A new article published in JAMA Health Forum outlines a path forward for eliminating hepatitis C virus (HCV) in the United States, emphasizing the need for coordinated, multi-stakeholder action to turn curative science into real-world public health impact. The article, “Stakeholder Engagement for Hepatitis C Virus Elimination,” is co-authored by Lou Garrison, Professor Emeritus of Health Economics in the Department of Pharmacy and The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, along with Bruce C. M. Wang, PhD.

Although highly effective cures for hepatitis C have been available for more than a decade, an estimated four million people in the U.S. still live with the virus—many without knowing it. Each year, tens of thousands of new infections occur, disproportionately affecting people who use drugs and others who face barriers to traditional health care.

The article arrives at a pivotal moment. In 2025, bipartisan legislation—the Cure Hepatitis C Act—was introduced in Congress, calling for a national elimination program and strategy. Garrison and Wang argue that new tools, including the first FDA-authorized point-of-care HCV RNA test coupled with curative direct-acting anti-viral medicines make it possible and cost-saving to move from a complex, multi-visit diagnostic process to a “test-and-treat” model that can deliver results and begin care in a single visit.

“Science has already given us what we need to cure hepatitis C,” said Garrison. “The remaining challenge is implementation—making sure people can be tested and treated where they are, in ways that are fast, trusted, and accessible.”

The authors outline a national framework that engages federal and state agencies, health systems, community organizations, insurers, and industry partners. The goal: create a simplified, equitable infrastructure that brings testing and treatment into nontraditional settings such as community clinics, mobile outreach programs, and harm-reduction sites—places where many at-risk individuals already receive care.

The article also underscores the economic case for action. Untreated HCV can lead to cirrhosis, liver cancer, and premature death, driving enormous health care costs. Prior analyses show that treatment is not only lifesaving but cost-saving over time, with the potential to save billions in public spending while preventing future transmission.

At the University of Washington School of Pharmacy, this work reflects a broader commitment to public health impact—bridging research, policy, and practice to address urgent health challenges. Through its leadership in health economics, outcomes research, and policy analysis, UW is helping shape national conversations about how innovations reach the people who need them most.

“Eliminating hepatitis C is achievable,” Garrison said. “What it will take is the will to coordinate across sectors and ensure that cures don’t remain confined to clinics that many people never reach.”

The article is published open access in JAMA Health Forum and is available at this JAMA link.

Can pharmacists improve childhood vaccination rates without disrupting well-child visits? According to CHOICE PhD student Dr. Shiven Bhardwaj and Dr. Jennifer Bacci – endowed associate professor in Innovative Pharmacy Practice – the latest research looks promising.

In collaboration with colleagues at Fred Hutchinson Cancer Center and the University of Pittsburgh School of Pharmacy, Bhardwaj and Bacci co-authored a study that addresses a common concern:

Would allowing pharmacists to vaccinate children result in more delayed or missed well-child visits?

The study found that commercially insured children who received vaccinations at a pharmacy were just as likely – if not more likely – to attend their well-child visits on time.

While pharmacists in Washington State have been vaccinating children for over 40 years, many states still prohibit them from doing so.

The research from Bhardwaj and Bacci provides fundamental evidence to support the expansion of pharmacy-based immunization services, reinforcing the role of pharmacists as key healthcare providers in ensuring timely and equitable access to pediatric care. By breaking down barriers to vaccination, Bacci, Bhardwaj and their colleagues are paving the way for more accessible, innovative, community-driven solutions to transform pharmacy practice.

In a recent article from the Journal of Public Economics, Dr. Jing Li – associate professor of health economics and Associate Director of The CHOICE Institute – examines the impact of direct-to-physician marketing payments from cancer drug companies on Medicare prescribing expenditures and patient mortality. Alongside co authors from Cornell University, Dr. Li’s latest publication uncovers a compelling trend:

Once physicians and cancer drug companies engage in a financial relationship – in other words, when physicians accept marketing payments from pharmaceutical firms – spending accelerates and prescribing increases without improving patient mortality.

Cancer-treating physicians frequently interact with pharmaceutical firms because they play a key role in deciding which drugs to prescribe – the ultimate influencers for which companies stand to profit.

Of the physicians considered for Dr. Li’s study, 67% of them received at least one marketing payment related to cancer treatment between 2014 and 2018. Major drugs like Opdivo and Keytruda reach more than half of prescribers with financial incentives like these. Upon receiving payment from a drug company, physician prescribing of the associated drug increased 4% in the year to follow, accelerating Part B cancer drug expenditure.

Following a marketing encounter with a drug company, Dr. Li’s findings suggest that physicians begin treating cancer patients with lower predicted mortality – that is, expanding the incentivized drug treatment to healthier patients with little meaningful improvement.

Professor Emeritus Lou Garrison recently visited China to give four talks on pharmaceutical market design and global differential pricing. He gave the keynote address for a new book launch at China Europe International Business School in Shanghai for Professors Eric Bouteiller and Annie Chicoye for their new book “Fundamentals of Market Access for Pharmaceuticals.” Lou commented that: “Our field has done a poor job of communicating the economics of pharmaceutical market design in terms of the role of the patent system in promoting innovation and improving access through generics. I highly recommend this book for not only providing the economic fundamentals but also explaining the complexities and challenges in improving real-world access for patients.”

Link to book introduction:  https://www.youtube.com/watch?v=U-WHaqhbB1I

Lou was also graciously hosted and gave talks at Roche China, China Pharmaceutical University (in Nanking) and Fudan University.

His talk emphasized the need to promote better global differential pricing to improve global assess to innovative medicines through more rapid and efficient health technology.  He said: “China is a great example of how to accelerate access, having made great progress since I first lectured about Markov modeling to the Central Drug Committee fifteen years ago.”

Lou also mentioned the ongoing work of ISPOR Global Access to Medical Innovation Special Interest Group that he helps to lead and his aim to accelerate its work in 2025.

CHOICE Institute PhD student Emma M. Cousin, PharmD, and Professor Sean D. Sullivan, BScPharm, PhD, published an article in the October 2024 issue of the Journal of Managed Care & Specialty Pharmacy titled “Drugs Anticipated to be Selected for the Medicare Drug Price Negotiation Program in 2025”. The study was completed in collaboration with Dr. Inma Hernandez and her research team at the University of California, San Diego. In this study, the authors identified high-spending Part D products likely to be included in the second round of negotiations in the Medicare Drug Price Negotiation Program. This work brings to light the challenges and complexities involved in selecting eligible drugs for the negotiation program.

Read the paper here.

Two University of Washington researchers have been named AAAS Fellows, according to an April 18 announcement by the American Association for the Advancement of Science. They are among 502 newly elected fellows from around the world, who are recognized for their “scientifically and socially distinguished achievements” in science and engineering.

A tradition dating back to 1874, election as an AAAS Fellow is a lifetime honor, and all fellows are expected to meet the commonly held standards of professional ethics and scientific integrity.

Professor Emeritus Lou Garrison recently gave three talks at a health technology assessment conference sponsored by KazSPOR and HTAi in Astana, Kazakhstan. He gave two short talks and a one-hour lecture on the basic economics of innovative pharmaceuticals. He began working three years ago with Dr. Alex Kostyuk, the founder and leader of HTA there, and with Dr. Alima Almadiyeva, who he mentored during her Fulbright-Humphreys fellowship at Emery University. His talks dovetail with his efforts as chair of a new ISPOR Special Interest Group on Global Access to Medical Innovation. He says that: “We urgently need to address the access or drug lag to innovative medicines in low- and middle-income countries by encouraging more efficient HTA and establishing more a more effective approach to global differential pricing.” This SIG is new and will have another information and recruitment session at the upcoming ISPOR meeting in Atlanta.

Lou was also able to visit the “Little Switzerland” by Lake Buraby, north of Astana, where he encountered a group of students eager to meet a UW faculty member.

The meeting sessions are available on YouTube: https://www.youtube.com/results?search_query=HTA2024KZ+(En)

Congratulations to Felipe Montano-Campos, a third-year PhD student in Health Economics and Outcomes Research at the CHOICE Institute, has been awarded the Fellowship from the Latino Center for Health. An interdisciplinary health sciences research center at the University of Washington, the Latino Center for Health is committed to improving the health and well-being of Latinx individuals, families, and communities in Washington state.

