MDM Policy and Practice最新文献

{"title":"Decision Making about Localized Esophageal Cancer Treatment: An Observational Study on Variation in Clinicians' Communication Behavior.","authors":"L F van de Water, G C Scholten, I Henselmans, J Heisterkamp, P M Jeene, F F B M Heesakkers, K J Neelis, B R Klarenbeek, M I van Berge Henegouwen, J W van den Berg, J Buijsen, E D Geijsen, H W M van Laarhoven, E M A Smets","doi":"10.1177/23814683251349473","DOIUrl":"10.1177/23814683251349473","url":null,"abstract":"<p><p><b>Background.</b> For localized esophageal cancer, more than 1 curative treatment option is available. As these different options are associated with substantially different treatment outcomes, decision making can be complex. Moreover, treatment decision making for a patient involves multiple health care providers (HCPs) from different disciplines over time, who might have their own role and perspective on the decision-making process. This study aims to describe how HCPs communicate during treatment decision consultations with patients with localized esophageal cancer. <b>Methods.</b> Audio recordings of 20 preintervention scripted standardized patient assessments (SPAs) from the SOURCE trial were used. Using 2 highly similar cases, acted by a simulated patient, considerably reduced variation at patient level. Audio recordings were content coded using open coding and rated on the degree of patient involvement in decision making using the OPTION-12. <b>Results.</b> Radiation and surgical HCPs discussed 1 to 4 different treatment options, from a total of 5 different options observed over all consultations. They discussed 0 to 11 different side effects and complications, from a total of 28. While some HCPs explicitly presented a choice, many used various implicit forms of suggesting a choice and either implicitly or explicitly marked their own preferences for treatment. Consultations showed a mean OPTION-12 score of 40.11 (range 0-100). <b>Conclusions.</b> This study shows extensive practice variation in how and to what extent standardized patients with localized esophageal cancer were involved in decision making and in the number and type of treatment options and pros and cons that were presented to them. <b>Implications.</b> The findings suggest a need for mutual alignment within oncologic HCPs treating patients with esophageal cancer.</p><p><strong>Highlights: </strong>Practice variation was found in how and to what extent health care providers involved standardized patients with localized esophageal cancer in decision making.Health care providers varied in the number and type of treatment options and pros and cons they presented.These findings suggest a need for multidisciplinary alignment.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"10 1","pages":"23814683251349473"},"PeriodicalIF":1.9,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12214366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Health Economic Evaluation of Routine Hepatocellular Carcinoma Surveillance for People with Compensated Cirrhosis to Support Australian Clinical Guidelines.","authors":"Joachim Worthington, Emily He, Michael Caruana, Stephen Wade, Barbara de Graaff, Anh Le Tuan Nguyen, Jacob George, Karen Canfell, Eleonora Feletto","doi":"10.1177/23814683251344962","DOIUrl":"10.1177/23814683251344962","url":null,"abstract":"<p><p><b>Background.</b> Liver cancer is the only cancer in Australia with rising incidence and mortality rates, despite the potential for early detection through surveillance of high-risk individuals. Hepatocellular carcinoma (HCC), the most common form of primary liver cancer, has curative treatment options available if detected early. Six-monthly HCC surveillance is recommended for people with liver cirrhosis and was proposed for inclusion in the 2023 Cancer Council Australia <i>Clinical Practice Guidelines for Hepatocellular Carcinoma Surveillance for People at High Risk in Australia</i>. To evaluate the proposed 2023 guideline recommendation, we developed Policy1-Liver, a novel mathematical model of liver disease, HCC, and surveillance. We then assessed the health and economic implications of 6-monthly HCC surveillance in Australia via ultrasound, with or without alpha-fetoprotein. <b>Methods.