Department of Comparative Effectiveness and Outcomes Research
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Item Cost per Opioid-Free Year: A Systematic Review and Summary AnalysisOyemakinde, B.E.; Ryan, D.; Cadet, T.; Judge, T.; Gopaldas, M.; Jalali, A.; Murphy, S.M. (Elsevier, 2025-07-22)OBJECTIVE: Opioids remain a leading cause of death in the U.S., and time-free from opioid use is a common measure of effectiveness in economic evaluations of opioid use disorder (OUD) interventions. This study reviews the economic evaluation literature on OUD, identify studies that calculated incremental cost-effectiveness ratios (ICER) based on time-free from opioids, and establishes a benchmark for comparison in future research. METHODS: The review examined economic evaluations of OUD interventions published in the peer-reviewed literature from inception to September 2024. ICERs of cost per period of opioid-free time were extracted or calculated from studies meeting the inclusion criteria. Monetary values were converted to 2024 USD, and ICERs normalized to cost per opioid-free year (OfY). Articles were classified by intervention location (U.S vs. International) and economic perspective. RESULTS: Fourteen articles met the inclusion criteria: 8 from the U.S., 4 from Australia, 1 from Malaysia, and 1 from the United Kingdom. Among the U.S.-based studies, the average ICER per OfY for the healthcare sector, the state policymaker, and the societal perspective were $243,053/OfY, $17,674/OfY, and $32,125/OfY, respectively. For international studies, average ICERs for the healthcare sector and societal perspectives were $79,765/OfY and $195,980/OfY. CONCLUSION: Cost per OfY is a widely used metric in economic evaluations due to its relative importance as a measure of clinical effectiveness. However, a universally accepted benchmark for decision-making does not yet exist. This review aggregates data from existing studies that provided this measure, offering an initial step for establishing a cost-effectiveness threshold for cost per OfY.Item Cardiac Surgeons at the Start of Their Practice Have Similar Volume/Outcome Association Compared With Established Surgeons.Caldonazo, T.; Rossi, C. S.; Rahouma, M.; Soletti, G.; Cancelli, G.; Harik, L.; Sandner, S.; Dell'Aquila, M.; An, K. R.; Redfors, B.; Girardi, L.; Gaudino, M. (1/23/25)Item Comparative- and Cost-Effectiveness Research Determining the Optimal Intervention for Advancing Transgender Women With HIV to Full Viral Suppression (Text Me, Alexis!): Protocol for a Randomized Controlled Trial.Reback, C. J.; Blue, T.; Jalali, A.; Landovitz, R.; Li, M. J.; Mata, R. P.; Ryan, D.; Jeng, P. J.; Murphy, S. M. (1/23/25)BACKGROUND: Many transgender women with HIV achieve suboptimal advancement through the HIV Care Continuum, including poor HIV health care usage, retention in HIV medical care, and rates of viral suppression. These issues are exacerbated by comorbid conditions, such as substance use disorder, which is also associated with reduced quality of life, increased overdose deaths, usage of high-cost health care services, engagement in a street economy, and cycles of incarceration. Thus, it is critical that efforts to End the HIV Epidemic include effective interventions to link and retain transgender women in HIV care through full viral suppression. OBJECTIVE: This study builds on the promising findings from our two Health Resources and Services Administration-funded demonstration projects, The Alexis Project and Text Me, Girl!, which used peer health navigation (PHN) and SMS text messaging, respectively, for advancing transgender women with HIV to full viral suppression. Though the effectiveness of both interventions has been established, their comparative effectiveness, required resources or costs, cost-effectiveness, and heterogeneous effects on subgroups, including those with substance use disorder, have not been evaluated. Given the many negative personal and public health consequences of untreated or undertreated HIV, and that HIV services for transgender women are frequently delivered in resource-limited, community-based settings, a comprehensive economic evaluation is critical to inform decisions of stakeholders, such as providers, insurers, and policy makers. METHODS: Text Me, Alexis! is a 3-arm randomized controlled trial. Participants (N=195) will be randomized (1:1:1) into: PHN alone (n=65), SMS text messaging alone (n=65), or PHN+SMS text messaging (n=65). Using the same time points as the Health Resources and Services Administration demonstration projects, the repeated-measures design will assess participants at baseline, 3, 6, 12, and 18 months post randomization. Over the course of the 90 days, participants in the PHN arm will receive unlimited navigation sessions; participants in the SMS text messaging arm will receive 270 theory-based SMS text messages (3 messages daily) that are targeted, tailored, and personalized specifically for transgender women with HIV; and participants in the PHN+SMS text messaging arm will receive a combined PHN and SMS text message intervention. The desired outcome of Text Me, Alexis! is viral suppression and cost-effectiveness. RESULTS: Recruitment began on April 10, 2024, and the first participant was enrolled on April 11, 2024. Data collection is expected to be completed in July 2027. Primary outcome analyses will begin immediately following the conclusion of the follow-up evaluations. CONCLUSIONS: Transgender women are a high-priority population for reaching End the HIV Epidemic goals. Findings have the potential to improve individual and population health outcomes by generating significant improvements in viral suppression among transgender women and guiding service provision and public policy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/65313.