Felipe’s current work focuses on modeling precision screening for cancer patients and examining how patient-doctor concordance in race/ethnicity and gender can enhance treatment and medical testing adherence. Specifically, he’s interested in how these factors contribute to improved health outcomes among Latinx populations.

Sara Khor, 5th year PhD student in The CHOICE Institute, was awarded the the American Society of Clinical Oncology (ASCO) Conquer Cancer Merit Award for her team’s study that examined the association between pre-diagnosis financial strain and later stage cancer diagnosis.

The team’s research explores the relationship between pre-diagnosis financial strain (FS), measured through credit reports, and later stage cancer diagnosis. Analyzing data from cancer patients in Western Washington (2014-2018), the study reveals that FS is associated with later stage cancer diagnosis, which could lead to adverse cancer outcomes. Among breast cancer patients, this association can be largely explained by nonreceipt of mammography. Their findings suggest that even with insurance coverage, individual’s financial stress may create an additional barrier to timely medical attention for suspicious cancer symptoms or routine screening, further exacerbating cancer disparities. This research highlights the need to develop strategies to improve access to care for these individuals.

In collaboration with her collaborators at the Hutchinson Institute for Cancer Outcomes Research, Veena Shankaran, Catherine Fedorenko, Kaiyue Yu, Zach Rivers, and Shannon Kestner, this study was also selected as a featured abstract in the Journal of Clinical Oncology.

Read the full publication here:

Khor S, Yu K, Fedorenko CR, Rivers Z, Kestner S, Shankaran V. Association between pre-diagnosis financial strain and later stage cancer representation. JCO Oncology Practice 2023 19:11_suppl, 127. Published online November 2023.

Access the report here: https://sop.washington.edu/wp-content/uploads/2023-CHOICE-Institute-Annual-Report.pdf

UW School of Pharmacy & CHOICE Institute Professor Andy Stergachis co-led an invitational workshop at the University of Oxford to discuss research on the relationship between substandard and falsified antimicrobials and antimicrobial resistance. Held on March 20-22, 2023, it was organized by the University of Washington Institute for Health Metrics Sciences and Global Medicines Program and the Medicine Quality Research Group FORESFA project in the Centre for Tropical Medicine & Global Health, University of Oxford. It brought together microbiologists, pharmacists, modelers, physicians, epidemiologists, implementers, policy makers and funders interested in this issue to help guide a newly funded continuation of the Global Research on Antimicrobial Resistance (GRAM) Project, https://www.healthdata.org/antimicrobial-resistance.

Professor Emeritus Lou Garrison spoke recently at health technology assessment (HTA) meetings held in Cairo and New Delhi with similar themes in both regions. HTA is well appreciated in both regions and steps are being taken to build institutions and capacity to carry out HTA.

Lou was a keynote speaker in the 1st Annual Arab Health Economics Meeting: Evolution of Health Economics in Arab Countries.

School of Pharmacy and The CHOICE Institute Professor Sean D. Sullivan is among four University of Washington researchers who have been named AAAS Fellows, according to a Jan. 31 announcement by the American Association for the Advancement of Science. They are among 506 new fellows from around the world elected in 2022, who are recognized for their “scientifically and socially distinguished achievements” in science and engineering.

A tradition dating back to 1874, election as an AAAS Fellow is a lifetime honor, and all fellows are expected to meet the commonly held standards of professional ethics and scientific integrity. The new fellows will be celebrated in Washington, D.C., in summer 2023.

Read more about Sean and the other recipients here.

During the past academic year 2021-22, UWSOP Professor and Associate Director Beth Devine enjoyed a sabbatical as a Fulbright US Senior Scholar and a Visiting Professor at the Institute for Methodology in Health Sciences, Department of Preventive Medicine and Public Health, School of Medicine, University of Murcia (UMU), in Murcia, España. With 38,000 students and established in 1272, UMU is the third oldest university in Spain and the thirteenth oldest in the world.

Embedded in a research group led by Alberto Torres-Cantero, MD, PhD, a graduate of the Harvard TH Chan School of Public Health, and former Fulbright Scholar, while in Murcia, Dr. Devine investigated the association between sources of information about Covid and beliefs in vaccine safety/efficacy, and willingness to be vaccinated. Joined by two junior investigators, she led an analysis of public opinion, cross-sectional, survey data collected by the European Commission in May 2021. Called Flash Eurobarometer 494, the dataset was comprised of a representative sample of individuals 15 years or older, living in 27 countries in the European Union. Using a latent class analysis, propensity score methods, and structural equation modeling, her team’s results suggest that 50% of those who rely on social media and friends/family for information reported that vaccines are neither safe nor effective, and never planned to be vaccinated. In contrast, 86% of respondents who rely on health professionals or national authorities reported that vaccines are safe/effective, and almost 72% indicated they had already been vaccinated or would be vaccinated as soon as possible. Demographics differed between groups. The countries with the highest proportion of vaccine recipients were Spain, Northern Ireland, Norway, Belgium, the Netherlands, and Germany. The European Commission has several initiatives in place to fight disinformation – Fighting Disinformation, #FactsMatter, and the Digital Services Act, 2022. Dr. Devine plans to submit the manuscript to Lancet Public Health.

She also gave guest lectures in the Epidemiology courses for MPH students who are residents in preventive medicine and completed an online course in the statistical programming language R. Furthermore, she studied Spanish, traveled extensively throughout the culturally and historically fascinating Iberian Peninsula and made several good friends. Spending time and sharing research projects with the other Fulbright Senior US Scholars located throughout España was inspiring and increased her appreciation for all types of research – from music to international human rights for displaced persons.

Congratulations to Lou Garrison, Professor Emeritus for The CHOICE Institute, who has been awarded the 2022 Avedis Donabedian Lifetime Achievement Award by ISPOR—The Professional Society for Health Economics and Outcomes Research recognizing his outstanding, life-long contribution to the improvement of health outcomes. bit.ly/3qMXZKt

October 21st, 2:00 – 4:30 PM | Hosted virtually on ZOOM Webinar | Hosted in-person at the Health Sciences Education Building, Room 101

Please join us for the 2022 CHOICE Institute Annual Symposium. Health Equity is a multidimensional construct. We are pleased to host three outstanding faculty to discuss some of the relevant dimensions of health equity and their implications for our work in HEOR. The event will be moderated by Stergachis Family Endowed Director Anirban Basu and Professor Josh Carlson. Refreshments will be served in the Rotunda Foyer immediately following the symposium.

Enrique Saldarriaga, PhD candidate in the School of Pharmacy and The CHOICE Institute, has won first place in the 2022 UW Three Minute Thesis (3MT) Competition. His dissertation, The Value of Using Local Data to Allocate Resources to Fight the HIV Epidemic: Case of Study in Atlanta, Georgia, combines statistical methods and mathematical modeling of infectious diseases to quantify the economic and health value of using local estimates of disease frequency to inform resources allocation for HIV prevention and care.

The 3MT is a professional development competition that celebrates the exciting capstone and research experiences of master’s and doctoral students at the University of Washington from all three campuses. The competition supports graduate students’ capacity to effectively explain their research or capstone project in three minutes, in a language appropriate to a public audience.

‘Impact’, the theme for the 2022 competition, can be defined as the positive outcome of a critical intervention, social policy, service provision model, legal framework, or technological innovation. Enrique’s research will provide a positive impact across several disease areas, including infectious diseases, cervical cancer, obesity and obesity-related conditions, and urology.

Enrique’s career goal is to generate evidence to inform decision-making processes that reduce health care access barriers among historically underserved demographic groups.

“My time at UW has provided me with extremely valuable lessons and resources to achieve this objective,” he said. “After graduation, I will join the Prevention Effectiveness fellowship at [the] CDC to assess strategies and interventions to prevent and reduce the spread of sexually transmitted diseases.”

Competition day finalists were selected from the preliminary rounds, based on the following presentation criteria: content, clarity, oral communication, visual communication, and theme.

“The UW 3MT competition provides an amazing opportunity to think about our studies in an engaging and accessible way to a general audience,” Enrique noted. “Winning UW 3MT is a recognition that I am on the right course in my communication skills development and a great motivation to continue working on them.”