</b> Policy1-Liver was calibrated to existing data sources on liver disease, HCC, and health care costs in Australia. We assessed the impact of 6-monthly routine HCC surveillance with ultrasound with or without alpha-fetoprotein testing as well as a range of other sensitivity analyses and alternative scenarios such as varying surveillance adherence and intervals to assess potential future modifications to surveillance. <b>Results.</b> We estimated that 6-monthly HCC surveillance, with or without alpha-fetoprotein, can increase early-stage diagnoses to up to 81% and reduce HCC mortality by 22% in people with cirrhosis. We estimate an incremental cost-effectiveness ratio of $28,423 per quality-adjusted life-year for 6-monthly surveillance with ultrasound alone compared with no surveillance. <b>Conclusions.</b> These findings support guideline-recommended 6-monthly HCC surveillance with ultrasound, affirming its health benefits and cost-effectiveness, and demonstrate the potential to improve cost-effectiveness by refining surveillance intervals and improving early-stage HCC survival. Supporting implementation of the surveillance guidelines will play a key role in improving HCC mortality rates in Australia.</p><p><strong>Highlights: </strong>Routine surveillance can improve the likelihood of early-stage detection of liver cancer, improving survival.Our modeling found that routine HCC surveillance with ultrasound would be cost-effective for people with liver cirrhosis in Australia.These findings can inform guidelines and investment in liver cancer control for high-risk patients.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"10 1","pages":"23814683251344962"},"PeriodicalIF":1.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a Decision Support Intervention for Adolescents and Young Adults Newly Diagnosed with Cancer: A Pilot Randomized Trial.","authors":"Lamia P Barakat, Shannon N Hammer, Yansong Wen, Ashley Anil, Lisa A Schwartz, Anne Reilly, Rochelle Bagatell, Marilyn M Schapira, Yimei Li, Janet A Deatrick","doi":"10.1177/23814683251344624","DOIUrl":"10.1177/23814683251344624","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background.&lt;/b&gt; Limited involvement in treatment-related decision making can affect adolescent and young adult (AYA) cancer outcomes and well-being. Information on developmentally consistent approaches to enhance involvement in and experiences with decision making is lacking. In a pilot randomized trial, we evaluated the feasibility, acceptability, and usability of a Web-based decision support intervention (DECIDES) for treatment-related decisions, with/without coach support. &lt;b&gt;Methods.&lt;/b&gt; Newly diagnosed/relapsed AYA (15-24 y old) and caregivers were randomized to usual care (&lt;i&gt;n&lt;/i&gt; = 11), DECIDES (&lt;i&gt;n&lt;/i&gt; = 21), or DECIDES+ (&lt;i&gt;n&lt;/i&gt; = 21 with a coach). Feedback on DECIDES was obtained in interviews with AYA and caregivers (DECIDES, DECIDES+) and oncology clinicians (&lt;i&gt;n&lt;/i&gt; = 13). Feasibility, acceptability, and usability are described. Quantitative data were integrated with qualitative data. Mean differences (MDs) between DECIDES groups and usual care at 8 wk after randomization are presented for knowledge, decision-making involvement, and decision processes. &lt;b&gt;Results.&lt;/b&gt; High retention was achieved. High acceptability and good-excellent usability of DECIDES were reported; qualitative data were congruent with these ratings. AYA and caregivers with a coach demonstrated higher engagement with DECIDES. Based on the MDs, as compared with usual care, AYA (DECIDES and DECIDES+) reported higher shared decision making (MD = 12.58, 11.93), higher decision-making involvement (MD = 19.31, 9.78), and lower decision regret (MD = -13.19, -16.55), respectively, and caregivers (DECIDES, DECIDES+) reported higher shared decision making and AYA decision-making involvement. Minimal changes to knowledge were observed. &lt;b&gt;Conclusions.&lt;/b&gt; DECIDES is feasible, acceptable, and usable for AYA treatment-related decision making with possible increases in AYA involvement. Findings suggest that decision support interventions warrant further evaluation for AYA across the treatment trajectory and for a range of treatment-related decisions. Delivery closer to the initial diagnosis and inclusion of a coach for engagement may be advantageous. This study is registered at ClinicalTrials.gov (NCT ID No. NCT06191679).