The multidisciplinary Medical Practice Evaluation Center team is internationally recognized in the evaluation of clinical outcomes, costs, and cost-effectiveness for preventing, managing, and treatment of HIV/AIDS and other infectious and non-communicable diseases.
Our faculty and fellows also conduct observational and interventional research studies in patient populations in the United States and in international settings. We also have team members who develop models outside the CEPAC model. Below are examples of the types of research projects on which Medical Practice Evaluation Center team members work.
Jump to: CEPAC Model Analyses | Modeling HIV Treatment and Prevention | Modeling of Pregnant Women, Infants, and Adolescents Affected by HIV | Modeling HIV Comorbidities | Modeling Clinical Trials | Modeling Tobacco and Nicotine Behaviors and Outcomes | Modeling CKRT Shortages during COVID-19
CEPAC Model Analyses
Many Medical Practice Evaluation Center research projects utilize the CEPAC (Cost-Effectiveness of Preventing AIDS Complications) model, which simulates a large cohort of patients.
Modeling HIV Treatment and Prevention Current and Future Policies
We frequently evaluate domestic and international HIV treatment and prevention policy, using the CEPAC model to compare the cost-effectiveness of existing policies to possible setting-specific alternatives to care.
Ongoing or prior CEPAC studies have included, for example: evaluating the use of genotype testing to guide selection of antiretroviral therapy (ART) in the United States; comparing first-line ART options in India; and examining the use of pre-exposure prophylaxis (PrEP) in high-risk groups in Brazil. We have also used the CEPAC model to estimate the years of life saved by national treatment policies in South Africa and Brazil and the impact of a loss of international aid to Côte d’Ivoire and South Africa.
The CEPAC model is also a powerful tool for exploring the potential impact of new treatments and prevention methods under development. For example, we have examined the efficacy, toxicity, and cost thresholds required for hypothetical HIV cure interventions to be viable at the population level in the United States and South Africa, and we plan to examine the cost-effectiveness of new cure strategies as they emerge.
We are also projecting the potential clinical impact and the cost-effectiveness of new long-acting ART and pre-exposure prophylaxis drugs, comparing these novel methods to existing drugs.
Modeling of Pregnant Mothers, Infants, and Adolescents Affected by HIV
The Pediatrics team has developed models to examine the potential benefit and cost-effectiveness of a range of approaches to care for women and children affected by HIV in Côte d’Ivoire, South Africa, and Zimbabwe. These include analyses of: medications for prevention of mother-to-child HIV transmission (PMTCT) and integrated care clinics for mothers and infants; novel infant diagnosis strategies including point-of-care assays and screening for HIV exposure in immunization clinics; first-line antiretroviral therapy (ART) regimens and ART switching strategies for children; and infant feeding recommendations.
The Pediatrics team has also been piloting regression-based metamodels that will allow us to develop webtools to help inform policymakers’ decisions. The Adolescent Team has focused on the clinical outcomes and cost-effectiveness of testing, screening and PrEP strategies for adolescents and young adults, including young men who have sex with men.
Modeling HIV-related Comorbidities
Over time, the CEPAC modeling team has developed new structures to simulate HIV-related co-morbidities that critically impact that care and outcomes of patients with HIV infection both in the US and internationally.Tuberculosis
This model is being used to examine policies for people with TB alone or those who are co-infected with HIV. Recent projects include a cost-effectiveness analysis of a novel TB screening strategy among hospitalized people with HIV in Malawi and South Africa, which was conducted in close partnership with the STAMP clinical trial, and a cost-effectiveness analysis of a new TB diagnostic tool among HIV-uninfected people in India.
With access to life-saving ART people with HIV live to a full life expectancy but can experience a greater incidence of non-communicable diseases (NCDs). The CEPAC model can project morbidity, mortality, and costs associated with NCDs among people with HIV. Published analyses have examined the impact of lung cancer, and cardiovascular diseases among people with HIV. Ongoing projects include the assessment of costs of NCD care among people with HIV domestically and internationally, and the impact of screening for hypertension.
Modeling Clinical Trials
Using data taken from ongoing clinical trials, we conduct CEPAC model analyses to estimate the cost-effectiveness of scaling up interventions to a population level. Similarly, we have used the CEPAC model to determine the impact that changing standards of care can have on ongoing clinical trials as well as the impact of trial results on a country-wide budget.
The MPEC also conducts analyses that estimate the value of information that could be gained from proposed clinical trials, assisting other investigators to design and carry out cost-effective trials with limited research funding.
Modeling Tobacco and Nicotine Behaviors and Outcomes
The Simulation of Tobacco and Nicotine Outcomes and Policy (STOP) model, developed by MPEC researchers, is a computer microsimulation model of tobacco- and nicotine-related behaviors, clinical outcomes, and health care costs. The STOP model can be used to study the clinical and health economic impact of cessation interventions and public policies around combustible tobacco and e-cigarettes. Additional details about the model can be found here.
Recent and current projects that use the STOP model include:
- projections of socioeconomic disparities in tobacco use and associated health outcomes in the US,
- analysis of the clinical impact of tobacco use among people with HIV in South Africa and the cost-effectiveness of integrating tobacco cessation interventions in HIV care, and
- evaluation of the effects of tobacco and e-cigarette public policies on the future use of these products among youth and adults.
Modeling Kidney Replacement Therapy Shortages During the COVID-19 Pandemic
Researchers at MPEC have developed models to project shortages in continuous kidney replacement therapy (CKRT) for critically ill patients during the coronavirus disease 2019 (COVID-19) pandemic. The models use projections from the Institute for Health Metrics and Evaluation, the Harvard Global Health Institute, and published literature to project nationwide and statewide CKRT demand, capacity, and shortages.
A more detailed discussion of the models can be found in the full article (Reddy et al., AJKD 2020).