UWSOP Professor and Associate Director David Veenstra, along with Vanderbilt University Professor Josh Peterson, and Geisinger Health Assistant Professor Jing Hao, have been awarded a 5-year, $4.5M grant from the National Human Genome Research Institute (NHGRI) to evaluate the clinical and economic outcomes of screening for cancer and cardiovascular disease risk using Polygenic Risk Scores (PRS).

PRS’s are an exciting approach in genomic medicine that utilize information from hundreds to thousands of genetic variants in a person’s genome to predict their risk of future disease. This project, the Rational Integration of PRS (RIPS), will evaluate the cost-effectiveness of using PRS to conduct population-level screening for breast cancer, colon cancer, and coronary heart disease. The investigators will also identify optimal PRS risk thresholds across diverse populations.

Dr. Veenstra will be joined by The CHOICE Institute’s senior research scientist Greg Guzauskas, and PhD candidate Joyce Jiang.

Dr. Kyu Eun Lee, PhD will be joining The CHOICE Institute and the Department of Pharmacy in January as The CHOICE Institute Endowed Assistant Professor of Health Decision Sciences. Dr. Lee obtained a PhD in Health Policy (Decision Science track) at Stanford University in 2020 and a Master of Science in Health Services Research at the University of Minnesota in 2014. Dr. Lee joins us most recently from the University of Pittsburgh, Public Health Dynamics Lab, where she completed a postdoctoral research fellowship.

Dr. Lee’s research focuses on using simulation models of diseases and policies to forecast the future burden on patients and populations and evaluates current and potential interventions preventing and treating infectious diseases and alcohol drinking disorders. She is also interested in decision science and disease modeling methods to improve model validity and computational efficiency. Her most recent work was on estimating the impact of non-pharmaceutical interventions for COVID-19 on the future influenza seasons and population immunity in the United States. She is also a fellowship recipient in Medical Decision Making from the Society of Medical Decision Making. Dr. Lee will bolster the strong training and research commitment in CHOICE in Health Decision Sciences, and bring new substantive and methodological expertise in these areas for our faculty and students.

We look forward to welcoming Dr. Lee, along with our other new faculty member, Dr. Jing Li, in January 2023!

Google Scholar: https://scholar.google.com/citations?user=d1TtZmsAAAAJ&amp%3Bhl=en

A research study published in Value in Health (and deemed as one of the Editor’s Choice articles) has determined that US insurance payers have higher preferences for clinical and health-related quality of life outcomes when assessing evidence to inform coverage and reimbursement decisions.

In a discrete choice experiment, 180 employees from payer organizations were tasked to choose between two chronic disease real-world evidence (RWE) studies assuming they were assessing evidence to inform formulary decisions for chronic disease treatment. Each RWE study was characterized by 7 attributes with 3 levels each: very informative, moderately informative, and not measured. The authors used a D-optimal main-effects design. Survey data was fitted to a conditional logic model to obtain a relative measure of the ranking of importance for each attribute. The results of the study found that clinical outcomes were the most preferred attribute. In fact, it was 4.68 times as important as productivity outcomes—the least preferred attribute. It was followed by health-related quality of life (2.78), methodologic rigor (2.09), resource utilization (1.71), and external validity (1.56).

This study provides a quantification of the value payers place on key RWE attributes. The authors found that payers have higher preferences for clinical and health-related quality of life outcomes than the other attributes. Between attributes’ levels, payers prefer high levels of information in clinical outcomes and methodologic rigor but are indifferent in other attributes.
Study first-author, Enrique Saldarriaga, 5th year PhD candidate at the CHOICE Institute says, “The motivation for this study was to bridge the gap between the information that payers seek and the attributes that RWE studies prioritize. We achieved that using a robust methodological framework for the experiment design and analysis. Our findings can effectively guide future research design.” The study was funded by an unrestricted gift from a consortium of biomedical industries to the University of Washington.

Read the full study here.

Saldarriaga EM, Hauber B, Carlson JJ, Barthold D, Veenstra DL, Devine B. Assessing Payers’ Preferences for Real-World Evidence in the United States: A Discrete Choice Experiment. Value Health. 2022 Mar;25(3):443-450. doi: 10.1016/j.jval.2021.09.016. Epub 2021 Oct 30. PMID: 35227457.

UWSOP Research Assistant Professor and CHOICE Faculty Fellow Douglas Barthold has been awarded a K01 grant from the National Institute of Aging (NIA) for his project titled, Long-term effects of today’s medical care access policies on the future burden of Alzheimer’s disease and related dementias.

NIH Mentored Research Scientist Development Awards provide support for an intensive, mentored career development experience in the biomedical, behavioral, or clinical sciences leading to research independence. NIA uses the K01 grant to support early-stage investigators pursuing career enhancement.

Barthold looks forward to gaining skills and expertise in simulation modeling to study long term effects of health policies.

“We know that diabetes and many other cardiovascular and metabolic conditions are related to dementia risk, and management of those conditions is one of the most important modifiable risk factors for dementia,” he said. “This project will examine how modern health policies that influence management of chronic conditions can translate into long-term effects on both individual health and well-being, as well as societal welfare.”

Barthold believes the success of this project can lead to future models that examine health policies yet to be conceived, in a range of disease areas.

“This will leave me well-positioned to lead an independent research program that influences future policy by identifying how patient costs and access to care relate to long-term healthy aging and Alzheimer’s disease and related dementias (ADRD),” he noted.

Dr. Jing Li, MA, PhD will be joining The CHOICE Institute and the Department of Pharmacy in August as an Assistant Professor of Health Economics. Dr. Li earned her PhD in Health Policy (Economics Track) from the University of California, Berkeley in 2016. She also holds a BA in Economics & English from Peking University, an MA in International Comparative Education from Stanford University, and an MA in Economics from the University of California, Berkeley.

Dr. Li joins us from Cornell University, Weill Cornell Medical College, Department of Population Health Sciences where she has served as an Assistant Professor in Health Policy and Economics since 2016. She has also been a Faculty Affiliate at the Institute for Health Economics, Health Behaviors and Disparities at Cornell University since 2017.

Dr. Li’s research focuses on innovative application of economic framework and advanced health econometrics to studying the causes and consequences of behavior and decision-making in health and health care, primarily using administrative healthcare claims and social and behavioral data, with the goal of improving population health. Her most recent work studies health and financial decision-making for older adults with dementia, as well as physician-industry relationships and drug prescribing decisions. Dr. Li is a current recipient of a National Institute on Aging K01 Career Development Award.

We are thrilled to welcome Dr. Li to the Department of Pharmacy and the CHOICE Institute.

Jing Li’s website: https://jingliwcm.wixsite.com/mysite

We are excited to announce that Elizabeth (Lizzy) Brouwer, PhD, will be re-joining the CHOICE Institute as a research scientist. Lizzy will be working on our ICER project team as a lead modeler.  In this role, she will develop cost-effectiveness models and participate in the development of ICER project reports.  Her first project, topic TBD, is scheduled for the July 2021 public meeting.

Lizzy earned her PhD from the CHOICE Institute in Spring 2020. Her dissertation research focused on the application of value-based insurance design to specialty medication in the face of copayment coupons.

In addition to working part-time with the CHOICE Institute, Lizzy dedicates the rest of her time as a Research Associate at Curta Consulting. When thinking about why she chose this field for a career, the answer is a simple one: “I am motivated by the enormous potential of health economics, real world evidence, and evidence-based health policy to change lives. Resources are finite, and millions of lives depend on whether spending is guided by evidence.”

Welcome back, Lizzy!

The 2020 Annual Report for the Comparative Health Outcomes, Policy & Economics (CHOICE) Institute is now available. Learn more about CHOICE’s extraordinary team and impactful work: https://lnkd.in/g6BFFYw

Researchers at the University of Minnesota and University of Washington found a statistical relationship between the number of hospital beds (ICU and non-ICU) occupied by COVID-19 patients in a state and reported mortality. Published today in the Journal of General Internal Medicine, this research is believed to be the first to use actual, state-level data to examine this association.

