Robert Kaplan

All Publications

• Efficacy and effectiveness studies of depression are not well-differentiated in the literature: a systematic review. BMJ evidence-based medicine Schmaling, K., Kaplan, R. M., Porzsolt, F. 2020

  Abstract

  BACKGROUND: In the literature on the treatment of depression, efficacy and effectiveness research have different purposes and should apply different research methodologies.OBJECTIVE: The purpose of the study was to review characteristics of depression treatment studies identified using efficacy or effectiveness search terms. We considered subject inclusion and exclusion criteria; numbers of subjects enrolled and the proportion in the primary analyses; inclusion of a Consolidated Standards of Reporting Trials (CONSORT) flow diagram; use of random assignment; use of placebo control conditions; lengths of treatment and follow-up; primary outcome variable; trial registration; journal impact factor.STUDY SELECTION: Studies indexed as efficacy AND 'real-world' AND depression or effectiveness AND 'real-world' AND depression in PubMed up to 18 May 2019.FINDINGS: 27 studies met the inclusion criteria: 13 effectiveness studies, 6 efficacy studies and 8 studies indexed as both effectiveness and efficacy. Studies identified as effectiveness, efficacy, or both differed on three outcome measures: the inclusion criteria were lengthier for efficacy than for effectiveness studies; efficacy studies were more likely to have a placebo control condition than effectiveness studies; and the journal impact factor was lower for effectiveness studies than for studies from the efficacy search or studies identified by both searches.CONCLUSIONS: Efficacy and effectiveness research hypothetically use different methodologies, but the efficacy and effectiveness literatures in the treatment of depression were comparable for most of the coded characteristics. The lack of distinguishable characteristics suggests that variably applied terminology may hinder efforts to narrow the gap between research and practice. PROSPERO REGISTRATION NUMBER: #CRD42019136840.

  View details for DOI 10.1136/bmjebm-2020-111337

  View details for PubMedID 32188642

• Questioning the Benefit of Statins for Low-Risk Populations-Medical Misinformation or Scientific Evidence?-Reply JAMA CARDIOLOGY Abramson, J., Kaplan, R. M., Redberg, R. F. 2020; 5 (2): 233

  View details for DOI 10.1001/jamacardio.2019.5123

  View details for Web of Science ID 000526818400020

  View details for PubMedID 31876926

• Association Between HEDIS Performance and Primary Care Physician Age, Group Affiliation, Training, and Participation in ACA Exchanges. Journal of general internal medicine Glassman, J. R., Hopkins, D. S., Bundorf, M. K., Kaplan, R. M., Ragavan, M. V., Glaseroff, A. n., Milstein, A. n. 2020

  Abstract

  There are a limited number of studies investigating the relationship between primary care physician (PCP) characteristics and the quality of care they deliver.To examine the association between PCP performance and physician age, solo versus group affiliation, training, and participation in California's Affordable Care Act (ACA) exchange.Observational study of 2013-2014 data from Healthcare Effectiveness Data and Information Set (HEDIS) measures and select physician characteristics.PCPs in California HMO and PPO practices (n = 5053) with part of their patient panel covered by a large commercial health insurance company.Hemoglobin A1c testing; medical attention nephropathy; appropriate treatment hypertension (ACE/ARB); breast cancer screening; proportion days covered by statins; monitoring ACE/ARBs; monitoring diuretics. A composite performance measure also was constructed.For the average 35- versus 75-year-old PCP, regression-adjusted mean composite relative performance scores were at the 60th versus 47th percentile (89% vs. 86% composite absolute HEDIS scores; p < .001). For group versus solo PCPs, scores were at the 55th versus 50th percentiles (88% vs. 87% composite absolute HEDIS scores; p < .001). The effect of age on performance was greater for group versus solo PCPs. There was no association between scores and participation in ACA exchanges.The associations between population-based care performance measures and PCP age, solo versus group affiliation, training, and participation in ACA exchanges, while statistically significant in some cases, were small. Understanding how to help older PCPs excel equally well in group practice compared with younger PCPs may be a fruitful avenue of future research.

  View details for DOI 10.1007/s11606-020-05642-3

  View details for PubMedID 31974901

• Long-Term Physical Exercise and Mindfulness Practice in an Aging Population. Frontiers in psychology Tang, Y., Fan, Y., Lu, Q., Tan, L., Tang, R., Kaplan, R. M., Pinho, M. C., Thomas, B. P., Chen, K., Friston, K. J., Reiman, E. M. 2020; 11: 358

  Abstract

  Previous studies have shown that physical exercise and mindfulness meditation can both lead to improvement in physical and mental health. However, it is unclear whether these two forms of training share the same underlying mechanisms. We compared two groups of older adults with 10 years of mindfulness meditation (integrative body-mind training, IBMT) or physical exercise (PE) experience to demonstrate their effects on brain, physiology and behavior. Healthy older adults were randomly selected from a large community health project and the groups were compared on measures of quality of life, autonomic activity (heart rate, heart rate variability, skin conductance response, respiratory amplitude/rate), immune function (secretory Immunoglobulin A, sIgA), stress hormone (cortisol) and brain imaging (resting state functional connectivity, structural differences). In comparison with PE, we found significantly higher ratings for the IBMT group on dimensions of life quality. Parasympathetic activity indexed by skin conductance response and high-frequency heart rate variability also showed more favorable outcomes in the IBMT group. However, the PE group showed lower basal heart rate and greater chest respiratory amplitude. Basal sIgA level was significantly higher and cortisol concentration was lower in the IBMT group. Lastly, the IBMT group had stronger brain connectivity between the dorsal anterior cingulate cortex (dACC) and the striatum at resting state, as well as greater volume of gray matter in the striatum. Our results indicate that mindfulness meditation and physical exercise function in part by different mechanisms, with PE increasing physical fitness and IBMT inducing plasticity in the central nervous systems. These findings suggest combining physical and mental training may achieve better health and quality of life results for an aging population.

