at marriage rose by 0.48 years, but birth spacing conditional on this did not otherwise change.

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Journal Articles

Relationship between season of birth, temperature exposure, and later life wellbeing

Adam Isen, Maya Rossin-Slater, Reed Walker
Proceedings of the National Academy of Sciences , 2017

We study how exposure to extreme temperatures in early periods of child development is related to adult economic outcomes measured 30 y later. Our analysis uses administrative earnings records for over 12 million individuals born in the United States between 1969 and 1977, linked to fine-scale, daily weather data and location and date of birth.

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Journal Articles

Marketplace Plans Provide Risk Protection, But Actuarial Values Overstate Realized Coverage For Most Enrollees

Maria Polyakova, Lynn M. Hua, M. Kate Bundorf
Health Affairs , 2017

The Affordable Care Act (ACA) has increased the number of Americans with health insurance. Yet many policy makers and consumers have questioned the value of Marketplace plan coverage because of the generally high levels of cost sharing. We simulated out-of-pocket spending for bronze, silver, or gold Marketplace plans (those having actuarial values of 60 percent, 70 percent, and 80 percent, respectively).

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Journal Articles

Validation of Risk Equations for Complications of Type 2 Diabetes (RECODe) Using Individual Participant Data From Diverse Longitudinal Cohorts in the U.S.

Sanjay Basu, Jeremy B. Sussman, Seth A. Berkowitz, Rodney A. Hayward, Alain G. Bertoni, Adolfo Correa, Stanford Mwasongwe, John S. Yudkin
American Diabetes Association , 2017
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Journal Articles

PCSK9 Inhibitors Economics and Policy

Mark A. Hlatky, Dhruv S. Kazi
Journal of the American College of Cardiology , 2017

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors substantially reduce low-density lipoprotein cholesterol, but it is presently unclear whether they also reduce mortality. The list prices of PCSK9 inhibitors in the United States (>$14,500 per year) are >100× higher than generic statins, and only a small fraction of their higher cost is likely to be recovered by prevention of cardiovascular events.

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Journal Articles

Supplemental Nutrition Assistance Program (SNAP) Participation and Health Care Expenditures Among Low-Income Adults

Seth A. Berkowitz, Hilary K. Seligman, Joseph Rigdon, James B. Meigs, Sanjay Basu
JAMA Internal Medicine , 2017

Objective

To determine whether the Supplemental Nutrition Assistance Program (SNAP), which addresses food insecurity, can reduce health care expenditures.

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Journal Articles

Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty A Systematic Review and Meta-analysis

Dario Tedesco, Davide Gori, Karishma Desai, Steven M. Asch, Ian R. Carroll, Catherine Curtin, Kathryn M. McDonald, Maria P. Fantini, Tina Hernandez-Boussard
JAMA Surgery , 2017

To systematically review and meta-analyze evidence of nonpharmacological interventions for postoperative pain management after total knee arthroplasty.

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Journal Articles

Social Isolation and Medicare Spending: Among Older Adults, Objective Isolation Increases Expenditures While Loneliness Does Not

Jonathan Shaw, Monica Farid, Claire Noel-Miller, Neesha Joseph, Ari Houser, Steven M. Asch, Jay Bhattacharya, Lynda Flowers
SAGE Journals , 2017

Objective: The purpose of this study was to evaluate the impact of objective isolation and loneliness on Medicare spending and outcomes. Method: We linked Health and Retirement Study data to Medicare claims to analyze objective isolation (scaled composite of

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