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Highlights: &lt;/strong&gt;Adolescents and young adults with newly diagnosed cancer, and their caregivers, endorsed that decision support is important for their understanding of cancer and treatment and for enhanced communication with their health care teams.Implementation of a decision support intervention shortly after cancer diagnosis is acceptable, feasible, and usable for adolescents and young adults and their caregivers.Oncology clinicians confirm the usability of decision support interventions for their adolescent and young adult patients at diagnosis.Access to a decision support intervention at diagnosis may improve the involvement of adolescents and young adults in their treatment-related decision making and decision processes.Fut","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"10 1","pages":"23814683251344624"},"PeriodicalIF":1.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cost-Effectiveness Analysis of Diffuse Large B-Cell Lymphoma Treatment Pathways in the United States.","authors":"Anik R Patel, Bradley Kievit, Ken Hasegawa, Markqayne Ray, Rishika Sharma, Sarahmaria Hofmann, Rob Blissett, Frederick L Locke","doi":"10.1177/23814683251345780","DOIUrl":"10.1177/23814683251345780","url":null,"abstract":"<p><p><b>Background.</b> Chimeric antigen receptor (CAR) T-cell therapies are approved as second-line (2L) or later therapy for diffuse large B-cell lymphoma (DLBCL). Recently, bispecific T-cell antibodies (BsAbs) have been approved as third-line (3L) treatments. The cost-effectiveness of different treatment sequences is unknown. This study aims to evaluate the cost-effectiveness of axicabtagene ciloleucel (axi-cel) compared with other treatment options for 2L DLBCL, from a US health care perspective at a cost-effectiveness threshold of $150,000 per quality-adjusted life-year (QALY). <b>Design.</b> This economic evaluation used a discrete event simulation decision. Model inputs were derived from 8 clinical trials and the published literature. Simulated patients received 2L axi-cel followed by 3L treatments, which were compared with treatment sequences of 2L intended autologous stem cell transplant (ASCT), polatuzumab vedotin with bendamustine and rituximab (Pola-BR), tafasitamab with lenalidomide (tafa-len), or rituximab with gemcitabine and oxaliplatin (R-GemOx), all of which were followed by 3L treatments (salvage chemotherapy, BsAbs, or axi-cel). In addition, axi-cel was compared directly with glofitamab and epcoritamab in 3L. Costs and QALYs, discounted at 3.0%, were used to derive incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMBs). <b>Results.</b> In the 2L base case, axi-cel was cost-effective compared with intended ASCT (ICER $145,004/QALY), which was cost-effective compared with R-GemOx (ICER $9,495/QALY). Axi-cel maximized NMB at $150,000 and $200,000/QALY thresholds, whereas intended ASCT maximized NMB at $100,000/QALY. In 3L-focused comparisons with epcoritamab and glofitamab, axi-cel was dominant and cost-effective (ICER $122,224/QALY), respectively. Axi-cel maximized NMB at $150,000 and $200,000/QALY thresholds, whereas glofitamab maximized NMB at $100,000/QALY. <b>Conclusions.</b> The findings of the study suggest that although other treatments were cost-effective at lower thresholds, axi-cel is a cost-effective treatment option in 2L/3L settings in the United States.</p><p><strong>Highlights: </strong>This study investigated whether axicabtagene ciloleucel (axi-cel) is cost-effective in second-line (2L) and third-line (3L) treatment sequences in the current relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) treatment paradigm.Using a novel treatment sequencing model, axi-cel was found to be cost-effective in both 2L treatment sequences and in direct comparisons with 3L bispecific T-cell antibodies.These findings suggest that axi-cel is a cost-effective treatment for R/R DLBCL regardless of treatment line positioning.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"10 1","pages":"23814683251345780"},"PeriodicalIF":1.9,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Role of Patient Preferences in Hepatocellular Carcinoma Treatment Decisions: A Qualitative Study.","authors":"Andrew M Moon, Daniel Richardson, Gabriel V Lupu, Donna M Evon, Hanna K Sanoff, Jessica Carda-Auten, Randall Teal, Myra Waheed, Ethan Basch, David M Mauro, Ted K Yanagihara, David A Gerber, Neil D Shah, Oren K Fix, Hersh Shroff, Tammy Triglianos, Jonathan D Sorah, Jingquan Jia, Ashwin Somasundaram, Lynne I Wagner, Michael D Kappelman, Matthew Schooler, Julia R Phillips, Hiwot A Ekuban, Ariel E Sanderford, A Sidney Barritt","doi":"10.1177/23814683251340055","DOIUrl":"10.1177/23814683251340055","url":null,"abstract":"<p><p><b>Background.