  View details for DOI 10.3389/fpsyg.2020.00358

  View details for PubMedID 32300317

• Recommendations for cancer screening would be different if we measured endpoints that are valid, reliable, specific, and important to patients. Cancer causes & control : CCC Porzsolt, F. n., Matosevic, R. n., Kaplan, R. M. 2020

  Abstract

  Despite enthusiasm for cancer screening, systematic reviews consistently fail to show that screening reduces all-cause mortality. This narrative review explores conceptual issues, and inconsistencies between evidence and opinion about screening.We examined the interpretation of screening studies in relation to three intellectual traditions: (1) The relationship between prevention and cure; (2) Confirmation bias and the challenge of incorporating new data: less care may produce better outcomes than more care; (3) The answers to three structured questions about efficacy, effectiveness, and value of treatments proposed by Sir Archie Cochrane and Sir Austin Bradford Hill.When considering extensions of life expectancy or all-cause mortality, systematic reviews typically show cancer screening to have only small effects and often non-significant effects on all-cause mortality. Early diagnosis does not assure application of an intervention that alters the pathway toward demise. The interpretation of screening results is also affected by several known biases. Investigators and advocates are encumbered by an over focus on studies designed to determine if a treatment can work under ideal circumstances. To advance the field, we need a greater emphasis on evaluations that ask 'Does the treatment work under real-world conditions?', and 'Is the treatment worth it?' in terms of outcomes that are meaningful to patients.

  View details for DOI 10.1007/s10552-020-01309-w

  View details for PubMedID 32415530

• Questioning the Benefit of Statins for Low-risk Populations-Medical Misinformation or Scientific Evidence? JAMA cardiology Abramson, J., Kaplan, R. M., Redberg, R. F. 2019

  View details for DOI 10.1001/jamacardio.2019.5117

  View details for PubMedID 31876932

• Impact of Baseline Fatigue on a Physical Activity Intervention to Prevent Mobility Disability. Journal of the American Geriatrics Society Glynn, N. W., Gmelin, T., Santanasto, A. J., Lovato, L. C., Lange-Maia, B. S., Nicklas, B. J., Fielding, R. A., Manini, T. M., Myers, V. H., de Rekeneire, N., Spring, B. J., Pahor, M., King, A. C., Rejeski, W. J., Newman, A. B., Lifestyle Interventions and Independence for Elders Study Group, Pahor, M., Guralnik, J. M., Anton, S. D., Buford, T. W., Leeuwenburgh, C., Nayfield, S. G., Manini, T. M., Caudle, C., Crump, L., Holmes, L., Lee, J., Lu, C., Miller, M. E., Espeland, M. A., Ambrosius, W. T., Applegate, W., Beavers, D. P., Byington, R. P., Cook, D., Furberg, C. D., Harvin, L. N., Henkin, L., Hepler, J., Hsu, F., Joyce, K., Lovato, L., Pierce, J., Roberson, W., Robertson, J., Rushing, J., Rushing, S., Stowe, C. L., Walkup, M. P., Hire, D., Rejeski, W. J., Katula, J. A., Brubaker, P. H., Mihalko, S. L., Jennings, J. M., Chen, S., Pierce, J. J., Chen, H., Hadley, E. C., Romashkan, S., Patel, K. V., Bethesda, Bonds, D., McDermott, M. M., Spring, B., Hauser, J., Kerwin, D., Domanchuk, K., Graff, R., Rego, A., Church, T. S., Blair, S. N., Myers, V. H., Monce, R., Britt, N. E., Harris, M. N., McGucken, A. P., Rodarte, R., Millet, H. K., Tudor-Locke, C., Butitta, B. P., Donatto, S. G., Cocreham, S. H., King, A. C., Castro, C. M., Haskell, W. L., Stafford, R. S., Pruitt, L. A., Yank, V., Berra, K., Bell, C., Thiessen, R. M., Youngman, K. P., Virgen, S. B., Maldonado, E., Tarin, K. N., Klaftenegger, H., Prosak, C. A., Campero, I., Garcia, D. M., Soto, J., Chio, L., Hoskins, D., Fielding, R. A., Nelson, M. E., Folta, S. C., Phillips, E. M., Liu, C. K., McDavitt, E. C., Reid, K. F., Kirn, D. R., Pasha, E. P., Kim, W. S., Krol, J. M., Beard, V. E., Tsiroyannis, E. X., Hau, C., Manini, T. M., Pahor, M., Anton, S. D., Buford, T. W., Marsiske, M., Nayfield, S. G., Sandesara, B. D., Black, M. L., Burk, W. L., Hoover, B. M., Knaggs, J. D., Marena, W. C., Korytov, I., Curtis, S. D., Lorow, M. S., Goswami, C. S., Lewis, M. A., Kamen, M., Bitz, J. N., Stanton, B. K., Hicks, T. T., Gay, C. W., Xie, C., Morris, H. L., Singletary, F. F., Causer, J., Yonce, S., Radcliff, K. A., Smith, M. P., Scott, J. S., Rodriguez, M. M., Fitch, M. S., Dunn, M. C., Schllesinger, J. Q., Newman, A. B., Studenski, S. A., Goodpaster, B. H., Lopez, O., Glynn, N. W., Nadkarni, N. K., Ives, D. G., Newman, M. A., Grove, G., Williams, K., Bonk, J. T., Rush, J., Kost, P., Vincent, P., Gerger, A., Romeo, J. R., Monheim, L. C., Kritchevsky, S. B., Marsh, A. P., Brinkley, T. E., Demons, J. S., Sink, K. M., Kennedy, K., Shertzer-Skinner, R., Wrights, A., Fries, R., Barr, D., Gill, T. M., Axtell, R. S., Kashaf, S. S., de Rekeneire, N., McGloin, J. M., Mautner, R., Huie-White, S. M., Bianco, L., Zocher, J., Wu, K. C., Shepard, D. M., Fennelly, B., Castro, R., Halpin, S., Brennan, M., Barnett, T., Iannone, L. P., Zenoni, M. A., Bugaj, J. A., Bailey, C., Charpentier, P., Hawthorne-Jones, G., Mignosa, B., Lewis, L., Williamson, J., Sink, K. M., Hendrie, H. C., Rapp, S. R., Verghese, J., Woolard, N., Espeland, M., Jennings, J., Wilson, V. K., Pepine, C. J., Ariet, M., Handberg, E., Deluca, D., Hill, J., Szady, A., Chupp, G. L., Flynn, G. M., Gill, T. M., Hankinson, J. L., Vaz Fragoso, C. A., Groessl, E. J., Kaplan, R. M. 2019