“These estimates provide a better understanding of the projections of the COVID-19 pandemic in the U.S. especially when states are gearing up to restart economic activities, and provide important practice insights for hospitals in terms of assessment of hospital bed and ICU bed capacity and preparedness,” said Pinar Karaca-Mandic, professor and academic director of the Medical Industry Leadership Institute (MILI) in the U of M’s Carlson School of Management, and study’s lead author.

Utilizing the U of M’s COVID-19 Hospitalization Tracking Project, researchers examined data from 23 states that reported daily percentages of ICU and non-ICU-bed use by COVID-19 patients.

The study found:

• COVID-19 patients occupied nearly 20% of all ICU-bed use in all states examined and about a 5% of non-ICU bed capacity;
• a 1 percentage point increase in ICU-bed use (17 beds on average) is associated with 2.84 more COVID-19 deaths over the next seven days;
• a 1 percentage point increase in non-ICU bed use (130 beds on average) was 17.84 more COVID-19 deaths.

“ICU and non-ICU bed use as a percentage of the bed capacity of a state were significantly associated with an increase of overall COVID-19 deaths over the next seven days, explained Anirban Basu, a professor of Health Economics and the Director of the The CHOICE Institute at the University of Washington and a study co-author. “The intensity of association for ICU-bed use was higher than non-ICU-bed use.”

The authors found that the results held true across a variety of alternate specifications.

“Most policy interventions to address the COVID-19 outbreak in the United States have focused on ‘flattening the curve’ – an approach to spread out hospitalizations over a longer duration to avoid overwhelming the healthcare system,” said Soumya Sen, associate professor and academic director of the Management Information Systems Research Center (MISRC) in the Carlson School, who co-authored the study. “The forecasting models informing these policy decisions make assumptions about the relation between the number of COVID-19 cases, hospitalizations, intensive care unit (ICU) demand, and subsequent impact on mortality.” Other study authors included Dr. Archelle Georgiou, Chief Health Officer of Starkey Hearing Technologies and an Executive-in-Residence with MILI at the Carlson School as well as Yi Zhu, a doctoral student at the Information Decision Sciences department of the Carlson School.

One limitation of this study is that during the COVID-19 era, some states may have been able to expand their hospital beds. However, the authors note that doing so for ICU beds was likely difficult due to infrastructure constraints.

According to a study released today, Anirban Basu, Stergachis Family Endowed Director of The CHOICE Institute at the UW School of Pharmacy, has developed one of the first models that can estimate the COVID-19 Infection Fatality Rate among symptomatic cases (IFR-S).

The Infection Fatality Rate (IFR) is a critical parameter in understanding the COVID-19 pandemic. Basu, who authored the study, says his goal for the model is to address the measurement errors associated with case fatality ratio using statistical techniques that will allow us to infer about the IFR.

“In general, the focus at the CHOICE Institute has been on knowing the current unknowns rather than forecasts,” he said. “For example, the Infection Fatality Rate among those who are affected today can help to recover the evolution of likely symptomatic cases that were undetected and gain a better understanding about testing coverages.”

Basu’s work aligns with UW’s Population Health Initiative of strengthening communities at home and abroad by delivering effective interventions with greater speed, efficiency and quality.

“Our hope is that our study results can help inform local and national policies that will save lives in the future,” said Basu. “Ultimately, we want this work to advance the health of people around the world.”

Basu also noted that the model should not be viewed as the ‘last word’ on estimating the COVID-19 IFR, but as one of the several methods being used to estimate this and related values. Also, IFR estimates are inherently dynamic in nature, and regular update of these estimates using newer data should be carried out.

The School of Pharmacy and Basu have developed a website that explores the infection and fatality rates by U.S. counties for people with symptoms. For this study, 116 counties in 33 states had COVID-19 data that fit Basu’s robust criteria for inclusion in the analysis.

UW’s CHOICE Institute Interactive: Explore the county-by-county and national infection fatality rates

In September, UW School of Pharmacy CHOICE alum Jonathan D. Campbell, PhD, will become Senior Vice President for Health Economics at the Institute for Clinical and Economic Review (ICER). Having collaborated with ICER closely over the past five years, Campbell will oversee the growth of ICER’s health economics team and lead in the future innovation of ICER’s value assessment methodology. In addition, he will continue to build ICER’s relationships with health economists around the country and with health technology assessment (HTA) agencies around the world.

Campbell, who graduated from the SOP’s CHOICE (formerly PORPP) PhD training program, says his education at UW helped inspire and influence his professional path. “I received education and mentorship from some of the world’s best researchers in the field of health economics and outcomes research,” he said. “I was encouraged to think deeply about health economics topics that matter, but to also not lose sight of the bigger picture. This ICER appointment would not have been possible without UW.”

Since graduating in 2007, Campbell has remained an active research collaborator with UW faculty and continues to lean on his UW mentors. “UW is a key academic collaborator to ICER in the economic modeling space,” he noted. “I look forward to the opportunity to work closely with UW faculty and researchers in my new leadership role at ICER.”

Sean D. Sullivan, professor and dean of the School of Pharmacy, served as Campbell’s primary mentor during his UW tenure and isn’t surprised by his former student’s success. “Everyone in the School of Pharmacy family is excited for Jon and his new role,” he said. “In addition to being an exemplary professional and world-class researcher, Jon is a natural leader, both passionate and compassionate. We’re thrilled for him.”

Campbell also received a MS in biostatistics, from the University of Washington. He earned bachelor’s degrees in mathematics and chemistry at St. Olaf College, where he graduated magna cum laude, Phi Beta Kappa.

Introducing “Health Years in Total:” A Novel Framework for Valuing Health Outcomes in Cost-Effectiveness Analyses. CHOICE Researchers Introduce a New metric that provides a robust and feasible approach that overcomes specific limitations of the QALY

Lawrenceville, NJ, USA—January 20, 2020—Value in Health, the official journal of ISPOR—the professional society for health economics and outcomes research, announced today the publication of an article introducing a new framework for valuing health outcomes in cost-effectiveness analyses. This new metric, “health years in total” (HYT), is a robust approach that overcomes specific limitations of quality-adjusted life-year (QALY) and equal value of life (EVL) measures. The report, “Health Years in Total: A New Health Objective Function for Cost-Effectiveness Analysis,” appears in the January 2020 issue of Value in Health.

Researchers from the University of Washington developed HYT as an alternative to other frameworks for valuing health outcomes in cost-effectiveness analyses. In short, HYT equals the sum of life expectancy plus modified QALYs. The modified QALYs are calculated over a time frame corresponding to the maximum survival of any given alternative. The Value in Health article establishes a theoretical framework, provides illustrations of the use of the HYT framework, and assesses decision-making thresholds for using HYT.

Despite the importance of QALY in cost-effectiveness analyses, its potential to be discriminatory toward patients with lower quality of life presents a critical challenge that has resulted in the exclusion of the use of cost-effectiveness analyses in some public healthcare decision making in the United States. The use of the QALY in cost-effectiveness analyses has been publicly criticized, as highlighted in the Oregon Health Insurance Experiment, specific language in the Affordable Care Act barring the use of QALYs, resistance to the Institute of Clinical and Economic Review’s activities, and the recent letter from the National Council on Disability to the President of the United States.

The main premise for these criticisms centers on the fact that QALYs, by definition, would value life extension for patients with lower baseline quality of life less than a similar life extension for patients with better baseline quality of life. The National Council on Disability specifically calls for alternatives to QALY. However, alternatives to QALY, such as EVL, have not gained traction because EVL fails to recognize the quality of life gains during added years of life. And disability-adjusted life years (DALYs), recommended by the World Health Organization, have the same limitations as QALYs.

“We propose a solution that can address this specific distributional issue of QALYs without failing to account for the quality of life impacts during the added years of life,” said author Anirban Basu, PhD, of The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA. “In this article, we introduce the framework of health years in total, which separates life expectancy effects from quality of life impacts through the use of an additive, rather than multiplicative, approach. By disentangling life expectancy impacts from quality of life effects, the HYT framework enables patients with lower quality of life to fully benefit from interventions that extend life expectancy.”

The HYT framework proves a robust alternative to QALY in the use of cost-effectiveness analyses. Continued development, application, and testing of the HYT framework are needed to assess its potential for moving the field beyond the limitations of QALYs, DALYs, and EVL.