</b> Hepatocellular carcinoma (HCC) treatment decisions are becoming increasingly complex as new treatment options emerge. Improved understanding of tradeoffs and patient preferences in treatment decisions will enhance patient-provider discussions, improve treatment development, and inform HCC treatment guidelines. We performed a qualitative study involving patients with HCC and medical providers to assess the role of patient preferences in HCC treatment choices. <b>Methods.</b> Patient participants included those with HCC seen within a single tertiary care center. Provider participants involved physicians and advanced practice providers who cared for patients with HCC from a single center. Baseline and posttreatment patient interviews were conducted by trained qualitative research experts, informed by semi-structured interview guides, and analyzed using thematic analysis with pilot-tested codebooks. Summaries included a narrative description of the themes and subthemes that emerged related to each code, and illustrative quotes were used to highlight each theme. <b>Results.</b> The baseline interview involved 30 patients with HCC (22 of whom participated in follow-up interviews) and 10 providers who cared for patients with HCC. Patients identified factors considered when making treatment decisions included provider confidence and experience, patient prior cancer experiences, other health issues, and faith. Providers primarily discussed the role of Barcelona Clinic Liver Cancer stage, liver function, performance status, and eligibility of liver transplantation in making treatment recommendations. There was general agreement among providers that there is a need to better understand the role of patient values to improve care for HCC. <b>Limitations.</b> Qualitative interviews were limited to patients and providers from a single center. <b>Conclusions.</b> This qualitative study provided information on the variety of values considered by both patients and providers in HCC treatment decisions and the importance of considering tradeoffs of efficacy, toxicity, and inconvenience/costs.</p><p><strong>Highlights: </strong>Hepatocellular carcinoma (HCC) treatment decisions are often complex and may become increasingly so as new treatment options emerge.Improved understanding of tradeoffs and patient preferences in treatment decisions will enhance patient-provider discussions, facilitate patient-centered trials to develop new treatments, and inform HCC treatment guidelines.This qualitative study of patients and providers provided information on the values considered in HCC treatment decisions and the importance of considering the tradeoffs of efficacy, toxicity, and inconvenience/costs.These insights can be used to develop preference elicitation tools, perform large-scale preference elicitation surveys, and systematically assess and incorporate patient preferences into treatment decisions.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"10 1","pages":"23814683251340055"},"PeriodicalIF":1.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Alternative Specifications of Uncertainty Relating to Extrapolation in Decision Models.","authors":"Doug Coyle, Kathryn Coyle","doi":"10.1177/23814683251340058","DOIUrl":"10.1177/23814683251340058","url":null,"abstract":"<p><p>Economic evaluations that incorporate value-of-information analysis frequently conclude that the greatest information value relates to replicating short-term clinical trials. This study builds on recent guidance relating to extrapolation in economic evaluation by assessing the impact of alternative approaches to representing the uncertainty around unobserved/extrapolated data with respect to incremental outcomes and value of information. When the uncertainty over unobserved and observed data is considered distinct but correlated (i.e., has a joint distribution), it is demonstrated that the value to replicating short-term clinical studies is lessened and that further studies relating to the unobserved periods likely provide more value.