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1. Real-World Safety and Effectiveness of a Bevacizumab Biosimilar (ABP 215) in Metastatic Colorectal Cancer Patients in Canada

Author

Cheung, Winson Y., Samimi, Setareh, Ma, Kim, Knight, Gregory John, Kassam, Shaqil, Colwell, Bruce, Beaudoin, Annie, Vincent, Mark David, Trinkaus, Mateya, Filion, Alain, Marquis, Katerine, Karachiwala, Hatim, Asmis, Timothy, Sideris, Lucas, Wani, Rajvi J., Ngan, Elaine, Inam, Naila, Du, Yinhao, Nunez, Leyla, Eberg, Maria, Alemayehu, Mistre, Meyer, Pierre-Francois, Mancini, Johanna, and Cirone Morris, Carlye

Published
2024
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3. An Inverse Optimization Approach to Measuring Clinical Pathway Concordance

Author

Chan, Timothy C. Y., Eberg, Maria, Forster, Katharina, Holloway, Claire, Ieraci, Luciano, Shalaby, Yusuf, and Yousefi, Nasrin

Subjects
Statistics - Applications, Mathematics - Optimization and Control
Abstract

Clinical pathways outline standardized processes in the delivery of care for a specific disease. Patient journeys through the healthcare system, though, can deviate substantially from these pathways. Given the positive benefits of clinical pathways, it is important to measure the concordance of patient pathways so that variations in health system performance or bottlenecks in the delivery of care can be detected, monitored, and acted upon. This paper proposes the first data-driven inverse optimization approach to measuring pathway concordance in any problem context. Our specific application considers clinical pathway concordance for stage III colon cancer. We develop a novel concordance metric and demonstrate using real patient data from Ontario, Canada that it has a statistically significant association with survival. Our methodological approach considers a patient's journey as a walk in a directed graph, where the costs on the arcs are derived by solving an inverse shortest path problem. The inverse optimization model uses two sources of information to find the arc costs: reference pathways developed by a provincial cancer agency (primary) and data from real-world patient-related activity from patients with both positive and negative clinical outcomes (secondary). Thus, our inverse optimization framework extends existing models by including data points of both varying "primacy" and "alignment". Data primacy is addressed through a two-stage approach to imputing the cost vector, while data alignment is addressed by a hybrid objective function that aims to minimize and maximize suboptimality error for different subsets of input data., Comment: 61 pages

Published
2019

4. Healthcare resource utilization following ustekinumab initiation among bio-naïve Canadian patients with moderately-to-severely active Crohn's disease.

Author

Bessissow, Talat, Narula, Neeraj, Ma, Christopher, In, Tracy S.H., Pone, Eneda, Eberg, Maria, and Jairath, Vipul

Abstract

Real-world healthcare resource utilization (HCRU) of bio-naïve patients with Crohn's disease (CD) receiving ustekinumab was assessed. A multicentre, retrospective chart review study of bio-naïve Canadian adult patients with moderately-to-severely active CD treated with ustekinumab was conducted. CD-related HCRU (i.e., surgery, hospitalization, or emergency room [ER] visits) was evaluated at Months 4, 6, and 12 post-ustekinumab initiation, and associated costs were sourced from a provincial database. Proportion of patients with HCRU events and ustekinumab persistence were summarized at each timepoint. Paired analysis compared HCRU events and associated costs incurred by the same patient whilst in remission vs. when not in remission. By Month 12, 11.1 % (17/153) of patients had record(s) of any CD-related HCRU event, with ER visits being the most common (7.7 %; 12/155). Hospitalization had the highest average cost (CAD $436.10; SD $2,089.25) across all patients, accounting for 82.2 % of the mean total annual cost/patient (CAD $530.47; SD $2,229.92). While in remission, ≤5 % of patients experienced some healthcare encounter, compared with 7 % when not in remission (P = 0.289). Finally, 93.5 % of patients persisted on ustekinumab at Month 12. HCRU rates and associated total annual costs were lower for bio-naïve CD patients receiving ustekinumab, and when patients were in remission. Most patients continued with ustekinumab at Month 12. [ABSTRACT FROM AUTHOR]

Published
2024
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5. Reprise du retard en chirurgie cause par la COVID-19 en Ontario : etude de modelisation de series chronologiques

