Publications by authors named "Vilija Joyce"
Aims: To compare healthcare costs and use between United States (US) Veterans Health Administration (VHA) patients with opioid use disorder (OUD) who experienced an opioid overdose (OD cohort) and patients with OUD who did not experience an opioid overdose (non-OD cohort).
Design: This is a retrospective cohort study of administrative and clinical data.
Setting: The largest integrated national health-care system is the US Veterans Health Administration's healthcare systems.
A call for better validation of opioid overdose risk algorithms.
J Am Med Inform Assoc
September 2023
Clinical decision support (CDS) systems powered by predictive models have the potential to improve the accuracy and efficiency of clinical decision-making. However, without sufficient validation, these systems have the potential to mislead clinicians and harm patients. This is especially true for CDS systems used by opioid prescribers and dispensers, where a flawed prediction can directly harm patients.
View Article and Find Full Text PDFIntroduction: Little is known about access to and use of prenatal care by veterans using U.S. Department of Veterans Affairs (VA) maternity benefits.
View Article and Find Full Text PDFImportance: Opioid use disorder (OUD) is a significant cause of morbidity and mortality in the US, yet many individuals with OUD do not receive treatment.
Objective: To assess the cost-effectiveness of OUD treatments and association of these treatments with outcomes in the US.
Design And Setting: This model-based cost-effectiveness analysis included a US population with OUD.
Objective: The objective was to compare differences in body mass index (BMI) calculated with self-reported versus clinically measured pre-conception data from women veterans in California.
Methods: Veterans Health Administration (VHA) and California state birth certificate data were used to develop a cohort of women who gave birth from 2007-2012 and had VHA data available to calculate BMI ( = 1,326 mothers, 1,473 births). Weighted Kappa statistics assessed concordance between self-reported and measured BMI.
The treatment of missing data in comparative effectiveness studies with right-censored outcomes and time-varying covariates is challenging because of the multilevel structure of the data. In particular, the performance of an accessible method like multiple imputation (MI) under an imputation model that ignores the multilevel structure is unknown and has not been compared to complete-case (CC) and single imputation methods that are most commonly applied in this context. Through an extensive simulation study, we compared statistical properties among CC analysis, last value carried forward, mean imputation, the use of missing indicators, and MI-based approaches with and without auxiliary variables under an extended Cox model when the interest lies in characterizing relationships between non-missing time-varying exposures and right-censored outcomes.
View Article and Find Full Text PDFObjective: To describe variation in payer and outcomes in Veterans' births.
Data/setting: Secondary data analyses of deliveries in California, 2000-2012.
Study Design: We performed a retrospective, population-based study of all live births to Veterans (confirmed via U.
Article Synopsis
- The study aimed to assess if the implementation of interferon-free treatment for hepatitis C virus (HCV) reached previously underserved groups, including those with genotype 1 virus and disparities like race and co-infections.
- The analysis of electronic medical records from the US Veterans Health Administration (VHA) revealed a significant increase in treatment rates from 2.4% in 2010 to 18.1% in 2015, particularly among populations like HIV co-infected individuals and African Americans.
- The VHA's efforts led to a sevenfold increase in HCV treatment and demonstrated success in addressing treatment disparities, indicating potential changes in community standards of care.
Congressional and Veterans Affairs (VA) leaders have recommended the VA become more of a purchaser than a provider of health care. Fee-for-service Medicare provides an example of how purchased care differs from the VA's directly provided care. Using established indicators of overly intensive end-of-life care, we compared the quality of care provided through the two systems to veterans dying of cancer in fiscal years 2010-14.
View Article and Find Full Text PDFArticle Synopsis
- The MOS-HIV survey is widely used in HIV studies, but its scores can't be directly used for cost-effectiveness analyses since they lack utility values for health states.
- The study aimed to create and validate algorithms that can estimate Health Utilities Index Mark 3 (HUI3) and EQ-5D-3L utility values from MOS-HIV data, using information from two separate clinical trials.
- The best predictions for HUI3 came from an ordinary least squares model with MOS-HIV dimensions, while the finite mixture model was best for EQ-5D-3L, though both models struggled with accuracy at lower health score ranges.
Article Synopsis
- Chronic hepatitis C is a widespread issue in the U.S., with healthcare systems needing to choose between various effective but expensive treatments for genotype 1 HCV.