  Abstract

  OBJECTIVES: Our aim was to examine the impacts of baseline fatigue on the effectiveness of a physical activity (PA) intervention to prevent major mobility disability (MMD) and persistent major mobility disability (PMMD) in participants from the Lifestyle Interventions and Independence for Elders (LIFE) study.DESIGN: Prospective cohort of individuals aged 65years or older undergoing structured PA intervention or health education (HE) for a mean of 2.6years.SETTING: LIFE was a multicenter eight-site randomized trial that compared the efficacy of a structured PA intervention with an HE program in reducing the incidence of MMD.PARTICIPANTS: Study participants (N=1591) at baseline were 78.9±5.2years of age, with low PA and at risk for mobility impairment.MEASUREMENTS: Self-reported fatigue was assessed using the modified trait version of the Exercise-Induced Feelings Inventory, a six-question scale rating energy levels in the past week. Responses ranged from 0 (none of the time) to 5 (all of the time). Total score was calculated by averaging across questions; baseline fatigue was based on the median split: 2 or higher=more fatigue (N=856) and lower than 2=less fatigue (N=735). Participants performed a usual-paced 400-m walk every 6months. We defined incident MMD as the inability to walk 400-m at follow-up visits; PMMD was defined as two consecutive walk failures. Cox proportional hazard models quantified the risk of MMD and PMMD in PA vs HE stratified by baseline fatigue adjusted for covariates.RESULTS: Among those with higher baseline fatigue, PA participants had a 29% and 40% lower risk of MMD and PMMD, respectively, over the trial compared with HE (hazard ratio [HR] for MMD=.71; 95% confidence interval [CI] =.57-.90; P=.004) and PMMD (HR=.60; 95% CI=.44-.82; P=.001). For those with lower baseline fatigue, no group differences in MMD (P=.36) or PMMD (P=.82) were found. Results of baseline fatigue by intervention interaction was MMD (P=.18) and PMMD (P=.05).CONCLUSION: A long-term moderate intensity PA intervention was particularly effective at preserving mobility in older adults with higher levels of baseline fatigue.

  View details for DOI 10.1111/jgs.16274

  View details for PubMedID 31867713

• Effects of Mental Health on the Costs of Care for Chronic Illnesses: In Reply. Psychiatric services (Washington, D.C.) Kaplan, R. M., Glassman, J. R., Milstein, A. 2019; 70 (12): 1183

  View details for DOI 10.1176/appi.ps.701203

  View details for PubMedID 31787061

• Comparison of Rating Scale, Time Tradeoff, and Conjoint Analysis Methods for Assessment of Preferences in Prostate Cancer. Medical decision making : an international journal of the Society for Medical Decision Making Kaplan, R. M., Crespi, C. M., Dahan, E., Saucedo, J. D., Pagan, C., Saigal, C. S. 2019: 272989X19873667

  Abstract

  Background. Conjoint analysis is widely used in studies of consumer preference but has only recently been applied to measure patient utilities for health outcomes. We compared the reliability, feasibility, and internal and predictive validity of conjoint scaling methods against better established rating scale and time tradeoff methods for assessing prostate cancer utilities in men at risk for prostate cancer. Methods. In total, 194 men who were biopsy negative for prostate cancer were randomly assigned to complete 2 preference assessment modules, either conjoint analysis and a rating scale module or conjoint analysis and a time tradeoff module. Each participant's most important attribute was identified and evaluated in relation to age group (age <65, age 65 and older), education (high school, some college, college graduate), race/ethnicity (white, black, Latino), and relationship status (in significant relationship v. not). The methods were also evaluated in terms of ease of use and satisfaction. Results. Rating scales were rated as easiest to use and respondents were more satisfied with rating scales and conjoint in comparison to time tradeoffs. Rating scales and conjoint measures demonstrated significantly higher internal validity compared to time tradeoff when evaluated through R2 of the fitted utility function. The 3 methods were similar in terms of predictive validity, but conjoint analysis outperformed the rating scale method when patients were presented with novel combinations of attribute levels (68% correct v. 43%, P = 0.003). Conclusions. Rating scales and conjoint analysis exercises offer greater ease of use and higher satisfaction when measuring patient preferences in men biopsied for prostate cancer in comparison to time tradeoff exercises. Conjoint analysis may be a more robust approach to preference measurement for men at risk for prostate cancer.

  View details for DOI 10.1177/0272989X19873667

  View details for PubMedID 31556793

• A Budget Impact Analysis of the Collaborative Care Model for Treating Opioid Use Disorder in Primary Care JOURNAL OF GENERAL INTERNAL MEDICINE Lee, C., Scheuter, C., Rochlin, D., Platchek, T., Kaplan, R. M. 2019; 34 (9): 1693–94

  View details for DOI 10.1007/s11606-019-04998-5

  View details for Web of Science ID 000483539200011

• Effects of Mental Health on the Costs of Care for Chronic Illnesses. Psychiatric services (Washington, D.C.) Kaplan, R. M., Glassman, J. R., Millstein, A. 2019: appips201900098

  Abstract

  OBJECTIVE: The study examined whether comorbid low mental health functioning inflates the cost of treating a chronic disease.METHODS: Data were from the 2015 Medical Expenditure Panel Survey (N=33,893). Costs were estimated from medical records and self-reported health care use. The mental component summary (MCS) score of the 12-item Short Form (SF-12) was used as a measure of mental health status. A general linear model estimated costs with fixed effects for chronic disease (present or absent) and mental health functioning (lowest, middle, and highest MCS score tertiles indicating low, middle, and high levels of mental health functioning, respectively). The SF-12 physical component summary score was a covariate. Eight conditions (arthritis, chronic obstructive pulmonary disease [COPD], high cholesterol, cancer, diabetes, stroke, coronary heart disease, and asthma) were analyzed separately.RESULTS: For each analysis, presence or absence of the chronic condition had a strong impact on cost. Lower mental health functioning also had a significant impact on cost. However, the interaction between mental health functioning and chronic disease diagnoses was statistically significant for only three conditions and accounted for only a small variation in cost. Sensitivity analyses using MCS score as a continuous variable, using a log10 transformation of the cost variable, and focusing only on persons with scores on the extreme low end did not significantly alter the conclusions.CONCLUSIONS: Contrary to expectation, the combination of poor mental functioning and chronic disease diagnosis did not have a strong synergistic effect on cost. Mental and general medical conditions appear to have independent effects on health care costs.

