Michael Fairley is a Ph.D. student in the Department of Management Science & Engineering at Stanford University.
Research Area: Health Policy
Research Abstract: Opioid dependence has become a national public health crisis. Veterans are particularly affected. The Veterans Affairs Health System (VA) must prioritize interventions under increasing budgetary constraints. Michael Fairley is developing a mathematical decision model to help the VA determine a portfolio of interventions to invest in that will maximize health and economic benefits. The proposed work requires knowledge not only from engineering, but also knowledge of medical, behavioral, and economic factors relevant to opioid dependence. Michael will create new methodology for quantitatively modeling economic and behavioral implications of policy decisions and will generate an evidence-based policy recommendation for VA.
Cost-effectiveness of Intensive Blood Pressure Management.
2016; 1 (8): 872-879
Among high-risk patients with hypertension, targeting a systolic blood pressure of 120 mm Hg reduces cardiovascular morbidity and mortality compared with a higher target. However, intensive blood pressure management incurs additional costs from treatment and from adverse events.To evaluate the incremental cost-effectiveness of intensive blood pressure management compared with standard management.This cost-effectiveness analysis conducted from September 2015 to August 2016 used a Markov cohort model to estimate cost-effectiveness of intensive blood pressure management among 68-year-old high-risk adults with hypertension but not diabetes. We used the Systolic Blood Pressure Intervention Trial (SPRINT) to estimate treatment effects and adverse event rates. We used Centers for Disease Control and Prevention Life Tables to project age- and cause-specific mortality, calibrated to rates reported in SPRINT. We also used population-based observational data to model development of heart failure, myocardial infarction, stroke, and subsequent mortality. Costs were based on published sources, Medicare data, and the National Inpatient Sample.Treatment of hypertension to a systolic blood pressure goal of 120 mm Hg (intensive management) or 140 mm Hg (standard management).Lifetime costs and quality-adjusted life-years (QALYs), discounted at 3% annually.Standard management yielded 9.6 QALYs and accrued $155 261 in lifetime costs, while intensive management yielded 10.5 QALYs and accrued $176 584 in costs. Intensive blood pressure management cost $23 777 per QALY gained. In a sensitivity analysis, serious adverse events would need to occur at 3 times the rate observed in SPRINT and be 3 times more common in the intensive management arm to prefer standard management.Intensive blood pressure management is cost-effective at typical thresholds for value in health care and remains so even with substantially higher adverse event rates.
View details for DOI 10.1001/jamacardio.2016.3517
View details for PubMedID 27627731