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ABOUT ISPOR

ISPOR, the professional society for health economics and outcomes research (HEOR), is an international, multistakeholder, nonprofit dedicated to advancing HEOR excellence to improve decision making for health globally. The Society is the leading source for scientific conferences, peer-reviewed and MEDLINE^®-indexed publications, good practices guidance, education, collaboration, and tools/resources in the field.

Web: www.ispor.org | LinkedIn: www.linkedin.com/company/ispororg | Twitter: www.twitter.com/ispororg (@ISPORorg) | YouTube: www.youtube.com/ispororg | Facebook: www.facebook.com/ispororg | Instagram: www.instagram.com/ispororg

ABOUT VALUE IN HEALTH

Value in Health (ISSN 1098-3015) is an international, indexed journal that publishes original research and health policy articles that advance the field of health economics and outcomes research to help healthcare leaders make evidence-based decisions. The journal’s 2018 impact factor score is 5.037. Value in Health is ranked 4th among 81 journals in health policy and services, 5th among 98 journals in healthcare sciences and services, and 11th among 363 journals in economics. Value in Health is a monthly publication that circulates to more than 10,000 readers around the world.

Web: www.ispor.org/valueinhealth | Twitter: www.twitter.com/isporjournals (@ISPORjournals)

About 15% of hospitals have closed since 1990, and rates of hospital closure—particularly in rural areas—have increased over the last decade.

Dr. Kritee Gujral and Dr. Anirban Basu’s recent National Bureau of Economic Research (NBER) working paper, “The Impact of Rural and Urban Hospital Closures on Inpatient Mortality,” which used California’s inpatient data from 1995-2011, showed that rural closures increase patient mortality by 5.9%, whereas urban closures have no measurable impact.

As previous studies had provided mixed evidence regarding the impact of closures on patients, with no large-scale published study showing adverse patient impact of hospital closures, their work calls attention

to this important issue and its patient-level impact, as hospital closures, especially in rural areas, are on the rise. Policymakers should ensure that patients, particularly vulnerable ones, have access to emergency transportation following a hospital closure, the authors say.

This work has received press coverage by several media outlets: NBC news, The Daily Yonder, The Brookings Institution, Center for American Progress and Iowa Public Radio. Dr. Gujral was also invited to present and share their findings to key individuals from Federal Office of Rural Health Policy and Office of Planning, Analysis, and Evaluation at the Health Resources and Services Administration.

Kritee Gujral is a postdoctoral fellow at the CHOICE Institute currently on the job market. Learn more about Kritee and her research.

Jens Grueger, PhD is the 2019-2020 President Elect for the Professional Society for Health Economics and Outcomes Research (ISPOR) and current Director and Partner at Boston Consulting Group in Zurich, Switzerland where he is the senior expert for pricing and market access in the life sciences. Previously, Dr Grueger was Head of Global Access at F. Hoffmann-La Roche, based in Basel, Switzerland. With his team, they drove holistic access strategies to ensure that Roche and healthcare systems deliver rapid, broad, and sustainable patient access to the company’s innovative offerings.

Dr. Grueger served for a number of years as the Novartis and then the Roche global representative to the UW School of Pharmacy Corporate Advisory Board. Jens has worked with and supported many CHOICE Institute initiatives. He has lectured in our classes and participated in several research projects with Drs. Sean Sullivan and Lou Garrison including recent work with ICER on appropriate cost-effectiveness thresholds in the United States (learn more from the associated webinar series here: https://icer.org/news-insights/commentaries/webinar-series-ce-thresholds/)

Jens was trained in mathematics and medicine, receiving a master’s degree in medical statistics (1984) and a PhD in theoretical statistics (1986) from the Technical University of Dortmund in Germany. He started his professional career as a health systems researcher, consulting with governments and payers (1986-1994). He led country, regional, and global health economics and outcomes research, pricing, and access organizations for SmithKline Beecham (1994-1999), Novartis (1999-2009), Pfizer (2009-2011) and Roche (2011-2019). He built on the principles of health economics when driving value-based pricing in order to accelerate and broaden access for patients to innovative medicines. He has been promoting risk sharing, performance-based pricing, indication-based pricing, and international differential pricing. He has been leading innovative projects to engage with health technology assessment, payers, and patients around scientific advice, joint clinical scientific assessment, and innovative approaches to evidence generation including real-world data.

Dr Grueger has been an active ISPOR member since 1999, serving on the ISPOR Board of Directors from 2004-2006. He was a member of the ISPOR task force on real-world data (2005-2007), and performance-based risk-sharing arrangements (2011-2013). He participated in scientific committees, workshop committees, and abstract review committees for ISPOR conferences. He has been invited twice to present in plenary sessions at ISPOR Europe conferences (2011 and 2016), chair work groups, and contribute to numerous issues panels. He has been a member of the ISPOR Nominations Committee for the last 2 years, and since 2018 has participated in the ISPOR Strategic Plan Work Group. He has been a scientific reviewer for Value in Health for many years.

We welcome Dr. Grueger to the UWSOP and look forward to our continued collaboration. Learn more about Dr. Grueger and his vision for ISPOR during his tenure as president: https://www.ispor.org/about/our-leaders/jens-grueger

Faculty Link: https://sop.washington.edu/people/jens-grueger/

The Society for Medical Decision Making (SMDM) brings together researchers, clinicians, educators, managers, and policy makers from diverse backgrounds and disciplines. SMDM is the leading society for studying and advancing decision sciences in health, including incorporation of patients’ values and preferences. It promotes scientific and methodological rigor in health care decision research and its application to health policy and clinical care.

This year, the 41st North American Meeting was just down the road in Portland Oregon. Due to the close proximity, nearly all CHOICE students and faculty were able to attend.

The CHOICE Institute’s PharmD/MS Fellow, Phoebe Wright, and PhD Candidate, Elizabeth Brouwer, were selected to serve as the social media reporters for the entire conference.

On serving as a student social media reporter, Phoebe says, “I love health economics, so being a social media reporter at SMDM allowed me to fully express and share my unsolicited thoughts, opinions, and summaries on cutting edge health economics research. The level of engagement from the health economics community was awesome! People are brilliant, and I’m glad I got help facilitate conversation among thought leaders.”

We asked Phoebe to share some of her favorite tweets from the conference and here they are: one, two, three.

Several students presented posters at the conference, including:

“Health Mass Index: Obesity Metrics to Reflect Health Rather Than Growth” Authors: Enrique Saldarriaga, Anirban Basu

“Catalogue of Age and Medical-Condition-Specific Healthcare Costs in the US to Inform Future Costs Calculations in Cost-Effectiveness Analysis” Authors: Boshen Jiao, Anirban Basu

“Characterizing Longitudinal Patterns of Tyrosine Kinase Inhibitor Adherence in Patients with Newly Diagnosed Chronic Myeloid Leukemia” Authors: Samantha Clark, Zachary Marcum, Aasthaa Bansal

Alternative Approaches to QALY Estimation within Standard Cost-Effectiveness Models: Literature Review, Feasibility Assessment, and Impact Evaluation” Authors: Elizabeth Brouwer, Eunice Kim, Phoebe Wright, Josh Carlson

CHOICE alum Will Canestaro was selected as a 2019 Seattle Health Innovator of the Year in Collaboration.

This award recognizes individuals who are exhibiting extraordinary talent in the four attributes that contribute to successful innovation: collaboration, customer focus, imagination, and perseverance. Recognized for collaboration, Will is currently the Managing Director at Washington Research Foundation/WRF Capital.

Will regularly collaborates with UWSOP students, faculty, and the institute through his work with the Washington Research Foundation, of which several UWSOP graduate and professional students are currently fellowship recipients.

Will earned his PhD from the CHOICE Institute in 2016. His dissertation research was on “Publication Bias: Development and Assessment of Methods for Adjustment and Quantification of Impact” and Dr. Josh Carlson served as his committee chair.

Will is a valuable catalyst for life science startups in the Pacific Northwest. In his role at WRF, Will is responsible for the Foundation’s investments in Life Science and Biotechnology start-ups where he provides insightful strategic advice and facilitates connections based on his own startup experience. During his PhD. studies at the UW, Will worked extensively with several university spin-outs to help them launch. He always finds time to meet with students and advise them; moreover, connect them to others in his network.