Author

Wang, Jonathan, Vahid, Saba, Eberg, Maria, Milroy, Shannon, Milkovich, John, Wright, Frances C., Hunter, Amber, Kalladeen, Ryan, Zanchetta, Claudia, Wijeysundera, Harindra C., and Irish, Jonathan

Subjects
Coronaviruses, Health
Abstract

CONTEXTE : Pour limiter la propagation de la maladie a coronavirus 2019 (COVID19), de nombreux pays ont decide de reduire le nombre d'interventions chirurgicales non urgentes, ce qui a cree des retards en chirurgie partout dans le monde. Notre objectif etait d'evaluer l'ampleur du retard pour ce type d'interventions en Ontario, au Canada, ainsi que le temps et les ressources necessaires pour y remedier. METHODES : Nous avons consulte 6 bases de donnees administratives decrivant la population ontarienne et canadienne pour degager la distribution du volume chirurgical et de la cadence des salles d'operation pour chaque type d'interventions et chaque region, et con naitre la duree d'occupation d'un lit d'hopital et d'un lit de soins intensifs. Les donnees utilisees concernent l'ensemble ou une partie de la periode du 1er janvier 2017 au 13 juin 2020. Nous avons estime l'ampleur du retard accumule et predit le temps necessaire pour le reprendre dans un scenario avec capacite d'appoint de + 10% (ajout d'un jour a 50% de la capacite par semaine) a l'aide de modeles de series chronologiques, de modeles de files d'attente et d'une analyse de sensibilite probabiliste. RESULTATS : Entre le 15 mars et le 13 juin 2020, le retard en chirurgie a l'echelle de l'Ontario s'est accru de 148 364 operations (intervalle de prevision a 95% 124 508-174 589) au total, et en moyenne de 11 413 operations par semaine. Pour reprendre le retard accumule, il faudra environ 84 semaines (intervalle de confiance [IC] a 95% 46-145) et une cadence hebdomadaire de 717 patients (IC a 95% 326-1367), qui elle demande 719 heures passees au bloc operatoire (IC a 95% 431-1038), 265 lits d'hopital (IC a 95% 87-678) et 9 lits de soins intensifs (IC a 95% 4-20) par semaine. INTERPRETATION : L'ampleur du retard en chirurgie du a la COVID-19 laisse entrevoir de graves consequences pour la phase de reprise en Ontario. Le cadre qui nous a servi a modeliser la reprise du retard peut etre adapte ailleurs, avec des donnees locales, pour faciliter la planification., Le 11 mars 2020, l'Organisation mondiale de la Sante (OMS) a declare que la propagation de la maladie a coronavirus 2019 (COVID-19), maladie qui a de lourdes consequences sur la [...]

Published
2021
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7. Clearing the surgical backlog caused by COVID-19 in Ontario: a time series modelling study

Author

Wang, Jonathan, Vahid, Saba, Eberg, Maria, Milroy, Shannon, Milkovich, John, Wright, Frances C., Hunter, Amber, Kalladeen, Ryan, Zanchetta, Claudia, Wijeysundera, Harindra C., and Irish, Jonathan

Subjects
Surgery -- Statistics -- Planning, Epidemics -- Statistics -- Control -- Ontario, Medical scheduling -- Statistics, COVID-19 -- Statistics -- Control, Company business planning, Health
Abstract

BACKGROUND: To mitigate the effects of coronavirus disease 2019 (COVID-19), jurisdictions worldwide ramped down nonemergent surgeries, creating a global surgical backlog. We sought to estimate the size of the nonemergent surgical backlog during COVID-19 in Ontario, Canada, and the time and resources required to clear the backlog. METHODS: We used 6 Ontario or Canadian population administrative sources to obtain data covering part or all of the period between Jan. 1, 2017, and June 13, 2020, on historical volumes and operating room throughput distributions by surgery type and region, and lengths of stay in ward and intensive care unit (ICU) beds. We used time series forecasting, queuing models and probabilistic sensitivity analysis to estimate the size of the backlog and clearance time for a +10% (+1 day per week at 50% capacity) surge scenario. RESULTS: Between Mar. 15 and June 13, 2020, the estimated backlog in Ontario was 148364 surgeries (95% prediction interval 124 508-174 589), an average weekly increase of 11413 surgeries. Estimated backlog clearance time is 84 weeks (95% confidence interval [CI] 46-145), with an estimated weekly throughput of 717 patients (95% CI 326-1367) requiring 719 operating room hours (95% CI 431-1038), 265 ward beds (95% CI 87-678) and 9 ICU beds (95% CI 4-20) per week. INTERPRETATION: The magnitude of the surgical backlog from COVID-19 raises serious implications for the recovery phase in Ontario. Our framework for modelling surgical backlog recovery can be adapted to other jurisdictions, using local data to assist with planning., On Mar. 11, 2020, the World Health Organization (WHO) declared a global pandemic of coronavirus disease 2019 (COVID-19), which has exacted a massive global impact on health, politics and the [...]