  View details for DOI 10.1176/appi.ps.201900098

  View details for PubMedID 31378194

• The role of economic analyses in promoting adoption of behavioral and psychosocial interventions in clinical settings. Health psychology : official journal of the Division of Health Psychology, American Psychological Association Jacobsen, P. B., Prasad, R., Villani, J., Lee, C., Rochlin, D., Scheuter, C., Kaplan, R. M., Freedland, K. E., Manber, R., Kanaan, J., Wilson, D. K. 2019; 38 (8): 680–88

  Abstract

  In this report, we offer three examples of how economic data could promote greater adoption of behavioral and psychosocial interventions in clinical settings where primary or specialty medical care is delivered to patients. The examples are collaborative care for depression, chronic pain management, and cognitive-behavioral therapy for insomnia. These interventions illustrate differences in the availability of cost and cost-effectiveness data and in the extent of intervention adoption and integration into routine delivery of medical care. Collaborative care has been widely studied from an economic perspective, with most studies demonstrating its relative cost-effectiveness per quality-adjusted life year (QALY) and some studies demonstrating its potential for cost neutrality or cost savings. The success of collaborative care for depression can be viewed as a model for how to promote greater adoption of other interventions, such as psychological therapies for chronic pain and insomnia. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

  View details for DOI 10.1037/hea0000774

  View details for PubMedID 31368752

• Economic analysis in behavioral health: Toward application of standardized methodologies. Health psychology : official journal of the Division of Health Psychology, American Psychological Association Kaplan, R. M., Gold, M., Duffy, S. Q., Miller, N., Glassman, J. R., Chambers, D. A., Ganiats, T. G., Berndt, S., Wilson, D. K. 2019; 38 (8): 672–79

  Abstract

  Health care remains the most expensive sector in the U.S. economy, now accounting for nearly 1 in every 5 dollars spent. The purpose of health care is to improve the health of populations. However, formal medical care is one of many alternatives for improving health. In order to make better use of scarce resources, cost-effectiveness methodologies have been developed to evaluate how to produce the most health within the constraints of available resources. Standardized cost-effectiveness methodologies are now commonly used in the evaluation of medical therapies and new technologies. However, these methods have rarely been employed for the evaluation of behavioral interventions. Behavioral interventions often use measures that are not generally applied in other areas of health outcomes research. A consequence of neglecting to employ standardized cost-effectiveness analysis is that behavioral, psychological, and environmental interventions may be left out of resource allocation discussions. The purpose of this paper is to review standardized approaches to cost-effectiveness analysis and to encourage their use for the evaluation of behavioral intervention programs. Application of standardized methods of cost-effectiveness analysis will allow direct comparisons between investing in behavioral interventions programs in comparison to a wide range of other alternatives. The methods are general and can be used to estimate the cost-effectiveness of social and environmental interventions in addition to traditional medical and surgical treatments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

  View details for DOI 10.1037/hea0000769

  View details for PubMedID 31368751

• Standards for economic analyses of interventions for the field of health psychology and behavioral medicine. Health psychology : official journal of the Division of Health Psychology, American Psychological Association Wilson, D. K., Christensen, A., Jacobsen, P. B., Kaplan, R. M. 2019; 38 (8): 669–71

  Abstract

  Behavioral interventions can be offered within a wide range of contexts, including public health, medicine, surgery, physical rehabilitation, nutrition, and other health services. These differing services compete for the same resources and it is difficult to compare their value. Systematic standardized methodologies for valuing outcomes are available and are being applied by economists and health services researchers, but are not widely used in our field. With support from the Society for Health Psychology, the National Cancer Institute (NCI), and the Office for Behavioral and Social Sciences Research (OBSSR) at the National Institutes of Health, two working group meetings were held to consider the use of well-established cost-effectiveness methodologies for the evaluation of behavioral and public health interventions. In this special section, we acknowledge a wide range of variability in terms of behavioral interventions typically delivered in nonclinical versus more traditional clinical settings. Three articles address (1) standardizing methods for conducting cost-effectiveness and cost-utility analyses, (2) providing examples to illustrate progress in applying these methods to evaluate interventions delivered in whole or in part in clinical settings, and (3) providing nonclinical intervention examples selected to highlight the challenges and opportunities for evaluating the cost-effectiveness of interventions in more diverse settings. The ability of our field to communicate cost-effectiveness data to policy makers, employers, and insurers that incorporates implementation costs is central to the likelihood of our interventions being adopted by practitioners and reimbursed by payers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

  View details for DOI 10.1037/hea0000770

  View details for PubMedID 31368750

• Cost impact of sobering centers on national health care spending in the United States. Translational behavioral medicine Scheuter, C., Rochlin, D. H., Lee, C., Milstein, A., Kaplan, R. M. 2019

  Abstract

  Acute alcohol intoxication is responsible for a sizable share of emergency department visits. Intoxicated individuals without other medical needs may not require the high level of care provided by an emergency department. We estimate the impact on U.S. health care spending if individuals with uncomplicated, acute alcohol intoxication were treated in sobering centers instead of the emergency department. We performed a budget impact analysis from the perspective of the U.S. health care system based on published and gray literature reports. Ninety-five percent confidence intervals (CI) were estimated using Monte Carlo modeling with random variation for three variables (cost of an emergency department visit, cost of a sobering center visit, and start-up costs per sobering center visit) and the percentage of cases diverted from emergency departments to sobering centers. Outcomes were expressed in terms of national savings in 2017 U.S. dollars. Assuming a diversion rate of 50% based on previous studies, national savings range from $230 million to $1.0 billion annually. In the Monte Carlo modeling, we found annual national savings of $99.02 million (95% CI: $95.89-$102.19 million), $792.34 million (95% CI: $767.09-$817.58 million), and $1,185.51 million (95% CI: $1,150.64-$1,226.37 million) with diversion rates of 5%, 40%, and 60%, respectively. Implementing sobering centers as a treatment alternative for individuals with uncomplicated acute alcohol intoxication could yield substantial cost savings for the U.S. health care system.

