Publications by authors named "Veenstra D"
Background: The introduction of cyclin-dependent kinases 4 and 6 inhibitors (CDK4/6is) has transformed the treatment landscape for patients with hormone receptor positive (HR+) and human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer (MBC). To our knowledge, no studies have quantified health care resource utilization (HRU) or economic burden following CDK4/6i initiation in the Medicare population.
Objective: To describe HRU and quantify health care costs among Medicare-enrolled patients with HR+ HER2- MBC treated with CDK4/6is in the first-line setting.
Article Synopsis
- Genomic screening for Lynch Syndrome (LS) and high polygenic risk scores (PRS) could improve colorectal cancer (CRC) screening by personalizing approaches for individuals based on their risk.
- A Markov model analysis showed that screening 1,000 people with LS+PRS could prevent 1.36 CRC cases and 0.65 deaths when compared to standard screening methods.
- The cost-effectiveness of this screening strategy was indicated by an incremental cost-effectiveness ratio of $124,415 per quality-adjusted life year (QALY), with a 69% chance of being cost-effective, especially when using a 90th percentile risk threshold.
Article Synopsis
- Family spillover effects, which impact family members and caregivers of patients, are often overlooked in health technology assessments (HTAs) and cost-effectiveness analyses (CEAs), despite formal value frameworks suggesting their importance.
- The study aimed to create stakeholder-driven recommendations for effectively measuring and incorporating family spillover effects in the US healthcare evaluation processes while identifying potential research opportunities.
- Through literature reviews and qualitative interviews with various healthcare stakeholders, several key themes emerged that emphasized the limitations of current practices and led to the formulation of 15 consensus-based recommendations for better integrating these effects into CEAs and HTAs.
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- The study aims to understand how potential future cancer treatment innovations influence oncologists' current treatment decisions and discussions with patients.* -
- An online survey with 201 oncologists revealed that a significant majority would discuss future treatments if they promised improved survival chances, especially if available soon.* -
- The results suggest that acknowledging the potential benefits of future innovations could enhance treatment decision-making; thus, guidelines should incorporate this aspect for better patient care.*
Article Synopsis
- New cancer diagnoses, especially hepatocellular carcinoma (HCC), lead to significant drops in workplace productivity, increased absenteeism, and added costs for employers.
- The study analyzed data from 2010 to 2020 to measure the mean workdays lost and the financial impact on commercially insured US adults diagnosed with early-, intermediate-, and advanced-stage HCC.
- Results showed that early-stage patients experienced the highest productivity loss, particularly those receiving intensive treatments, with an average of 22.6 workdays lost, resulting in substantial indirect costs.
Background: Although several types of psychotherapy effectively reduce psychological distress associated with personality disorders, randomised controlled trials (RCT) have systematically excluded older patients. We aimed to examine the effectiveness of group schema therapy combined with psychomotor therapy (GST + PMT) in later life compared with treatment as usual (TAU).
Methods: We did an open-label, multicentre, RCT in eight outpatient clinics for geriatric psychiatry in the Netherlands.
Polygenic risk scores (PRSs) have improved in predictive performance, but several challenges remain to be addressed before PRSs can be implemented in the clinic, including reduced predictive performance of PRSs in diverse populations, and the interpretation and communication of genetic results to both providers and patients. To address these challenges, the National Human Genome Research Institute-funded Electronic Medical Records and Genomics (eMERGE) Network has developed a framework and pipeline for return of a PRS-based genome-informed risk assessment to 25,000 diverse adults and children as part of a clinical study. From an initial list of 23 conditions, ten were selected for implementation based on PRS performance, medical actionability and potential clinical utility, including cardiometabolic diseases and cancer.
View Article and Find Full Text PDFWe investigated the effect of shortening time between innovations with the accelerated approval (AA) pathway on patient outcomes for three solid tumors. This real-world analysis evaluated patients receiving sequential AA pathway-approved innovations after initial treatment with existing therapies in three solid tumor case studies. Outcomes attributable to AA were estimated and assumed approval occurred at the time of conversion to approval and extrapolated to the US population.
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- Nirmatrelvir/ritonavir (NMV/r) is a treatment for mild-to-moderate COVID-19 in high-risk adults and has also been approved for certain pediatric patients by the FDA.
- The study aims to evaluate the annual budget impact of NMV/r within a US commercial health plan during the Omicron variant's prevalence.
- Results show that NMV/r could potentially reduce hospitalizations significantly, leading to a total budget impact of approximately $2.7 million, with additional cost savings when considering various post-COVID conditions.
Article Synopsis
- * In a study involving 16,218 adults, those with actionable genetic findings underwent significantly more healthcare services in the year following result disclosure compared to before and to those without such findings.
- * The annual healthcare costs for individuals with pathogenic findings nearly doubled, increasing from an average of $162 to $343, indicating a notable financial impact on healthcare payors.
Article Synopsis
- Population genetic screening for preventable adult-onset hereditary conditions may enhance disease management but often yields uninformative results, with many individuals not at greater risk for illness.
- A study at the University of Washington examined responses from 1352 patients who received these uninformative results, focusing on their perceived changes in health risk and behavior.
- Findings indicated low psychosocial harms from the screening, with only a small percentage believing their disease risk had changed or planning to alter their healthcare behaviors, highlighting the need for more research on the long-term impact of such screening results.
Article Synopsis
- The CHARM study focused on providing genetic testing and risk management for cancer to underserved populations, addressing barriers to access in low-income and low-literacy groups.
- Conducted at Kaiser Permanente Northwest and Denver Health from 2018 to 2020, the study monitored participants for an average of 15.4 months to evaluate the use of cancer screenings and surgical procedures after receiving genetic test results.