- This study used a decision-analytic model to evaluate the cost-effectiveness of different HCV treatment regimens, finding that newer treatments like Sofosbuvir/ledipasvir (SOF-LDV) and 3D provide better health outcomes and lower costs compared to older therapies.
- Results indicate that SOF-LDV is more cost-effective than 3D and other treatments, particularly in the Department of Veterans Affairs, but the overall high drug prices still lead to significant treatment costs, necessitating price reductions for enhanced cost-effectiveness.
Background: To characterize the association of antiretroviral drug combinations on risk of cardiovascular events.
Methods: Certain antiretroviral medications for human immunodeficiency virus (HIV) have been implicated in increasing risk of cardiovascular disease. However, antiretroviral drugs are typically prescribed in combination.
Objectives: To determine the association between preexisting characteristics and current health and the cost of different types of advanced human immunodeficiency virus (HIV) care.
Methods: Treatment-experienced patients failing highly active antiretroviral treatment (ART) in the United States, Canada, and the United Kingdom were factorial randomized to an antiretroviral-free period and ART intensification. Cost was estimated by multiplying patient-reported utilization by a unit cost.
Objective: To estimate the cost-effectiveness of a supported employment (SE) intervention that had been previously found effective in veterans with spinal cord injuries (SCIs).
Design: Cost-effectiveness analysis, using cost and quality-of-life data gathered in a trial of SE for veterans with SCI.
Setting: SCI centers in the Veterans Health Administration.
Objective: Newer antiretroviral drugs provide substantial benefits but are expensive. The cost-effectiveness of using antiretroviral drugs in combination for patients with multidrug-resistant HIV disease was determined.
Design: A cohort state-transition model was built representing treatment-experienced patients with low CD4 counts, high viral load levels, and multidrug-resistant virus.
Background And Objectives: This study examined the relationship between health-related quality of life and subsequent mortality among AKI survivors treated with renal replacement therapy.
Design, Setting, Participants, & Measurements: Multivariable Cox regression models were used to assess the associations between Health Utilities Index Mark 3 (HUI3) and ambulation, emotion, cognition, and pain scores at 60 days and all-cause mortality at 1 year in 60-day AKI survivors (n=439 with evaluable HUI3 assessments) from a randomized multicenter study comparing less- with more-intensive renal replacement therapies.
Results: The median 60-day HUI3 index score was 0.
Background: The effect of adherence, treatment failure, and comorbidities on the cost of HIV care is not well understood.
Objective: To characterize the cost of HIV care including combination antiretroviral treatment (ART).
Research Design: Observational study of administrative data.
Background: The effect of antiretroviral therapy (ART) interruption or intensification on health-related quality of life (HRQoL) in advanced HIV patients is unknown.
Objective: To assess the impact of temporary treatment interruption and intensification of ART on HRQoL.
Design: A 2 x 2 factorial open label randomized controlled trial.
Objectives: To assess the concurrent validity and responsiveness of the Health Utility Index 3 (HUI3) in patients with advanced HIV/AIDS, and to determine the responsiveness of this measure, the MOS-HIV and EQ-5D to HIV-related clinical events.
Methods: Data from the OPTIMA (OPTions In Management with Antiretrovirals) trial was analyzed. Two aspects of the validity of the HUI3 were considered: concurrent validity was evaluated using Spearman correlations with MOS-HIV component and summary scores.
Objective: To investigate the relative magnitude and duration of impact of AIDS-defining events (ADEs) and non-AIDS serious adverse events (SAEs) on health-related quality of life (HRQoL) among patients with advanced HIV/AIDS.
Methods: We use data from OPTIMA (OPTions In Management with Antiretrovirals), a multinational, randomized, open, control, clinical management trial of treatment strategies for patients with multidrug-resistant HIV and advanced immune disease. Longitudinal models were used to determine the effects of ADEs and SAEs on HRQoL across periods before, during, and after event onset.
Objective: To assess and compare alternative approaches of measuring preference-based health-related quality of life (HRQoL) in treatment-experienced HIV patients and evaluate their association with health status and clinical variables.
Design: Cross-sectional study.
Setting: Twenty-eight Veterans Affairs hospitals in the United States, 13 hospitals in Canada, and 8 hospitals in the United Kingdom.