Will has been on the management team for the Institute for Translational Health Sciences, ITHS/WRF Summer Commercialization Fellows program, and teaches the Health Innovation Practicum. He has served on and been a great collaborator on committees and boards for M3 Biotechnology, Faraday Pharmaceuticals, Phase Genomics, Icosavax, One Radio, Life Science Washington Institute, and the ITHS. He was also recognized by Puget Sound Business Insider as a 40 under 40 for 2019: https://www.bizjournals.com/seattle/news/2019/09/29/psbjs-40-under-40-honorees-reveal-stories.html

He was recognized for this honor at the Health Innovation NW 2019 Annual Awards and Holiday Party.

We are excited to share that CHOICE alumnus, @WilliamCanestaro, was selected as a 2019 Seattle Health Innovator of the Year. Congratulations! A true testament to your impact as a collaborator, connector and innovator.@Health_Seattle #125yearsofimpact #CHOICEInstitute @wrfseattle pic.twitter.com/tkFxlUbW43

— UW School of Pharmacy (@UW_Pharmacy) December 16, 2019

CHOICE faculty member Doug Barthold has expanded his research program that studies risk factors and care for Alzheimer’s disease and related dementias (ADRD). In a recent publication, he and his co-authors examined diagnosis patterns to understand how different types of dementia are diagnosed, and the degree to which specialist physicians offer more precise diagnoses than non-specialists. They found that dementia subtype is often unknown at the time of initial diagnosis, but a precise diagnosis is reached sooner for patients who see specialists. Moreover, specialist access was limited for racial and ethnic minorities, who experience higher rates of ADRD incidence.

Reaching a specific diagnosis of dementia subtype provides important information that facilitates care planning for patients and caregivers, and these findings show the importance of access to specialists, especially in high risk populations.

Read the full publication here:
Drabo EF, Barthold D, Joyce G, Ferido P, Chui HC, Zissimopoulos J, 2019. “Longitudinal analysis of dementia diagnosis and specialty care among racially diverse Medicare beneficiaries.” Alzheimer’s & Dementia. Published online September 4, 2019

UW Cost-Effectiveness Modeling Team, Ryan Hansen and Greg Guzauskas, were recently presenters at the Institute for Clinical and Economic Review’s (ICER) New England CEPAC Meeting on Type 2 Diabetes at Brown University in Providence, Rhode Island.

The UW Team created a cost-effectiveness microsimulation model to evaluate the value of oral semaglutide added to ongoing background diabetes treatment compared to four alternative treatment strategies. Drs. Hansen and Guzauskas were praised for a very effective presentation of a complex disease model by both the ICER Policy Roundtable Participants and the CEPAC Members.

The New England Comparative Effectiveness Public Advisory Council (New England CEPAC), a core program of the Institute for Clinical and Economic Review (ICER), is a nationally-recognized community forum. The New England CEPAC convenes three times each year at public meetings to review objective evidence reports and develop recommendations for how stakeholders can apply evidence to improve the quality and value of health care.

New England CEPAC directly engages clinicians, patients, and payers during public meetings to discuss implications of the evidence for clinical decision-making and coverage policies. Application of evidence takes shape through new medical policies, benefit designs, and patient and clinician tools to improve clinical care and patient outcomes.

Learn more here: https://icer-review.org/programs/new-england-cepac/
Dr. Ryan Hansen is an Assistant Professor in the CHOICE Institute and Dr. Greg Guzauskas is a Senior Research Scientist in the CHOICE Institute.

Teams at UWSOP and Fred Hutch look at emerging sickle cell disease therapies

The National Institutes of Health’s National Heart, Lung, and Blood Institute (NHLBI) funded a unique collaborative, The Sickle Cell Clinical and Economic Impact Consortium that brings together The CHOICE Institute at the UW School of Pharmacy (UWSOP), Fred Hutch, NHLBI, and The Emmes Corporation. The Collaborative enables the two teams at The CHOICE Institute and the Fred Hutch to develop models that will give insight into the clinical and economic benefits of cures for sickle cell disease over the lifetime of the patients. The goal is to clarify the potential long-term benefits of genetic therapies for this genetic disease. Results and public versions of the models will be made publicly available.

About 100,000 people in the U.S. are affected by sickle cell disease (2 sickle cell genes or one and another abnormal gene), a disproportionate percentage of which are black or Hispanic.  About one in 13 black or African Americans have sickle cell trait (1 sickle cell gene) and are at risk for having a child with the disease. The inherited blood disorder leads to many medical complications and shortens the life spans of people affected by about 20-30 years.

The disease can lead to episodes of excruciating pain, stroke, heart, lung, and kidney damage. The trauma of the pain and repeat hospitalizations for young children can cause stigmatization, depression, and social isolation. For people with living the disease, early intervention and access to care are vital for their long-term prognosis, physically and psychologically.

Historically, the treatments have decreased the frequency and severity of complications. More recently, some patients have been cured with bone marrow transplantation with a sibling or alternate donor, but many do not have genetically well-matched marrow donors, and there can be serious complications.

With detailed feedback from all Consortium members and a variety of stakeholder inputs, the teams will develop simulation models for patients from the age of diagnosis over their lifetimes and investigate the state-specific estimates of comorbidities and complications, quality of life, health care utilization, and costs. Models will be informed using extensive literature review and datasets from both public and private sources, which will likely make these models the most comprehensive ever to be built around sickle cell disease in the United States. The potential impact of different types of curative therapies will be studied.

The researchers at the CHOICE Institute and Fred Hutch are global leaders in disease modeling, particularly for genetic diseases. The UW School of Pharmacy team is led by Principal Investigator and CHOICE Director Anirban Basu, with CHOICE Professor Beth Devine and Seattle Children’s M.A. Bender serving as co-investigators. Fred Hutch’s team is led by Dr. Joshua Roth along with co-investigator Dr. Scott Ramsey. Both groups have a long history of collaborative work.

“Our findings can inform the development strategies to use gene therapy to treat patients with severe sickle cell disease with the objectives of reducing disease complications, extending survival, and improving quality of life,” says Joshua Roth at Fred Hutch.  “Our team is very excited to apply our expertise in economic modeling to address these important issues.”

The collaborative agreement (OTA 1OT3HL152448) is funded by the NIH National Institutes of Health National Heart, Lung, and Blood Institute (NHLBI) for a potential duration of 3 years of funding totaling $3M for the UW team.

To find the posters and presentations of CHOICE students, alumni, and faculty, please refer to the PDF attached here.

CHOICE at ISPOR 2019

Congratulations to the 2019 winners of the Louis Sr. and Marilyn Garrison Endowed Prize in Health Policy and Economics, Elizabeth Brouwer (4th year CHOICE PhD student) and Gilbert Ko (3rd year PharmD/MBA student)!

CHOICE Professor Emeritus, Dr. Lou Garrison, is seen here presenting Lizzy with the award, named in honor of his parents, at the CHOICE Annual Retreat.

This year’s prize was awarded to both Lizzy and Gilbert for their impressive papers: “Implicit Adoption of Cost-Effectiveness-driven Value-Based Formularies in Private Health Insurance 2010-2013,” authored by Elizabeth D. Brouwer, Anirban Basu, John Watkins, Kai Yeung and Gilbert’s paper, “Gene Therapy for Hemophilia A: Value-Based Pricing.”

Congratulations, Gilbert and Lizzy!

Two CHOICE graduate students were recently awarded global health travel fellowships. Erik Landaas received the Global Opportunities (GO) Health fellowship for his work in Thailand. Enrique Saldarriaga received the Stergachis Endowed Fellowship for International Exchange for his work in Kenya with Dr. Ruanne Barnabas, Associate Professor in Global Health and Medicine at the University of Washington and affiliate at the Fred Hutchinson Cancer Research Center.

Improving cervical cancer screenings in Kenya: Enrique Saldarriaga

This summer, through the Stergachis Fellowship, CHOICE PhD student Enrique Saldarriaga will be conducting research in Kenya on estimating the cost of cervical cancer screening. Working with Dr. Ruanne Barnabas, their project aims to estimate the lower-cost of five different techniques of STI screening. They hope to develop an investment case for HIV and cervical cancer interplay infections.