  View details for DOI 10.1093/tbm/ibz075

  View details for PubMedID 31116401

• Contributions of Health Care to Longevity: A Review of 4 Estimation Methods. Annals of family medicine Kaplan, R. M., Milstein, A. 2019; 17 (3): 267–72

  Abstract

  PURPOSE: Health care expenditures and biomedical research funding are often justified by the belief that modern health care powerfully improves life expectancy in wealthy countries. We examined 4 different methods of estimating the effect of health care on health outcomes.METHODS: We reviewed the contributions of medical care to health outcomes using 4 methods: (1) analyses by McGinnis and Schroeder, (2) Wennberg and colleagues' studies of small area variation, (3) Park and colleagues' analysis of County Health Rankings and Roadmaps, and (4) the RAND Health Insurance Experiment.RESULTS: The 4 methods, using different data sets, produced estimates ranging from 0% to 17% of premature mortality attributable to deficiencies in health care access or delivery. Estimates of the effect of behavioral factors ranged from 16% to 65%.CONCLUSIONS: The results converge to suggest that restricted access to medical care accounts for about 10% of premature death or other undesirable health outcomes. Health care has modest effects on the extension of US life expectancy, while behavioral and social determinants may have larger effects.

  View details for PubMedID 31085531

• Contributions of Health Care to Longevity: A Review of 4 Estimation Methods ANNALS OF FAMILY MEDICINE Kaplan, R. M., Milstein, A. 2019; 17 (3): 267–72

  View details for DOI 10.1370/afm.2362

  View details for Web of Science ID 000467759600011

• A Budget Impact Analysis of the Collaborative Care Model for Treating Opioid Use Disorder in Primary Care. Journal of general internal medicine Lee, C. M., Scheuter, C., Rochlin, D., Platchek, T., Kaplan, R. M. 2019

  View details for PubMedID 31011978

• Economic Benefit of "Modern" Nonemergency Medical Transportation That Utilizes Digital Transportation Networks AMERICAN JOURNAL OF PUBLIC HEALTH Rochlin, D. H., Lee, C., Scheuter, C., Milstein, A., Kaplan, R. M. 2019; 109 (3): 472–74

  View details for DOI 10.2105/AJPH.2018.304857

  View details for Web of Science ID 000457864000048

• Economic Benefit of "Modern" Nonemergency Medical Transportation That Utilizes Digital Transportation Networks. American journal of public health Rochlin, D. H., Lee, C., Scheuter, C., Milstein, A., Kaplan, R. M. 2019: e1–e3

  Abstract

  OBJECTIVES: To determine the economic benefit of "modern" nonemergency medical transportation (NEMT) that utilizes digital transportation networks compared with traditional NEMT in the United States.METHODS: We used the National Academies' NEMT cost-effectiveness model to perform a baseline cost savings analysis for provision of NEMT for transportation-disadvantaged Medicaid beneficiaries. On the basis of a review of the literature, commercial information, and structured expert interviews, we performed a sensitivity analysis to determine the incremental economic benefit of using modern NEMT. We estimated confidence intervals (CIs) by using Monte Carlo simulation.RESULTS: Total annual net savings for traditional NEMT in Medicaid was approximately $4 billion. For modern NEMT, estimated savings on ride costs varied from 30% to 70%. In comparison with traditional, modern NEMT was estimated to save $268 per expected user (95% CI=$248, $288 per member per year) and $537 million annually (95% CI=$496 million, $577 million) when scaled nationally.CONCLUSIONS: Modern NEMT has the potential to yield greater cost savings than traditional NEMT while also improving patient experience. Public Health Implications: Barriers to NEMT are a health risk affecting high-need, economically disadvantaged patients. Economic arguments supporting modern NEMT are important given decreased support for human services spending. (Am J Public Health. Published online ahead of print January 24, 2019: e1-e3. doi:10.2105/AJPH.2018.304857).

  View details for PubMedID 30676791

• Physical Activity and Performance Impact Long-term Quality of Life in Older Adults at Risk for Major Mobility Disability AMERICAN JOURNAL OF PREVENTIVE MEDICINE Groessl, E. J., Kaplan, R. M., Rejeski, W., Katula, J. A., Glynn, N. W., King, A. C., Anton, S. D., Walkup, M., Lu, C., Reid, K., Spring, B., Pahor, M. 2019; 56 (1): 141–46

  View details for DOI 10.1016/j.amepre.2018.09.006

  View details for Web of Science ID 000453383700020

• METHODS FOR QUANTIFYING EFFICACY-EFFECTIVENESS GAP OF RANDOMIZED CONTROLLED TRIALS: EXAMPLES IN ARDS Adibuzzaman, M., Jung, Y., Bareinboim, E., Griffin, P., Kethireddy, S., Bikak, M., Kaplan, R. LIPPINCOTT WILLIAMS & WILKINS. 2019

  View details for Web of Science ID 000498593400292

• Physical Activity and Performance Impact Long-term Quality of Life in Older Adults at Risk for Major Mobility Disability. American journal of preventive medicine Groessl, E. J., Kaplan, R. M., Rejeski, W. J., Katula, J. A., Glynn, N. W., King, A. C., Anton, S. D., Walkup, M., Lu, C., Reid, K., Spring, B., Pahor, M. 2019; 56 (1): 141–46