</p><p><strong>Highlights: </strong>Current practice in economic evaluation often involves the inappropriate specification of uncertainty with respect to unobserved data.Appropriate specification of uncertainty will lead to more pertinent recommendations over future clinical studies.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"10 1","pages":"23814683251340058"},"PeriodicalIF":1.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing the Design of and Emerging Evidence for Health Care Organization-Based Lung Cancer Screening Interventions: A Systematic Review.","authors":"Jennifer Elston Lafata, Katharine A Rendle, Jocelyn V Wainwright, Mary E Cooley, Anil Vachani, Christine Neslund-Dudas, Michelle R Odelberg, Liana Alcaro, Claire Staresinic, Gwen L Alexander, Rebecca B Carlson, Marilyn M Schapira","doi":"10.1177/23814683251328375","DOIUrl":"https://doi.org/10.1177/23814683251328375","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background.&lt;/b&gt; Implementing a lung cancer screening (LCS) program with low-dose computed tomography (LDCT) is complex, requiring health care organizations to consider several steps along the screening continuum from eligibility assessment to recommended follow-up testing adherence. The evidence to support LDCT screening implementation remains unclear. &lt;b&gt;Purpose.&lt;/b&gt; To summarize interventions facilitating LCS initiation, adoption, or improvement within health care organizations. &lt;b&gt;Data Sources.&lt;/b&gt; Librarian-assisted literature reviews identified published studies between January 1, 2011, and December 31, 2023, using CINAHL, Cochrane Library, Embase, Ovid Medline, PsycINFO, and Scopus. &lt;b&gt;Study Selection.&lt;/b&gt; Published interventions focusing on any step in the LCS process before lung cancer diagnosis, including risk/eligibility assessment, shared decision making (SDM), and annual screening or diagnostic testing. &lt;b&gt;Data Abstraction.&lt;/b&gt; We used a title/abstract review process, full-text review, and risk-of-bias assessments. We characterized studies by design, unit of observation, participant sociodemographic characteristics, primary outcome, and step in the LCS process. DistillerSR and Covidence were used for data management. &lt;b&gt;Data Synthesis.&lt;/b&gt; We identified 64 study-eligible published articles, including 19 randomized and 45 nonrandomized studies. SDM interventions were most frequently studied (&lt;i&gt;n&lt;/i&gt; = 20) followed by initial LCS uptake (&lt;i&gt;n&lt;/i&gt; = 12). Most studies (&lt;i&gt;n&lt;/i&gt; = 33) evaluated educational interventions, typically in one-on-one settings. Studies assessed at either low or moderate/some risk of bias reported statistically significant findings in the domains of improved knowledge (&lt;i&gt;n&lt;/i&gt; = 7) and other aspects of decision making (&lt;i&gt;n&lt;/i&gt; = 8), such as perceived risk or decisional conflict. Findings regarding LCS uptake were more variable. &lt;b&gt;Limitations.&lt;/b&gt; The review includes only English-language studies published prior to 2024. The risk of bias was high among 5 of the randomized clinical trials and serious among 27 of the quasi-experimental design studies. &lt;b&gt;Conclusions.&lt;/b&gt; LCS intervention strategies have focused on SDM and initial LCS uptake, leaving gaps in knowledge about how to support risk and eligibility assessment, adherence to annual screening, or diagnostic testing. Expanding interventions beyond those that are education focused and with single-level targets would expand the LDCT screening implementation evidence base.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Highlights: &lt;/strong&gt;Most lung cancer screening (LCS) interventions evaluated to date have been educational in nature and focused primarily on shared decision making or the initial uptake of screening, with some interventions demonstrating statistically significant improvements in patient knowledge and initial LCS order/uptake.A critical gap in knowledge remains regarding how to effectively support LCS eligibility assessment as well as adherence to annual screening and","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"10 1","pages":"23814683251328375"},"PeriodicalIF":1.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Care Provider Preferences Regarding Artificial Intelligence in Point-of-Care Cancer Screening.","authors":"Vinayak S Ahluwalia, Marilyn M Schapira, Gary E Weissman, Ravi B Parikh","doi":"10.1177/23814683251329007","DOIUrl":"10.1177/23814683251329007","url":null,"abstract":"<p><p><b>Background.