Published
2020
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17. Ambulatory Toxicity Management (AToM) Pilot: results of a pilot study of a pro-active, telephone-based intervention to improve toxicity management during chemotherapy for breast cancer

Author

Krzyzanowska, Monika K., MacKay, Cassandra, Han, Heekyung, Eberg, Maria, Gandhi, Sonal, Laferriere, Nicole B., Powis, Melanie, Howell, Doris, Atzema, Clare L., Chan, Kelvin K. W., Kukreti, Vishal, Mitchell, Sandra, Nayer, Marla, Pasetka, Mark, Knittel-Keren, Dafna, and Redwood, Erin

Published
2019
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33. Additional file 2: of Ambulatory Toxicity Management (AToM) Pilot: results of a pilot study of a pro-active, telephone-based intervention to improve toxicity management during chemotherapy for breast cancer

Author

Krzyzanowska, Monika, MacKay, Cassandra, Heekyung Han, Eberg, Maria, Gandhi, Sonal, Laferriere, Nicole, Powis, Melanie, Howell, Doris, Atzema, Clare, Chan, Kelvin, Vishal Kukreti, Mitchell, Sandra, Nayer, Marla, Pasetka, Mark, Knittel-Keren, Dafna, and Redwood, Erin

Abstract

Table S1. Baseline demographic and clinical characteristics of selected controls and study participants from administrative data, by centre. (DOCX 19 kb)

Published
2019
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35. Population-based outcomes of men with a single negative prostate biopsy: Importance of continued follow-up among older patients

Author

Sayyid, Rashid K., primary, Alibhai, Shabbir M.H., additional, Sutradhar, Rinku, additional, Eberg, Maria, additional, Fung, Kinwah, additional, Klaassen, Zachary, additional, Goldberg, Hanan, additional, Perlis, Nathan, additional, Madi, Rabii, additional, Terris, Martha K., additional, Urbach, David R., additional, and Fleshner, Neil E., additional

Published
2019
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36. Effect of PET/CT on the Management and Outcomes of Participants with Hodgkin and Aggressive Non-Hodgkin Lymphoma: A Multicenter Registry

Author

Metser, Ur, primary, Prica, Anca, additional, Hodgson, David C., additional, Mozuraitis, Mindaugas, additional, Eberg, Maria, additional, Mak, Victor, additional, Green, Bo, additional, Singnurkar, Amit, additional, Dudebout, Jill, additional, MacCrostie, Pamela, additional, Tau, Noam, additional, Mittmann, Nicole, additional, and Langer, Deanna L., additional

Published
2019
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37. Statin potency and the risk of hospitalization for community‐acquired pneumonia

Author

Shin, Ju‐Young, Eberg, Maria, Ernst, Pierre, and Filion, Kristian B.

Subjects
Aged, 80 and over, Male, Pharmacoepidemiology, Smoking, Age Factors, Comorbidity, Pneumonia, Middle Aged, United Kingdom, Cohort Studies, Community-Acquired Infections, Hospitalization, Risk Factors, Case-Control Studies, Humans, Female, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Propensity Score, Aged, Retrospective Studies
Abstract

Previous studies suggest that statins may have beneficial respiratory effects. However, it is unclear if these purported benefits vary with statin potency. Our objective was to determine if higher potency statins, compared with lower potency statins, were associated with a reduced risk of hospitalization for community-acquired pneumonia (HCAP).We conducted a nested case-control analysis of a retrospective, population-based cohort of new users of statins using data extracted from the UK's Clinical Practice Research Datalink and Hospital Episode Statistics. For each HCAP case, we used risk set sampling to randomly select up to 10 controls, matched on sex, age, cohort entry date and follow-up duration. We used conditional logistic regression with high-dimensional propensity scores to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for HCAP with current use of higher potency statin vs. lower potency statins.A total of 217 721 patients entered the cohort on a lower potency statin and 130 707 entered on a higher potency statin; these patients resulted in 2251 cases of HCAP during 561 886 person-years of observation (rate: 4.0 HCAP per 1000 persons per year, 95% CI: 3.8-4.2). The analysis included 22 178 matched controls. Compared with lower potency statins, higher potency statins were associated with an increased rate of HCAP (HR: 1.14, 95% CI: 1.03-1.27). Higher potency statins were also associated with an increased rate of fatal HCAP (HR: 1.29, 95% CI: 1.04-1.59).Higher potency statins were not associated with a decreased risk of HCAP compared with lower potency statins.

