Jack Ching is a Health Policy Ph.D. student in the Decision Sciences track, with research interests in health systems design and implementation. Prior to joining Stanford in 2016, he worked for three years as a business consultant with The Permanente Medical Group, focusing on operational and quality improvement, as well as large-scale population health programs. He holds a Bachelor’s in Operations Research and Financial Engineering from Princeton University.
Impact of Treatment Duration on Mortality Among Veterans with Opioid Use Disorder in the United States Veterans Health Administration.
Addiction (Abingdon, England)
BACKGROUND AND AIMS: While long-term medication-assisted treatment (MAT) using methadone or buprenorphine is associated with significantly lower all-cause mortality for individuals with opioid use disorder (OUD), periods of initiating or discontinuing treatment are associated with higher mortality risks relative to stable treatment. This study aimed to identify the OUD treatment durations necessary for the elevated mortality risks during treatment transitions to be balanced by reductions in mortality while receiving treatment.DESIGN: Simulation model based on a compartmental model of OUD diagnosis, MAT receipt, and all-cause mortality among Veterans with OUD in the United States Veteran Health Administration (VA) in 2017-2018. We simulated methadone and buprenorphine treatments of varying durations using parameters obtained through calibration and published meta-analyses of studies from North America, Europe, and Australia.SETTING: USA PARTICIPANTS: Simulated cohorts of 10,000 individuals with OUD MEASUREMENTS: All-cause mortality over 12 months FINDINGS: Receiving methadone for 4 months or longer or buprenorphine for 2 months or longer resulted in 54 (95% CI: 5-90) and 65 (95% CI: 21-89) fewer deaths relative to not receiving MAT for the same duration, using VA-specific mortality rates. We estimated shorter treatment durations necessary to achieve net mortality benefits of 2 months or longer for methadone and 1 month or longer for buprenorphine, using non-VA population literature estimates. Sensitivity analyses demonstrated that necessary treatment durations increased more with smaller mortality reductions on treatment than with larger relative risks during treatment transitions.CONCLUSIONS: Short periods (<6 months) of treatment with either methadone or buprenorphine are likely to yield net mortality benefits for people with opioid use disorder relative to receiving no medications, despite periods of elevated all-cause mortality risk during transitions into and out of treatment. Retaining people with opioid use disorder in treatment longer can increase these benefits.
View details for DOI 10.1111/add.15574
View details for PubMedID 33999485
MODELING INTERVENTIONS TO EXPAND MEDICATION-ASSISTED TREATMENT AMONG VETERANS WITH OPIOID USE DISORDER IN THE VETERANS HEALTH ADMINISTRATION
SAGE PUBLICATIONS INC. 2021: E189-E190
View details for Web of Science ID 000648637500155
ESTIMATED MORTALITY RATES AMONG TREATED AND UNTREATED VETERANS WITH OPIOID USE DISORDER IN THE VETERANS HEALTH ADMINISTRATION
SAGE PUBLICATIONS INC. 2020: E105–E106
View details for Web of Science ID 000509275600095
CO-MORBIDITIES AND SEVERE ADVERSE EVENTS AMONG TREATED AND UNTREATED VETERANS WITH OPIOID USE DISORDER IN THE VETERANS HEALTH ADMINISTRATION
SAGE PUBLICATIONS INC. 2020: E167–E168
View details for Web of Science ID 000509275600147
- Cost Effectiveness of Endoscopic Resection vs Transanal Resection of Complex Benign Rectal Polyps CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2019; 17 (13): 2740-+
Cost Effectiveness of Endoscopic Resection vs Transanal Resection of Complex Benign Rectal Polyps.
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
BACKGROUND & AIMS: Complex benign rectal polyps can be managed with transanal surgery or with endoscopic resection (ER). Though the complication rate after ER is lower than transanal surgery, recurrence is higher. Patients lost to follow up after ER might therefore be at increased risk for rectal cancer. We evaluated the costs, benefits, and cost effectiveness of ER compared to 2 surgical techniques for removing complex rectal polyps, using a 50-year time horizon-this allowed us to capture rates of cancer development among patients lost from follow-up surveillance.METHODS: We created a Markov model to simulate the lifetime outcomes and costs of ER, transanal endoscopic microsurgery (TEM), and transanal minimally invasive surgery (TAMIS) for the management of a complex benign rectal polyp. We assessed the effect of surveillance by allowing a portion of the patients to be lost to follow up. We calculated the cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio or each intervention over a 50-year time horizon.RESULTS: We found that TEM was slightly more effective than TAMIS and ER (TEM, 19.54 QALYs; TAMIS, 19.53 QALYs; and ER19.53, QALYs), but ER had a lower lifetime discounted cost (ER cost $7161, TEM cost $10,459, and TAMIS cost $11,253). TEM was not cost effective compared to ER, with an incremental cost-effectiveness ratio of $485,333/QALY. TAMIS was ruled out by extended dominance. TEM became cost effective when the mortality from ER exceeded 0.63%, or if loss to follow up exceeded 25.5%.CONCLUSIONS: Using a Markov model, we found that ER, TEM, and TAMIS have similar effectiveness, but ER is less expensive, in management of benign rectal polyps. As the rate of loss to follow up increases, transanal surgery becomes more effective relative to ER.
View details for PubMedID 30849517