</b> It is unclear how to optimize the user interface and user experience of cancer screening artificial intelligence (AI) tools for clinical decision-making in primary care. <b>Methods.</b> We developed an electronic survey for US primary care clinicians to assess 1) general attitudes toward AI in cancer screening and 2) preferences for various aspects of AI model deployment in the context of colorectal, breast, and lung cancer screening. We descriptively analyzed the responses. <b>Results.</b> Ninety-nine surveys met criteria for analysis out of 733 potential respondents (response rate 14%). Ninety (>90%) somewhat or strongly agreed that their medical education did not provide adequate AI training. A plurality (52%, 39%, and 37% for colon, breast, and lung cancers, respectively) preferred that AI tools recommend the interval to the next screening as compared with the 5-y probability of future cancer diagnosis, a binary recommendation of \"screen now,\" or identification of suspicious imaging findings. In terms of workflow, respondents preferred generating a flag in the electronic health record to communicate an AI prediction versus an interactive smartphone application or the delegation of findings to another healthcare professional. No majority preference emerged for an explainability method for breast cancer screening. <b>Limitations.</b> The sample was primarily obtained from a single health care system in the Northeast. <b>Conclusions.</b> Providers indicated that AI models can be most helpful in cancer screening by providing prescriptive outputs, such as recommended intervals until next screening, and by integrating with the electronic health record. <b>Implications.</b> A preliminary framework for AI model development in cancer screening may help ensure effective integration into clinical workflow. These findings can better inform how healthcare systems govern and receive reimbursement for services that use AI.</p><p><strong>Highlights: </strong>Clinicians do not feel their undergraduate or graduate medical education has properly prepared them to engage with AI in patient care.We provide a preliminary framework for deploying AI models in primary care-based cancer screening.This framework may have implications for health system governance and provider reimbursement in the age of AI.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"10 1","pages":"23814683251329007"},"PeriodicalIF":1.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Cost-Effectiveness of Tenofovir Alafenamide for Chronic Hepatitis B Virus in Taiwan.","authors":"Elise Chia-Hui Tan, Alon Yehoshua, Sushanth Jeyakumar, Pongo Peng, Amy Lin, Nathaniel J Smith, Nandita Kachru","doi":"10.1177/23814683251328659","DOIUrl":"10.1177/23814683251328659","url":null,"abstract":"<p><p><b>Background.</b> Chronic hepatitis B (CHB) is a lifelong disease requiring long-term or indefinite therapy, resulting in substantial economic burden. Thus, careful consideration must be used in the selection of therapies. <b>Aim.</b> This analysis assessed the cost-effectiveness of tenofovir alafenamide (TAF) compared with tenofovir disoproxil fumarate (TDF) and entecavir (ETV) from the perspective of the Taiwan National Health Insurance Administration Healthcare payer for the management of CHB over a lifetime horizon. <b>Methods.</b> An individual patient simulation model assessed the impact of treatment on CHB infection for liver- and safety-related outcomes. Patients could achieve spontaneous or treatment-induced responses, experience a reactivation of the disease, develop long-term liver complications, or experience treatment-related renal or bone complications. Patient population profiles were based on clinical trial and real-world data. Data on clinical parameters (safety, mortality, resistance risk, and flare), health utilities, and costs were sourced from the published literature. <b>Results.</b> TAF was associated with fewer liver disease events and fewer cases of bone and renal complications per 100 person-years. TAF also had higher eAg and sAg seroconversion compared with TDF and ETV. As compared with both treatments, TAF was both more effective and more costly, resulting in incremental cost-effectiveness ratios of USD 3,348 and USD 3,940 per quality-adjusted life-year gained versus TDF and ETV, respectively. <b>Conclusion.