The Childhood Obesity Intervention Cost Effectiveness Study
The CHOICES (CHildhood Obesity Intervention Cost Effectiveness Study) project is a collaboration between the Harvard School of Public Health, Columbia University and research partners at Deakin and Queensland University in Australia. CHOICES is funded by the JPB Foundation. The goal of CHOICES is to generate cost-effectiveness estimates for 40 of the most relevant childhood obesity interventions in the United States, identify those that are most cost-effective and help those strategies become a focus for discussion and action. The research team will build on previous work funded by the Robert Wood Johnson Foundation to develop a cost-effectiveness model for obesity prevention in the US. This work has included adapting the Australian ACE-Obesity model to the US context, and estimating the cost-effectiveness of four relevant childhood obesity interventions making use of the best available evidence, and calculating health impacts in terms of cost per body mass index (BMI) unit reduced and disability-adjusted life years (DALYs) saved. During the three years of the CHOICES project, we will form a nationally prominent stakeholder group to both provide input into intervention selection, effectiveness assessment and cost, as well as to review important implementation issues including feasibility, scalability, and equity. This group will include public health practitioners, researchers, policymakers, and community leaders. Interventions to be evaluated include policy-based approaches, family-oriented approaches, community-based approaches, and innovative uses of media and health communication methods, as well as more traditional school curriculums and community programs. The result of this process will be policy recommendations for cost-effective childhood obesity intervention strategies (using DALYs and QALYs) in a range of settings, including local, state and national government, school administrators and community-based programs.
The team at HSPH includes Steve Gortmaker, Angie Cradock, Milt Weinstein and Stephen Resch; at Columbia, Y. Claire Wang; at Deakin, Boyd Swinburn, Marj Moodie, Rob Carter and Gary Sacks; and at Queensland, Theo Vos, Jan Barendregt, Linda Cobiac and Lennert Veerman.
Methods Development for Evaluation of Comparative Effectiveness of HIV Management Strategies
Millions of HIV-infected individuals are receiving antiretroviral therapy (ART). The use of ART has led to dramatic reductions in mortality and suffering, and can reduce HIV transmission as well. However, key questions about the use of ART remain unanswered. Prominent among them is when to switch to a different combination of ART after the first-line ART fails to control the replication of the virus. Current clinical guidelines reflect the lack of evidence on this issue: some of them recommend switching immediately following virologic failure (a tight-control strategy) while others recommend waiting until confirmation of high viral load before switching (a loose-control strategy). Tight control strategies avoid ongoing viral replication in the presence of antiretrovirals and the selection of drug resistant mutations, but they also require more frequent monitoring and may accumulate toxicities and run through therapeutic options faster than loose-control strategies. Because randomized trials cannot be expected to answer questions about the comparative effectiveness of different switching strategies on clinically relevant outcomes over long periods across all populations, high-quality prospective observational studies are our best chance. However, the complexity of these studies cannot be adequately handled by conventional statistical and epidemiologic methods. We are developing innovative methods to evaluate the comparative effectiveness of switching strategies and, in collaboration with HIV experts around the world, we are applying these methods to large cohorts of HIV-infected individuals from Europe, America, and Africa. We expect that our findings will help inform clinical guidelines for the management of HIV patients, as well as aid the design of future randomized trials.
The team at HSPH includes Miguel Hernán, Lauren Cain and Roger Logan.
HIV/AIDS Policy Modeling for the U.S.
While global attention is focused on HIV/AIDS in Africa and the developing world, it remains a serious health problem in urban America and the leading cause of death in many segments of the U.S. population, including young African-American women and men, and others who are sexually exposed to intravenous drug users and their partners. A team of investigators, based at the Massachusetts General Hospital, the Center fro Health Decision Science, Brigham and Women’s Hospital, and Yale University, is using a mathematical simulation model to compare the health outcomes and costs associated with alternative treatment strategies for individuals with HIV/AIDS. Among the questions that the group has analyzed are: whether the recent change in clinical guidelines that calls for initiation of anti-retroviral treatment earlier in the progression of the disease (CD4 cell counts < 500/ml) than had been recommended previously (CD4 cell counts < 350/ml) is cost-effective; the extent to which failure to identify and treat women and minorities leads to widening disparities in health outcomes; and whether universal or periodic testing for HIV infection is warranted in the U.S.. The CEPAC (Cost-Effectiveness of Preventing AIDS Complications) team works closely with NIH-sponsored clinical trials investigators to extrapolate findings from clinical trials to lifetime outcomes and to study the value of performing particular clinical trials based on the potential impact of outcomes and/or costs of care.
The team at HSPH includes Kenneth Freedberg, Sue Goldie, Stephen Resch, George Seage and Milton Weinstein.
Cardiovascular Disease Policy Modeling for Comparative Evaluation of Screening Prevention and Treatment
HSPH researchers are developing an integrated Cardiovascular Disease (CVD) Prevention Model which can be used to estimate the health and economic consequences of various screening, prevention, and treatment strategies for coronary heart disease, stroke, and congestive heart failure (CHF) in the U.S. population over the age of 35 and several subpopulations. The model will look at the relationship between lifestyle and environmental risk factors implicated in the development of the three main contributors of CVD morbidity and mortality – CHD, CHF and stroke. The model will incorporate observed epidemiological data, natural history data, and trends from the published literature and publicly available databases in the US, and will have the flexibility to be adapted to other developing regions and sub-populations of the U.S. In addition, the model will also incorporate the effectiveness and costs of population and individually based preventive interventions. Overall, the project is designed to help achieve effective translation of research into practice by identifying cost-effective approaches to the prevention, diagnosis and treatment of CVD.
HSPH researchers include Thomas Gaziano, Joshua Salomon and Milton Weinstein.