Published
2017

38. Estimation of high‐dimensional propensity scores with multiple exposure levels.

Author

Eberg, Maria, Platt, Robert W., Reynier, Pauline, and Filion, Kristian B.

Abstract

Purpose Little information is available on the performance of high‐dimensional propensity scores (HDPS) in settings with more than two exposure levels. Our objective was to adapt the HDPS algorithm to allow for the inclusion of multilevel treatments and compare estimates obtained via this approach with those obtained via pairwise comparisons in a case study using real‐world data. Methods: We conducted a retrospective cohort study of cardiovascular events associated with three smoking cessation drugs (varenicline, bupropion, nicotine replacement therapy [NRT]) using the Clinical Practice Research Datalink. We applied the binary HDPS algorithm adjusted for pre‐specified and empirically‐selected covariates to cohorts formed by each treatment pair. We then constructed multinomial HDPS models on a cohort of new users of any of the three drugs, adjusting for predefined covariates and different combinations of empirically‐selected covariates. After trimming the area of non‐overlap of the HDPS distributions, the effects of the study drugs on cardiovascular events were estimated with the Cox proportional hazards models adjusted for propensity score category. Results: Outcome models adjusted for multinomial HDPS estimated treatment effects that were slightly more protective than those estimated in pairwise comparisons (varenicline vs NRT: HRMultinomial = 0.60‐0.62, HRPairwise = 0.64; bupropion vs NRT: HRMultinomial = 0.70‐0.72, HRPairwise = 0.76). Trimming rates were similar between the two approaches. Conclusions: The extension of HDPS to multilevel exposures is a valid and practical approach to confounder control that may be useful when comparing different classes of drugs prescribed for the same indication or different molecules within a given drug class. [ABSTRACT FROM AUTHOR]

Published
2020
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40. Confounding by Drug Formulary Restriction in Pharmacoepidemiologic Research

Author

Filion, Kristian B., Eberg, Maria, and Ernst, Pierre

Subjects
Databases, Factual, Pharmacoepidemiology, Quebec, Confounding Factors, Epidemiologic, Formularies as Topic, Article, Asthma, Fluticasone-Salmeterol Drug Combination, Bronchodilator Agents, Cohort Studies, Hospitalization, Pulmonary Disease, Chronic Obstructive, Drug Utilization Review, Outcome Assessment, Health Care, Humans, Mortality, Retrospective Studies
Abstract

The potential consequences of confounding due to drug formulary restrictions in pharmacoepidemiologic research remain incompletely understood. Our objective was to illustrate this potential bias using the example of fluticasone/salmeterol combination therapy, an oral inhaler used to treat asthma and chronic obstructive pulmonary disease, whose use is restricted in the province of Quebec, Canada.We identified all new users of fluticasone/salmeterol in Quebec's administrative databases and classified those who received their initial dispensing of fluticasone/salmeterol between 1 September 1999 and 30 September 2003 as users from the liberal period and those who received it between 1 January 2004 and 31 October 2006 as users from the restricted period. The primary outcome was time to first hospitalization for respiratory causes within 12 months of cohort entry.Our cohort included 72 154 new users from the liberal period and 5058 from the restricted period. Compared with use during the liberal period, use during the restricted period was associated with an increased rate of hospitalization for respiratory causes (crude hazard ratio [HR] = 1.41, 95% confidence interval [CI] = 1.32, 1.51). Subsequent adjustment for age, sex, and hospitalization for respiratory causes in the previous year attenuated the association (HR = 1.05, 95%CI = 0.98, 1.12). Further adjustment for other potential confounders resulted in a lower rate during the restricted period (HR = 0.78, 95%CI = 0.73, 0.83).Formulary restrictions can result in substantial and unexpected confounding and should be considered during the design and analysis of pharmacoepidemiologic studies.

Published
2015

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