  Abstract

  INTRODUCTION: Older adults are a rapidly growing segment of the U.S.POPULATION: Mobility problems that lead to further disability can be addressed through physical activity interventions. Quality of life outcome results are reported from a large trial of physical activity for sedentary older adults at risk for mobility disability.METHODS: Data were from the Lifestyle Interventions and Independence for Elders study. This multisite RCT compared physical activity to health education among 1,635 randomly assigned sedentary older adults at risk for mobility disability in 2010-2011. Measures included demographics; comorbidity; a timed 400-meter walk; the Short Physical Performance Battery; and the Quality of Well-Being Scale (0-1.0 scale). Baseline and long-term follow-up (2.6 years) health-related quality of life data were collected as a secondary outcome. Multivariate linear regression modeling was used to examine covariates of health-related quality of life over time in 2017.RESULTS: The sample had an overall mean Quality of Well-Being score of 0.613. Both groups declined in quality of life over time, but assignment to the physical activity intervention resulted in a slower decline in health-related quality of life scores (p=0.03). Intervention attendance was associated with higher health-related quality of life for both groups. Baseline characteristics including younger age, fewer comorbid conditions, non-white ethnicity, and faster 400-meter walk times were also associated with higher health-related quality of life over time.CONCLUSIONS: Declining mobility measured by physical performance is associated with lower quality of life in sedentary older adults. Physical activity interventions can slow the decline in quality of life, and targeting specific subgroups may enhance the effects of such interventions.

  View details for PubMedID 30573142

• Neural correlates of perceived physical and mental fatigability in older adults: A pilot study EXPERIMENTAL GERONTOLOGY Wasson, E., Rosso, A. L., Santanasto, A. J., Rosano, C., Butters, M. A., Rejeski, W., Boudreau, R. M., Aizenstein, H., Gmelin, T., Glynn, N. W., Pahor, M., Guralnik, J. M., Anton, S. D., Buford, T. W., Leeuwenburgh, C., Nayfield, S. G., Manini, T. M., Caudle, C., Crump, L., Holmes, L., Lee, J., Lu, C., Miller, M. E., Espeland, M. A., Ambrosius, W. T., Applegate, W., Beavers, D. P., Byington, R. P., Cook, D., Furberg, C. D., Harvin, L. N., Henkin, L., Hepler, J., Hsu, F., Joyce, K., Lovato, L., Pierce, J., Roberson, W., Robertson, J., Rushing, J., Rushing, S., Stowe, C. L., Walkup, M. P., Hire, D., Katula, J. A., Brubaker, P. H., Mihalko, S. L., Jennings, J. M., Hadley, E. C., Romashkan, S., Patel, K., Bonds, D., Mcdermott, M. M., Spring, B., Hauser, J., Kerwin, D., Domanchuk, K., Graff, R., Rego, A., Church, T. S., Blair, S. N., Myers, V. H., Monce, R., Britt, N. E., Harris, M., McGucken, A., Rodarte, R., Millet, H. K., Tudor-Locke, C., Butitta, B. P., Donatto, S. G., Cocreham, S. H., King, A. C., Castro, C. M., Haskell, W. L., Stafford, R. S., Pruitt, L. A., Yank, V., Berra, K., Bell, C., Thiessen, R. M., Youngman, K. P., Virgen, S. B., Maldonado, E., Tarin, K. N., Klaftenegger, H., Prosak, C. A., Campero, I., Garcia, D. M., Soto, J., Chio, L., Hoskins, D., Fielding, R. A., Nelson, M. E., Folta, S. C., Phillips, E. M., Liu, C. K., McDavitt, E. C., Reid, K. F., Kim, D. R., Pasha, E. P., Kim, W. S., Krol, J. M., Beard, V. E., Tsiroyannis, E. X., Hau, C., Marsiske, M., Sandesara, B. D., Black, M. L., Burk, W. L., Hoover, B. M., Knaggs, J. D., Marena, W. C., Korytov, I., Curtis, S. D., Lorow, M. S., Goswami, C. S., Lewis, M. A., Kamen, M., Bitz, J. N., Stanton, B. K., Hicks, T. T., Gay, C. W., Xie, C., Morris, H. L., Singletary, F. F., Causer, J., Yonce, S., Radcliff, K. A., Smith, M., Scott, J. S., Rodriguez, M. M., Fitch, M. S., Dunn, M. C., Schllesinger, J. Q., Newman, A. B., Studenski, S. A., Goodpaster, B. H., Lopez, O., Nadkarni, N. K., Ives, D. G., Newman, M. A., Grove, G., Williams, K., Bonk, J. T., Rush, J., Kost, P., Vincent, P., Gerger, A., Romeo, J. R., Monheim, L. C., Kritchevsky, S. B., Marsh, A. P., Brinkley, T. E., Demons, J. S., Sink, K. M., Kennedy, K., Shertzer-Skinner, R., Wrights, A., Fries, R., Barr, D., Gill, T. M., Axtell, R. S., Kashaf, S. S., de Rekeneire, N., McGloin, J. M., Mautner, R., Huie-White, S. M., Bianco, L., Zocher, J., Wu, K. C., Shepard, D. M., Fennelly, B., Castro, R., Halpin, S., Brennan, M., Barnett, T., Iannone, L. P., Zenoni, M. A., Bugaj, J. A., Bailey, C., Charpentier, P., Hawthorne-Jones, G., Mignosa, B., Lewis, L., Williamson, J., Hendrie, H. C., Rapp, S. R., Verghese, J., Woolard, N., Espeland, M., Jennings, J., Wilson, V. K., Pepine, C. J., Ariet, M., Handberg, E., Deluca, D., Hill, J., Szady, A., Chupp, G. L., Flynn, G. M., Hankinson, J. L., Fragoso, C., Groessl, E. J., Kaplan, R. M., LIFE Study Grp 2019; 115: 139–47

