Meta-Modeling as a Variance-Reduction Technique for Stochastic Model-Based Cost-Effectiveness Analyses.

PurposeWhen using stochastic models for cost-effectiveness analysis (CEA), run-to-run outcome variability arising from model stochasticity can sometimes exceed the change in outcomes resulting from an intervention, especially when individual-level efficacy is small, leading to counterintuitive results. This issue is compounded for probabilistic sensitivity analyses (PSAs), in which stochastic noise can obscure the influence of parameter uncertainty. This study evaluates meta-modeling as a variance-reduction technique to mitigate stochastic noise while preserving parameter uncertainty in PSAs.

Evaluating trade-offs between COVID-19 prevention and learning loss: an agent-based simulation analysis.

The COVID-19 pandemic presented significant challenges in educational settings. Schools implemented a variety of COVID-19 mitigation strategies, some of which were controversial due to potential disruptions to in-person learning. We developed an agent-based model of COVID-19 in a US high school setting to evaluate potential trade-offs between preventing COVID-19 infections versus avoiding in-person learning loss under different mitigation policies in a post-Omicron context.

Modeling the potential impact of viral load monitoring on vertical transmission of HIV in Kenya.

Introduction: Viral load monitoring among pregnant and breastfeeding women (PBFW) can reduce vertical transmission by identifying PBFW with unsuppressed viral load and promoting re-suppression. However, the impact of varying degrees of adherence to viral load monitoring guidelines on the prevention of vertical transmission (PVT) is unknown.

Methods: We developed a microsimulation model of HIV progression and PVT care for PBFW living with recently acquired HIV in Kenya.

A Sequential Calibration Approach to Address Challenges of Repeated Calibration of a COVID-19 Model.

Background: Mathematical models served a critical role in COVID-19 decision making throughout the pandemic. Model calibration is an essential, but often computationally burdensome, step in model development that provides estimates for difficult-to-measure parameters and establishes an up-to-date modeling platform for scenario analysis. In the evolving COVID-19 pandemic, frequent recalibration was necessary to provide ongoing support to decision makers.

Modeling the risk of aquatic species invasion spread through boater movements and river connections.

Aquatic invasive species (AIS) are one of the greatest threats to the functioning of aquatic ecosystems worldwide. Once an invasive species has been introduced to a new region, many governments develop management strategies to reduce further spread. Nevertheless, managing AIS in a new region is challenging because of the vast areas that need protection and limited resources.

Adaptive COVID-19 Mitigation Strategies: Tradeoffs between Trigger Thresholds, Response Timing, and Effectiveness.

Unlabelled: To support proactive decision making during the COVID-19 pandemic, mathematical models have been leveraged to identify surveillance indicator thresholds at which strengthening nonpharmaceutical interventions (NPIs) is necessary to protect health care capacity. Understanding tradeoffs between different adaptive COVID-19 response components is important when designing strategies that balance public preference and public health goals. We considered 3 components of an adaptive COVID-19 response: 1) the threshold at which to implement the NPI, 2) the time needed to implement the NPI, and 3) the effectiveness of the NPI.

Diagnosed Gonorrhea Among Privately Insured Women: Analysis of United States Claims Data.

Gonorrhea incidence in the United States has risen by nearly 50% in the last decade, while screening rates have increased. Gonorrhea sequelae rates could indicate whether increased gonorrhea incidence is due to better screening. We estimated the association of gonorrhea diagnosis with pelvic inflammatory disease (PID), ectopic pregnancy (EP), and tubal factor infertility (TFI) in women and detected changes in associations over time.

The illusion of personal health decisions for infectious disease management: disease spread in social contact networks.

Close contacts between individuals provide opportunities for the transmission of diseases, including COVID-19. While individuals take part in many different types of interactions, including those with classmates, co-workers and household members, it is the conglomeration of all of these interactions that produces the complex social contact network interconnecting individuals across the population. Thus, while an individual might decide their own risk tolerance in response to a threat of infection, the consequences of such decisions are rarely so confined, propagating far beyond any one person.

