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Researchers must often make assumptions about the efficacy of an intervention in a target population without the benefit of trial data specific to that population. Such assumptions may be particularly tenuous with models of vaccination strategies, since the distribution of pathogen strains in target populations may differ substantially from the strain(More)
Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer death in both men and women and second leading cause of cancer death when men and women are combined in the United States (US). Almost two-thirds of CRC survivors are living 5 years after diagnosis. Considering the recent decline in both incidence and mortality, the(More)
OBJECTIVES To examine the public health impact of mass vaccination with live attenuated human rotavirus vaccine (RIX4414) in a birth cohort in India, and to estimate the cost effectiveness and affordability of such a programme. DESIGN Decision analytical Markov model encompassing all direct medical costs. Infection risk and severity depended on age,(More)
The accumulated evidence from two decades of randomized controlled trials has not yet resolved the question of how best to monitor colorectal cancer (CRC) survivors for early detection of recurrent and metachronous disease or even whether doing so has its intended effect. A new wave of trial data in the coming years and an evolving knowledge of relevant(More)
With the impact of pay for performance likely to broaden and deepen in the coming years, ensuring that the quality measures used in these initiatives are based on the best possible clinical evidence and expert consensus is paramount. Two types of organizations greatly influence the content of quality measures: measure development organizations-such as the(More)
BACKGROUND The components separation technique (CST) is performed through an open or endoscopic approach. It is unclear whether the costs associated with the endoscopic instruments outweigh any clinical benefit derived from their use and the avoidance of lipocutaneous flaps. This study aimed to compare the direct costs associated with each approach. (More)
BACKGROUND Approximately one-third of those treated curatively for colorectal cancer (CRC) will experience recurrence. No evidence-based consensus exists on how best to follow patients after initial treatment to detect asymptomatic recurrence. Here, a new approach for simulating surveillance and recurrence among CRC survivors is outlined, and development(More)
Most patients treated with curative intent for colorectal cancer (CRC) are included in a follow-up program involving periodic evaluations. The survival benefits of a follow-up program are well delineated, and previous meta-analyses have suggested an overall survival improvement of 5%-10% by intensive follow-up. However, in a recent randomized trial, there(More)
PURPOSE The paradox of primary care is the observation that primary care is associated with apparently low levels of evidence-based care for individual diseases, but systems based on primary care have healthier populations, use fewer resources, and have less health inequality. The purpose of this article is to explore, from a complex systems perspective,(More)
Boundary objects in participatory group processes help participants share their understanding of systems across disciplinary and social boundaries. We report development of a series of boundary objects in a group model building project in which stakeholders and modelers constructed agent-based models (ABMs) of health care seeking and delivery. We propose(More)