  Abstract

  This pilot work examined associations of brain grey matter volumes (GMV) with perceived fatigability in older adults to elucidate disablement mechanisms. A subsample (n = 29; age = 77.2 ± 5.5; 86% female) of participants from the Lifestyle Interventions and Independence for Elders (LIFE) Study was utilized to quantify GMV for regions of interest in the basal ganglia and limbic system normalized to intracranial volume. The Pittsburgh Fatigability Scale measured physical and mental fatigability (score 0-50; higher physical fatigability ≥ 15; higher mental fatigability ≥ 13). We used an exploratory alpha level of p < 0.1. Nineteen (66%) participants had higher physical fatigability, 19 (66%) had higher mental fatigability, of these, 17 (57%) had both. Right hippocampal volumes/ICV were smaller in participants with higher verses lower physical fatigability (0.261 ± 0.039 vs. 0.273 ± 0.022, p = 0.07); associations were similar for right putamen and bilateral thalamus. Higher mental fatigability was associated with smaller right hippocampus, thalamus, and posterior cingulum and bilateral amygdala. Higher fatigability in older adults may be associated with smaller volumes of the basal ganglia and limbic system, indicating mechanisms for further exploration.

  View details for DOI 10.1016/j.exger.2018.12.003

  View details for Web of Science ID 000455223100016

  View details for PubMedID 30528639

  View details for PubMedCentralID PMC6331252

• Effect of Hospitalizations on Physical Activity Patterns in Mobility-Limited Older Adults. Journal of the American Geriatrics Society Wanigatunga, A. A., Gill, T. M., Marsh, A. P., Hsu, F., Yaghjyan, L., Woods, A. J., Glynn, N. W., King, A. C., Newton, R. L., Fielding, R. A., Pahor, M., Manini, T. M., Lifestyles Intervention and Independence for Elders Study Investigators 2018

  Abstract

  OBJECTIVES: To evaluate the effect of hospitalizations on patterns of sedentary and physical activity time in mobility-limited older adults randomized to structured physical activity or health education.DESIGN: Secondary analysis of investigator-blinded, parallel-group, randomized trial conducted at 8 U.S. centers between February 2010 and December 2013.PARTICIPANTS: Sedentary men and women aged 70 to 89 at baseline who wore a hip-fitted accelerometer 7 consecutive days at baseline and 6, 12, and 24 months after randomization (N=1,341).MEASUREMENTS: Participants were randomized to a physical activity (PA; n = 669) intervention that included aerobic, resistance, and flexibility training or to a health education (HE; n = 672) intervention that consisted of workshops on older adult health and light upper-extremity stretching. Accelerometer patterns were characterized as bouts of sedentary (<100 counts/min; ≥1, ≥10, ≥30, ≥60 minute lengths) and activity (≥100 counts/min; ≥1, ≥2, ≥5, ≥10 minute lengths) time. Each participant was categorized as having 0, 1 to 3, or 4 or more cumulative hospital days before each accelerometer assessment.RESULTS: Hospitalization increased sedentary time similarly in both intervention groups (8 min/d for 1-3 cumulative hospital days and 16 min/d for ≥4 cumulative hospital days). Hospitalization was also associated with less physical activity time across all bouts of less than 10 minutes (≥1: -7 min/d for 1-3 cumulative hospital days, -16 min/d for ≥4 cumulative hospital days; ≥2: -5 min/d for 1-3 cumulative hospital days, -11 min/d for ≥4 cumulative hospital days; ≥5: -3 min/d for 1-3 cumulative hospital days, -4 min/d for ≥4 cumulative hospital days). There was no evidence of recovery to prehospitalization levels (time effect p >.41). PA participants had less sedentary time in bouts of less than 30 minutes than HE participants (-8 to -10 min/d) and more total activity (+3 to +6 min/d), although hospital-related changes were similar between the intervention groups (interaction effect p >.26).CONCLUSION: Participating in a PA intervention before hospitalization had expected benefits, but participants remained susceptible to hospitalization's detrimental effects on their daily activity levels. There was no evidence of better activity recovery after hospitalization.

  View details for PubMedID 30452084

• Systems Delivery Innovation for Alzheimer Disease. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry Bott, N. T., Sheckter, C. C., Yang, D., Peters, S., Brady, B., Plowman, S., Borson, S., Leff, B., Kaplan, R. M., Platchek, T., Milstein, A. 2018

  Abstract

  OBJECTIVE: The authors describe a comprehensive care model for Alzheimer disease (AD) that improves value within 1-3 years after implementation by leveraging targeted outpatient chronic care management, cognitively protective acute care, and timely caregiver support.METHODS: Using current best evidence, expert opinion, and macroeconomic modeling, the authors designed a comprehensive care model for AD that improves the quality of care while reducing total per capita healthcare spending by more than 15%. Cost savings were measured as reduced spending by payers. Cost estimates were derived from medical literature and national databases, including both public and private U.S. payers. All estimates reflect the value in 2015 dollars using a consumer price index inflation calculator. Outcome estimates were determined at year 2, accounting for implementation and steady-state intervention costs.RESULTS: After accounting for implementation and recurring operating costs of approximately $9.5 billion, estimated net cost savings of between $13 and $41 billion can be accomplished concurrently with improvements in quality and experience of coordinated chronic care ($0.01-$6.8 billion), cognitively protective acute care ($8.7-$26.6 billion), timely caregiver support ($4.3-$7.5 billion), and caregiver efficiency ($4.1-$7.2 billion).CONCLUSION: A high-value care model for AD may improve the experience of patients with AD while significantly lowering costs.