Barriers, opportunities, and potential costs of expanding HIV support services.

Experiencing housing instability, food insecurity, and financial stress can negatively impact retention in care and treatment adherence for people living with HIV. Expanding services that support socioeconomic needs could help improve HIV outcomes. Our objective was to investigate barriers, opportunities, and costs of expanding socioeconomic support programs.

Evaluation of Strategies to Improve Uptake of Expedited Partner Therapy for Treatment in Minnesota: A Decision Analytic Model.

Unlabelled: Despite the established effectiveness of expedited partner therapy (EPT) in partner treatment of bacterial sexually transmitted infections (STI), the practice is underutilized. To estimate the relative effectiveness of strategies to increase EPT uptake (numbers of partners treated for chlamydia). We developed a care cascade model of cumulative probabilities to estimate the number of partners treated under strategies to increase EPT uptake in Minnesota.

Longitudinal Trajectories of Alcohol Use in Vietnamese Adults with Hazardous Alcohol Use and HIV.

A three-armed drinking cessation trial in Vietnam found that both a brief and intensive version of an intervention effectively reduced hazardous drinking in people living with HIV. We used group-based trajectory modeling (GBTM) to assess the extent to which findings may vary by latent subgroups distinguished by their unique responses to the intervention. Using data on drinking patterns collected over the 12 months, GBTM identified five trajectory groups, three of which were suboptimal ["non-response" (17.

The Role of HIV Partner Services in the Modern Biomedical HIV Prevention Era: A Network Modeling Study.

Background: HIV partner services can accelerate the use of antiretroviral-based HIV prevention tools (antiretroviral therapy [ART] and preexposure prophylaxis [PrEP]), but its population impact on long-term HIV incidence reduction is challenging to quantify with traditional partner services metrics of partner identified or HIV screened. Understanding the role of partner services within the portfolio of HIV prevention interventions, including using it to efficiently deliver antiretrovirals, is needed to achieve HIV prevention targets.

Methods: We used a stochastic network model of HIV/sexually transmitted infection transmission for men who have sex with men, calibrated to surveillance-based estimates in the Atlanta area, a jurisdiction with high HIV burden and suboptimal partner services uptake.

Variation in local Ryan White HIV/AIDS program service use and impacts on viral suppression: informing quality improvement efforts.

The U.S. Ryan White HIV/AIDS Program (RWHAP) funds comprehensive services for people living with HIV to support viral suppression (VS).

A Tutorial on Time-Dependent Cohort State-Transition Models in R Using a Cost-Effectiveness Analysis Example.

In an introductory tutorial, we illustrated building cohort state-transition models (cSTMs) in R, where the state transition probabilities were constant over time. However, in practice, many cSTMs require transitions, rewards, or both to vary over time (time dependent). This tutorial illustrates adding 2 types of time dependence using a previously published cost-effectiveness analysis of multiple strategies as an example.

A Statewide Mixed-Methods Study of Provider Knowledge and Behavior Administering Expedited Partner Therapy for Chlamydia and Gonorrhea.

Background: Expedited partner therapy (EPT) refers to the practice of having patients diagnosed with chlamydia or gonorrhea deliver medication directly to their partner(s) to treat them presumptively for infection. Although EPT facilitates timely treatment and prevents reinfection, it remains underused. We used findings from key informant interviews to design and implement a statewide survey to estimate knowledge and utilization of EPT and to identify barriers and facilitators to EPT among Minnesota providers.

An Introductory Tutorial on Cohort State-Transition Models in R Using a Cost-Effectiveness Analysis Example.

Decision models can combine information from different sources to simulate the long-term consequences of alternative strategies in the presence of uncertainty. A cohort state-transition model (cSTM) is a decision model commonly used in medical decision making to simulate the transitions of a hypothetical cohort among various health states over time. This tutorial focuses on time-independent cSTM, in which transition probabilities among health states remain constant over time.