- Although only a small percentage of participants received actionable recommendations, those who did showed moderate engagement in risk management practices, indicating that the study successfully increased access to genetic services and preventive care without leading to overuse of these services.
Article Synopsis
- Screening adherence for mammography and MRI is crucial for individuals with inherited genetic variants linked to higher breast cancer risk, yet it remains low in practice.
- A study assessed the percentage of time individuals adhered to annual mammograms and breast MRIs, revealing an average adherence of 48% for mammograms and 34% for MRIs among those with certain genetic variants.
- The findings suggest a need for further research to understand and improve adherence to these important screening practices, particularly for those with pathogenic variants in breast cancer-associated genes.
Article Synopsis
- - The text discusses the advancements in polygenic risk scores (PRS) and their potential to enhance clinical practice, but highlights challenges in effectiveness across diverse populations, which can worsen health disparities.
- - A project funded by NHGRI called the eMERGE Network is evaluating PRS for 23 health conditions in 25,000 individuals from different backgrounds, focusing on actionable findings and relevant evidence for African and Hispanic populations.
- - The study identified ten key health conditions for PRS assessment (like breast cancer and diabetes), and established a framework for implementing PRS in clinical settings, ensuring compliance and reliability across different genetic ancestries.
Article Synopsis
- The study investigates the cost-effectiveness of population screening for genetic conditions like Lynch syndrome, hereditary breast and ovarian cancer syndrome, and familial hypercholesterolemia in U.S. adults aged 20 to 60.
- Using a decision analytic Markov model and data from published literature, the analysis focuses on the health outcomes and costs associated with genomic screening over a lifetime perspective.
- Results show that screening 100,000 unselected 30-year-olds could reduce cancer and cardiovascular cases and provide significant quality-adjusted life-years at a cost-effectiveness ratio of $68,600 per QALY gained, making it a potentially valuable public health strategy.
Introduction: Although there is increasing interest in conducting cancer clinical trials in older adults, the benefit of such trials is unclear. We aimed to quantify the real-world clinical and economic effects of two phase 3 trials (CALGB 9343 and PRIME II) which showed that post-lumpectomy radiation therapy (RT) improves loco-regional recurrence but makes no improvement in overall survival among older women with early-stage breast cancer (ESBC).
Materials And Methods: We developed a health-transition model to quantify the incremental clinical and economic outcomes between scenarios with vs.
Background: Despite increasing focus on conducting cancer clinical trials in older adults, it is unclear whether such evidence influences practice patterns. We aimed to estimate the impact of cumulative evidence from older adult-specific trial results from the CALGB 9343 and PRIME II trials that found post-lumpectomy irradiation has little benefit among older adults with early-stage breast cancer (ESBC).
Methods: Patients diagnosed with ESBC between 2000 and 2018 were identified from the SEER registry data.
Article Synopsis
- * This is especially critical for patients from underrepresented groups, who often face higher rates of uncertain genetic findings.
- * The text outlines key challenges and proposes solutions for a systematic approach to genetic variant reinterpretation, including infrastructure needs, patient consent, triggering processes, data flow, cost coverage, and implementation policies.
Article Synopsis
- The study aims to assess the risk of common diseases by considering clinical, monogenic, and polygenic factors, which may be reflected in an individual's family history.
- The eMERGE network is enrolling 25,000 individuals in a prospective study to create and return a comprehensive risk assessment report (GIRA) that includes various genetic risk factors and care recommendations.
- The GIRA report provides actionable guidelines for health care based on genetic data, highlighting the importance of integrating genetic risk assessment into routine health care practices.
Introduction: Conducting older adult-specific clinical trials can help overcome the lack of clinical evidence for older adults due to their underrepresentation in clinical trials. Understanding factors contributing to the successful completion of such trials can help trial sponsors and researchers prioritize studies and optimize study design. We aimed to develop a model that predicts trial failure among older adult-specific cancer clinical trials using trial-level factors.
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- Pediatric genomic sequencing (GS) can impact the health of both children and families, highlighting the need for an understanding of caregivers' perspectives on its utility.
- This study involved semi-structured interviews with 41 caregivers to identify factors influencing their decisions to pursue GS for their pediatric patients, focusing on family-level issues.
- The analysis revealed four key domains affecting caregivers' decision-making: underlying values, perceived benefits, perceived risks, and practical considerations, which can enhance future assessments of pediatric GS's value to families.
Article Synopsis
- About half of high-risk HER2-positive early-stage breast cancer patients do not achieve a pathologic complete response after neoadjuvant therapy, and the extent of their residual disease has not been quantified before.
- Using decision-modeling techniques, the study simulated cancer outcomes over 10 years, revealing significant recurrence and mortality rates among this patient group treated with T-DM1.
- The findings projected that over 9,300 people would be diagnosed in the U.S. in 2021, leading to substantial healthcare costs and highlighting the need to address the ongoing risk of recurrence in patients not achieving complete response.
Article Synopsis
- Population genomic screening for familial hypercholesterolemia (FH) can help prevent early cardiovascular disease, but its economic viability is under scrutiny.
- A model showed that screening 20-year-olds could yield significant health benefits (111 QALYs per 100,000) but comes with a high cost ($181,000 per QALY).
- Current costs for genomic testing make FH screening less cost-effective, but lowering test prices or screening younger populations could enhance its value.
Article Synopsis
- Limited data exists on clinician and participant behaviors after revealing genomic risk variants for familial hypercholesterolemia (FH) from a screening program.
- A study involving 96 participants analyzed clinician prescription changes, participant medication adherence, and LDL cholesterol levels before and after disclosing the FH risk variant.
- Results showed that, although many patients improved their adherence to medication and achieved lower LDL levels post-disclosure, a significant number still experienced nonprescribing issues and continued nonadherence to lipid-lowering therapies.