At the KEMRI/WRP clinical research center laboratories in Kenya, Enrique will collect critical costing data necessary to evaluate the cost effectiveness of these five screening methods. This is important work, as cervical cancer accounted for 570,000 new cases and 311,000 death worldwide in 2018, with the vast majority of those concentrated in sub-Saharan Africa and South-Eastern Asia. Moreover, its one of the leading-cause of death among women in Kenya.

There is vast literature showing the health benefits of screening strategies for early treatment and cervical-lesions progression prevention. Potential interventions need to go through an economic evaluation to determine: value of money (economic return in health outcomes terms) and feasibility of the investment specific for the setting.

A lack of rigorous economic assessment results in sub-optimal decisions, inefficient resources allocation, and compromises stability of intervention in time. Ultimately, all of this affects the scope of the intervention and the number of women whose progression to high-grade of cancer lesions might be prevented. This study focuses on a key element of economic evaluations: costing.

Enrique will use a micro-costing technique that starts identifying all relevant cost components at the individual (per case) level, from all health services involved in the services provision, to finally adding them up to estimate a unitary cost per person screened under five different techniques: Visual Inspection with Acetic Acid (VIA) or Visual Inspection with Lugol’s Iodine (VILI), histopathology based screening (PAP smear), qualitative rapid HPV tests, and semi-quantitative HPV research assays.

Testing the PupilScreen app in Thailand: Erik Landaas

An opportunity made possible by his GO fellowship, this summer Erik will continue his work on the PupilScreen phone app by conducting study oversight with hospitals in Thailand to ensure good study fidelity. The PupilScreen app offers a low-cost, easy to use test for Traumatic Brain Injury (TBI).

He will observe the full scope of the study protocol including patient enrollment, device screening, data collection, data management and protected health information (PHI) to ensure the patients’ confidentiality.  Being there will also help with addressing any problems that may occur and solve issues in real-time.

Additionally, he hopes to work with  Naresuan University Hospital’s computer science program to annotate the patient screens from the PupilScreen app for machine learning algorithms. He has been invited to provide lectures at Naresuan University’s School of Pharmacy and School of Nursing about his research: PupilScreen and his work at UW Medicine, as well as the review of new medical technologies (Smart Innovation).

Read more about Erik’s PupilScreen project

Link to CHOICE Institute archived news

Please join us in welcoming Anthony Morgan (who goes by Morgan) to The CHOICE Institute! Morgan is serving as CHOICE’s first Research Project Manager. Prior to joining us here at UWSOP, he was at Seattle Children’s Hospital.

Morgan has been managing public health programs and research projects since 2002. He has a strong history of managing multiple public health programs and research initiatives focused on a variety of racial, sexual and gender minority adolescents and emerging adults.

Morgan has successfully managed single and multi-site projects at Columbia and Johns Hopkins Universities as well as local hospitals including Seattle Children’s and community-based organizations such as Seattle Counseling Service and Gay Men’s Health Crisis.

Morgan brings a wealth of experience, knowledge and skill to the position of Research Project Manager at the CHOICE Institute. We are so pleased he has joined the team here. Welcome, Morgan!

Link to CHOICE Institute archived news

Congratulations to CHOICE PhD student Elizabeth Brouwer who received conference travel funds from the Population Health Initiative at the University of Washington! Elizabeth will use the funds to attend the American Society of Health Economists conference (ASHEcon) in June 2019.

Elizabeth will be speaking on a panel titled, “Impacts of Federal, State, and Commercial Prescription Drug Access Policies,” where she will explore the national uptake of value-based insurance in private health formularies.

This is part of Elizabeth’s dissertation on value-based formulary design and its application to the US health care system. Elizabeth is currently conducting this research with CHOICE Institute faculty Ryan Hansen, Anirban Basu, Douglas Barthold, and Kai Yeung.

Link to CHOICE Institute archived news

Congratulations to third-year PhD student in the CHOICE Institute, Lauren Strand who was named the UWSOP Magnuson Scholar for 2019-2020. Magnuson Scholars are selected for their excellent academic performance and outstanding potential for research in the health sciences; they receive $30,000 to support their research, education, and training. 

Originally interested in studying prescription drugs of potential abuse from the public health perspective, Lauren has become fascinated by the economic underpinnings of prescription drug use and abuse. For her dissertation, she will investigate the relationship between recreational cannabis policy/roll-out and prescribing in the state of Washington and in several other legalizing states.

She will focus on putative “substitutable” classes of drugs such as opioids. If there is evidence of substitution occurring over time, for future study she is interested in how such real-world patterns of prescription drug substitution could relate to negative overdose outcomes such as hospitalization and death.

While this research area is challenging and fast-paced, she hopes her findings might help inform future initiatives in Washington and other states.

We are so proud of you, Lauren! Congratulations on this significant award and recognition for your research.

Link to CHOICE Institute archived news

This year, the CHOICE Institute’s Certificate in Health Economics and Outcomes Research program has been reaching a wide audience.

In addition to offering the traditional distance learning program to US and international students, engaging 40 students from 4 countries this year, CHOICE is running a separate program sponsored by AbbVie for 24 Ministry of Health officials from Saudi Arabia.

Professor Emeritus Lou Garrison has been instrumental in setting up the course for this cohort and providing customized, supplemental instruction.

Link to CHOICE Institute archived news

CHOICE faculty member Doug Barthold was awarded the Alzheimer’s Disease Research Center Pilot Award, for a proposal titled “Alzheimer’s disease related neuropathology among patients with medication treated type 2 diabetes in a community-based autopsy cohort.”

The award is for one year. His study will look at the relationship between use of type II diabetes medications and Alzheimer’s disease related neuropathology.

Alzheimer’s disease-related neuropathology is one of the signs of Alzheimer’s disease that are observed in an autopsied brain. Many other studies have found links between diabetes medications and the clinical presentation of Alzheimer’s disease, but researchers have yet to examine the neuropathology of diabetes medication users.

This is important, because there are inconsistencies between what clinicians observe and what is seen in the brain after an autopsy.

Link to CHOICE Institute archived news

The CHOICE Institute welcomed Professor Emeritus Charles E. Phelps, PhD, for the 2019 CHOICE Institute Annual Symposium. Dr. Phelps provided an overview of multiple-criteria decision analysis (MCDA) methods.

“The CHOICE Institute was delighted to host Professor Emeritus Charles Phelps at the keynote speaker for the CHOICE Annual Symposium. Professor Phelps discussed alternative methods and challenges to conduct multi-criteria decision analysis and took the audience through an hand-on exercise. Understanding these tools are important for engaging with health technology assessment bodies and helping them develop a transparent assessment process when desired.” –Anirban Basu, Professor and Stergachis Family Endowed Director, The CHOICE Institute.

He discussed how to use MCDA in a budget-constrained decision context, and demonstrate potential uses for individuals. The seminar concluded with an exercise using alternative group choice mechanisms and a discussion of their merits.

Charles E. Phelps started his career at the RAND Corporation, working from 1971-1984, when he joined the University of Rochester as a professor and director of the public policy analysis program. He later became the provost of the University of Rochester until his retirement. He is an expert on health and health care economics.

Link to CHOICE Institute archived news

Associate Dean Andy Stergachis was appointed to a committee of the National Academies of Sciences, Engineering, and Medicine to conduct a study sponsored by the Veterans Administration, to assess the long-term health effects of antimalarial drugs used by adults, in particular mefloquine, for the prophylaxis of malaria.

The National Academies was charged with studying the long-term health effects that may result from use of medications used to prevent malaria. Long term and repeat deployments to countries with endemic malaria, like Afghanistan, have meant service members may take antimalarials for extended periods of time. There has been a concern that this long-term preventative use of antimalarials, in particular mefloquine, may result in health problems for military personnel. The committee will look at the effects on organ systems, especially neurologic and mental health outcomes, including the potential development of Posttraumatic Stress Disorder (PTSD). Additionally, the committee will consider approaches for identifying short-term, long-term, and persistent adverse health effects of antimalarials. The committee will develop findings and conclusions based on its review of the evidence.