Optimal timing and effectiveness of COVID-19 outbreak responses in China: a modelling study.

Background: In January 2020, an outbreak of atypical pneumonia caused by a novel coronavirus, SARS-CoV-2, was reported in Wuhan, China. On Jan 23, 2020, the Chinese government instituted mitigation strategies to control spread. Most modeling studies have focused on projecting epidemiological outcomes throughout the pandemic.

Occupational Segregation And Hypertension Inequity: The Implication Of The Inverse Hazard Law Among Healthcare Workers.

Unlabelled: In the United States (US), Black-particularly Black female-healthcare workers are more likely to hold occupations with high job demand, low job control with limited support from supervisors or coworkers and are more vulnerable to job loss than their white counterparts. These work-related factors increase the risk of hypertension. This study examines the extent to which occupational segregation explains the persistent racial inequity in hypertension in the healthcare workforce and the potential health impact of workforce desegregation policies.

Predicting the onset of hypertension for workers: does including work characteristics improve risk predictive accuracy?

Despite extensive evidence of work as a key social determinant of hypertension, risk prediction equations incorporating this information are lacking. Such limitations hinder clinicians' ability to tailor patient care and comprehensively address hypertension risk factors. This study examined whether including work characteristics in hypertension risk equations improves their predictive accuracy.

Cost-effectiveness of Fecal Microbiota Transplantation for First Recurrent Clostridioides difficile Infection.

Background: Both the American College of Gastroenterology and the Infectious Diseases Society of America (IDSA)/Society for Healthcare Epidemiology of America 2021 Clostridioides difficile infection (CDI) guidelines recommend fecal microbiota transplantation (FMT) for persons with multiple recurrent CDI. Emerging data suggest that FMT may have high cure rates when used for first recurrent CDI. The aim of this study was to assess the cost-effectiveness of FMT for first recurrent CDI.

Cost-Effectiveness of Interventions to Improve HIV Pre-exposure Prophylaxis Initiation, Adherence, and Persistence Among Men Who Have Sex With Men.

Background: To help achieve Ending the HIV Epidemic (EHE) goals of reducing new HIV incidence, pre-exposure prophylaxis (PrEP) use and engagement must increase despite multidimensional barriers to scale-up and limitations in funding. We investigated the cost-effectiveness of interventions spanning the PrEP continuum of care.

Setting: Men who have sex with men in Atlanta, GA, a focal jurisdiction for the EHE plan.

Cost-Effectiveness of HIV Retention and Re-engagement Interventions in High-Income Countries: A Systematic Literature Review.

Engagement in lifelong HIV care is critical for both patient and public health, yet there are limited resources to invest in improving HIV outcomes. We systematically reviewed evidence on the cost-effectiveness of retention and re-engagement interventions. We searched five databases for peer-reviewed studies published between 2010 and 2020.

Retention in Care, Mortality, Loss-to-Follow-Up, and Viral Suppression among Antiretroviral Treatment-Naïve and Experienced Persons Participating in a Nationally Representative HIV Pre-Treatment Drug Resistance Survey in Mexico.

We describe associations of pretreatment drug resistance (PDR) with clinical outcomes such as remaining in care, loss to follow-up (LTFU), viral suppression, and death in Mexico, in real-life clinical settings. We analyzed clinical outcomes after a two-year follow up period in participants of a large 2017-2018 nationally representative PDR survey cross-referenced with information of the national ministry of health HIV database. Participants were stratified according to prior ART exposure and presence of efavirenz/nevirapine PDR.

Impact of university re-opening on total community COVID-19 burden.

Background: University students have higher average number of contacts than the general population. Students returning to university campuses may exacerbate COVID-19 dynamics in the surrounding community.

Methods: We developed a dynamic transmission model of COVID-19 in a mid-sized city currently experiencing a low infection rate.