</b> TAF leads to better health outcomes at acceptable incremental costs compared with the most commonly used therapies in the management of CHB, thus making it a cost-effective option for the treatment of CHB in Taiwan.</p><p><strong>Highlights: </strong>The cost-effectiveness of tenofovir alafenamide (TAF) versus tenofovir disoproxil fumarate (TDF) and entecavir (ETV) was assessed in patients with chronic hepatitis B in Taiwan.TAF was associated with fewer liver disease events, fewer cases of bone and renal complications, and higher eAG and sAG seroconversion compared with TDF and ETV; TAF was found to be cost-effective compared with both treatments.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"10 1","pages":"23814683251328659"},"PeriodicalIF":1.9,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the Gap: A Mixed-Methods Study on Factors Influencing Breast Cancer Clinicians' Decisions to Use Clinical Prediction Models.","authors":"Mary Ann E Binuya, Sabine C Linn, Annelies H Boekhout, Marjanka K Schmidt, Ellen G Engelhardt","doi":"10.1177/23814683251328377","DOIUrl":"10.1177/23814683251328377","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background.&lt;/b&gt; Clinical prediction models provide tailored risk estimates that can help guide decisions in breast cancer care. Despite their potential, few models are widely used in clinical practice. We aimed to identify the factors influencing breast cancer clinicians' decisions to adopt prediction models and assess their relative importance. &lt;b&gt;Methods.&lt;/b&gt; We conducted a mixed-methods study, beginning with semi-structured interviews, followed by a nationwide online survey. Thematic analysis was used to qualitatively summarize the interviews and identify key factors. For the survey, we used descriptive analysis to characterize the sample and Mann-Whitney &lt;i&gt;U&lt;/i&gt; and Kruskal-Wallis tests to explore differences in score (0 = &lt;i&gt;not important&lt;/i&gt; to 10 = &lt;i&gt;very important&lt;/i&gt;) distributions. &lt;b&gt;Results.&lt;/b&gt; Interviews (&lt;i&gt;N&lt;/i&gt; = 16) identified eight key factors influencing model use. Practical/methodological factors included accessibility, cost, understandability, &lt;i&gt;objective&lt;/i&gt; accuracy, actionability, and clinical relevance. Perceptual factors included acceptability, &lt;i&gt;subjective&lt;/i&gt; accuracy, and risk communication. In the survey (&lt;i&gt;N&lt;/i&gt; = 146; 137 model users), clinicians ranked online accessibility (median score = 9 [interquartile range = 8-10]) as most important. Cost was also highly rated, with preferences for freely available models (9 [8-10]) and those with reimbursable tests (8 [8-10]). Formal regulatory approval (7 [5-8]) and direct integration with electronic health records (6 [3-8]) were considered less critical. Subgroup analysis revealed differences in score distributions; for example, clinicians from general hospitals prioritized inclusion of new biomarkers more than those in academic settings. &lt;b&gt;Conclusions.&lt;/b&gt; Breast cancer clinicians' decisions to initiate use of prediction models are influenced by practical and perceptual factors, extending beyond technical metrics such as discrimination and calibration. Addressing these factors more holistically through collaborative efforts between model developers, clinicians, and communication and implementation experts, for instance, by developing clinician-friendly online tools that prioritize usability and local adaptability, could increase model uptake.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Highlights: &lt;/strong&gt;Accessibility, cost, and practical considerations, such as ease of use and clinical utility, were prioritized slightly more than technical validation metrics, such as discrimination and calibration, when deciding to start using a clinical prediction model.Most breast cancer clinicians valued models with clear inputs (e.g., variable definitions, cutoffs) and outputs; few were interested in the exact model specifications.Perceptual or subjective factors, including perceived accuracy and peer acceptability, also influenced model adoption but were secondary to practical considerations.Sociodemographic variables, such as clinical specialization and hospital setting, influenced the importa","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"10 1","pages":"23814683251328377"},"PeriodicalIF":1.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}