Link to CHOICE Institute archived news

Traumatic brain injury (TBI) is one of the leading causes of morbidity and mortality worldwide. CHOICE PhD student Erik Landaas has partnered with PhD students at UW School of Nursing, Kwankaew Wongchareon and Ana Carolina Sauer Liberato, along with students at UW Computer Science, UW Engineering, and UW Neurosurgery to create a new mobile health phone app called PupilScreen.

PupilScreen uses smartphone technology and machine learning to detect traumatic brain injury. It is the first smartphone app capable of objectively detecting concussion and other traumatic brain injuries in the field: on the sidelines of a sports game, on a battlefield, in the home of an elderly person prone to falls, and in low-income countries without the resources for advanced testing equipment. PupilScreen can detect changes in a pupil’s response to light using a smartphone’s video camera and deep learning tools—a type of artificial intelligence—that can quantify changes imperceptible to the human eye.

Erik and his colleagues in Nursing are testing the app’s performance, which is being conducted at a level-one trauma center, Budhachinaraj Hospital, Phitsanulok Province, and located in north-central Thailand. They are evaluating the reliability and validity of the PupilScreen Smartphone App in individuals who have suffered a TBI and have been taken to the hospital emergency department (ED) or intensive care unit (ICU) the hospital. Their evaluations measure PupilScreen to the established gold standard, Pupillometer.

The team is testing in Thailand because two of their co-investigators are originally from Thailand and have an established relationship with the hospital’s medical director and clinical leadership, as well as have an academic appointment at neighboring Naresuan University.

The instruments used for screening patients with suspected TBI are either cost prohibitive in low-income countries or have poor clinical effectiveness, so the low cost of the PupilScreen app and its accessibility makes it a highly attractive device for screening patients with head injuries. If the app is shown to have equivalent reliability and validity to a Pupillometer, it may be poised to become the new standard device for screening TBI patients.

“This is a unique opportunity for a PhD student to be able to design, develop and implement a clinical trial,” said Erik. “All of my UW graduate and doctoral training has prepared me for this study. I achieved an MPH from the UW and in my PhD program I have studied global health, epidemiology, biostatistics, health economics, all of which have provided me with sophisticated skills that I am now able to put into real world practice.” Long term, he hopes to develop and evaluate new medical technologies that can be implemented cost-effectively and improve clinical outcomes, while offering clinicians worldwide more accurate tools for diagnosis and guiding care.

Erik received funding support through the Washington Research Foundation for this important project.  His research will be showcased at the Dawgs in the Desert Alumni Event in Palm Springs on March 19. The team will present their research and highlight the collaboration between the School of Pharmacy and the School of Nursing.

Link to CHOICE Institute archived news

CHOICE Alumnae Carrie Savage Bennette and Blythe Adamson, recent CHOICE alum, will be presenting/co-leading one of the short courses, Tools for Reproducible Real-World Data Analysis. This course will focus on the concepts and tools of reproducible research and reporting of modern data analyses. The need for more reproducible tools in health economics and outcomes research is growing rapidly as analyses of real world data become more frequent, involve larger datasets, and employ more complex computations.

This course will cover the principles of structuring and organizing a modern data analysis, literate statistical analysis tools, formal version control, software testing and debugging, and developing reproducible reports. Numerous real-world examples and an interactive class exercise will be used to reinforce the concepts and tools introduced.

The course will run Saturday at ISPOR.

Link to CHOICE Institute archived news

Congratulations to the twelve UWSOP students, comprised of eleven CHOICE Students and fellows and one PharmD student (co-authored with a CHOICE student), who were selected to present posters the annual ISPOR conference in May. Several students had multiple abstracts accepted, making a total of 15 research posters from UWSOP to be represented by CHOICE at the conference.

Jaime Ta
Allergan Fellow
Net Health Benefit – ASCO Vs. I.C.E.R. Value Frameworks: Are We Talking about the Same Thing?

Lizzy Brouwer
PhD Student
A Systematic Review and Content Analysis of Rhetoric about the Institute for Clinical and Economic Review (ICER) in the Written Media, 2015-2017

and

Identifying and Assessing the Feasibility of Proposed Alternative Approaches to QALY Estimation within Cost-Effectiveness Models Using a Systematic Literature Review: an Updated Analysis

Woojung Lee
PhD Student
Do Patient Concerns about Antihypertensive Use as a Dementia Prevention Strategy Vary By Current Use of Antihypertensive Medication?

Sabra Zaraa
PhD Student
Cost-Effectiveness Analysis of Tafenoquine with a Rapid Diagnostic Test for G6PD Deficiency in Patients with Plasmodium Vivax Infections in Brazil

Enrique Saldarriaga
PhD Student
Renal Health Program: Cost-Effectiveness Analysis of a Secondary Prevention Strategy To Delay Progression to Dialysis and Overall Mortality Among CKD Patients in Lima, Peru

and

Income-Elasticity of the Body Mass Index. Results From A Peruvian Household Survey

Samantha Clark
PhD Student
Implications of Using a Data Integration Pipeline to Streamline the Clinical Trial Process for Glioblastoma Treatment Combinations

Thomas Hopkins
Bayer Fellow
Systematic Review of Adverse Events Associated with the Immunotherapy Checkpoint Inhibitor Drug Class

Edward (Eddie) Neuberger
Genentech Fellow
Cost-Utility of Cannabidiol in Addition to Background Therapy Versus Background Therapy Alone in Lennox-Gastaut Syndrome

Erik Landaas
PhD Student
Incorporating Health Technology Assessment into Laboratory Medicine at UW Medicine

and

Health Technology Assessment of a Less Invasive Bladder Cancer Test

Wei-Jhih Wang
PhD Student
A Novel Method for Assessing Feasibility of Generating Real-World Data Based Control Groups

and

Assessing the Generalizability of Clinical Trials Without Individual-Level Trial Data

Lauren Strand
PhD Student
A Remedy for Despair? Short-Term Changes in Economic Conditions and Opioid Prescribing in Washington State

Eunice Kim
PharmD
A Systematic Review and Content Analysis of Rhetoric about the Institute for Clinical and Economic Review (ICER) in the Written Media, 2015-2017

Link to CHOICE Institute archived news

Please welcome Marina Gano, the new Department of Pharmacy/CHOICE Institute Graduate Program and Operations Manager.

Marina grew up in Fairbanks, Alaska, after first living in Germany and Maryland. She earned a Bachelor of Arts in Foreign Languages and Literature (Spanish and German) from the University of Alaska Fairbanks (UAF).

Her career in higher education began in the Office of Admissions and Registrar at UAF, and then moved to the UW in 2014 as an advisor in Graduate Enrollment Management Services (GEMS). In this role, Marina provided advising, training, and support to the staff, faculty, students, and applicants of the three UW campuses.

Marina recently earned a Master of Education degree in Educational Leadership and Policy Studies (Higher Education). Through her role in GEMS and her graduate program, she’s gained valuable knowledge and perspectives regarding graduate education and the UW, which will be of great value in her role.

In her free time, Marina enjoys cooking and trying new recipes, listening to podcasts, gardening, traveling, creating art such as needlework, painting, calligraphy, and spending time with her two cats Cosmo and Luna.

Welcome Marina!

Link to CHOICE Institute archived news

The CHOICE Institute & the Hutchinson Institute for Cancer Outcomes Research (HICOR) Joint Seminar

On Wednesday, May 2nd, Peter Neumann, Sc.D. joined our PHEnOM seminar to discuss whether the Institute for Clinical and Economic Review (ICER) is becoming the U.S.’ counterpart to England’s National Institute for Health and Care Excellence (NICE).

PHEnOM facilitates discussion between faculty, students and researchers in the fields of health economics, econometrics and methodology development in outcomes research. NICE evaluates the effectiveness and cost-effectiveness of health strategies for that country’s health system.

Peter is Director of the Center for the Evaluation of Value and Risk in Health at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, and Professor of Medicine at Tufts University School of Medicine.

Advance your career in patient-centered outcomes research at the University of Washington. Learn more about studying Pharmaceutical Outcomes Research and Policy at The CHOICE Institute at UWSOP.

Link to Department of Pharmacy archived news