  View details for PubMedID 30477913

• Does information from ClinicalTrials.gov increase transparency and reduce bias? Results from a five-report case series SYSTEMATIC REVIEWS Adam, G. P., Springs, S., Trikalinos, T., Williams, J. W., Eaton, J. L., Von Isenburg, M., Gierisch, J. M., Wilson, L. M., Robinson, K. A., Viswanathan, M., Middleton, J., Forman-Hoffman, V. L., Berliner, E., Kaplan, R. M. 2018; 7: 59

  Abstract

  We investigated whether information in ClinicalTrials.gov would impact the conclusions of five ongoing systematic reviews.We considered five reviews that included 495 studies total. Each review team conducted a search of ClinicalTrials.gov up to the date of the review's last literature search, screened the records using the review's eligibility criteria, extracted information, and assessed risk of bias and applicability. Each team then evaluated the impact of the evidence found in ClinicalTrials.gov on the conclusions in the review.Across the five reviews, the number of studies that had both a registry record and a publication varied widely, from none in one review to 43% of all studies identified in another. Among the studies with both a record and publication, there was also wide variability in the match between published outcomes and those listed in ClinicalTrials.gov. Of the 173 total ClinicalTrials.gov records identified across the five projects, between 11 and 43% did not have an associated publication. In the 14% of records that contained results, the new data provided in the ClinicalTrials.gov records did not change the results or conclusions of the reviews. Finally, a large number of published studies were not registered in ClinicalTrials.gov, but many of these were published before ClinicalTrials.gov's inception date of 2000.Improved prospective registration of trials and consistent reporting of results in ClinicalTrials.gov would help make ClinicalTrials.gov records more useful in finding unpublished information and identifying potential biases. In addition, consistent indexing in databases, such as MEDLINE, would allow for better matching of records and publications, leading to increased utility of these searches for systematic review projects.

  View details for PubMedID 29661214

• AN UPDATE ON THE COST-EFFECTIVENESS WORKING GROUP ON METHODOLOGY, COLLABORATIVE CARE AND DISSEMINATION Wilson, D. K., Kaplan, R. M., Jacobsen, P., Riley, W. OXFORD UNIV PRESS INC. 2018: S430

  View details for Web of Science ID 000431185201257

• One In Five Fewer Heart Attacks: Impact, Savings, And Sustainability In San Diego County Collaborative. Health affairs (Project Hope) Fremont, A., Kim, A. Y., Bailey, K., Hanley, H. R., Thorne, C., Dudl, R. J., Kaplan, R. M., Shortell, S. M., DeMaria, A. N. 2018; 37 (9): 1457–65

  Abstract

  Before 2011 rates of hospitalization for heart attacks were about the same in San Diego County as they were in the rest of California. In 2011 a multistakeholder population health collaborative consisting of partners at the federal, state, and local levels launched Be There San Diego. The collaborative's goal was to reduce cardiovascular events through the spread of best practices aimed at improving control of hypertension, lipid levels, and blood sugar and through patient and medical community activation. Using hospital discharge data for the period 2007-16, we compared acute myocardial infarction (AMI) hospitalization rates in San Diego County and the rest of the state before and after the demonstration project started. AMI hospitalization rates decreased by 22percent in San Diego County versus 8percent in the rest of the state, with an estimated 3,826 AMI hospitalizations avoided and $86million in savings in San Diego. Results show that a science-based health collaborative can improve outcomes while lowering costs, and efforts are under way to ensure the collaborative's sustainability.

  View details for PubMedID 30179541

• Educational Attainment and Health Outcomes: Data From the Medical Expenditures Panel Survey HEALTH PSYCHOLOGY Kaplan, R. M., Fang, Z., Kirby, J. 2017; 36 (6): 598–608

  Abstract

  Using data from the nationally representative Medical Expenditures Panel Survey (MEPS), we explored the extent to which health care utilization and health risk-taking, together with previously examined mediators, can explain the education-health gradient above and beyond what can be explained by previously examined mediators such as age, race, and poverty status.Health was measured using the Physical Component Score (PCS) from the Medical Outcomes Study 12-Item Short Form (SF-12). Educational attainment was self-reported and categorized as 1 (less than high school), 2 (high school graduate or GED), 3 (some college), 4 (bachelor's degree), and 5 (graduate degree).In bivariate analysis, we found systematic graded relationships between educational attainment and health including, SF-12 PCS scores, self-rated health, and activity limitations. In addition, education was associated with having more office visits and outpatient visits and less risk tolerance. Those with less education were also more likely to be uninsured throughout the year. Multivariate regression analysis suggested that adjustment for age, race, poverty status and marital status explained part, but not nearly all, of the relationship between education and health. Adding a variety of variables on health care and attitudes to the models provided no additional explanatory power. This pattern of results persisted even after stratifying on the number of self-reported chronic conditions.Our findings provide no evidence that access to and use of health care explains the education-health gradient. However, more research is necessary to conclusively rule out medical care as a mediator between education and health. (PsycINFO Database Record

  View details for DOI 10.1037/hea0000431

  View details for Web of Science ID 000402052300010

  View details for PubMedID 28383926

• Reply to E.C. Winkler et al. Journal of clinical oncology Kaplan, R. M., Milstein, A. 2017; 35 (4): 468-?

  View details for DOI 10.1200/JCO.2016.69.4570

  View details for PubMedID 28129520

• NIH behavioral and social sciences research support: 1980-2016. The American psychologist Kaplan, R. M., Johnson, S. B., Kobor, P. C. 2017; 72 (8): 808–21

  Abstract

  The history of behavioral and social science research funding at the National Institutes of Health (NIH) between 1980 and 2016 is reviewed. Noncommunicable diseases are now the primary cause of death worldwide and most are strongly linked to behavior. Developed under the prevailing zeitgeist of the biomedical model, behavioral and social science has often been underfunded at NIH. In 1990, the Senate Appropriations Committee, recognizing that behavior may contribute to about half of all premature deaths, recommended that funding for behavioral and social sciences research should be about 10% of the NIH budget. NIH and American Psychological Association efforts to address this goal are described. Data from several sources suggest that this goal has never been realized. Patterns of federal funding for research may have a significant influence on scientific disciplines. Fields of study that have received more extramural funding are associated with greater growth in faculty and higher faculty salaries. A renewed effort to increase the federal investment in behavioral and social sciences research is necessary. (PsycINFO Database Record

  View details for PubMedID 29172582

• Cost-effectiveness of the LIFE Physical Activity Intervention for Older Adults at Increased Risk for Mobility Disability. journals of gerontology. Series A, Biological sciences and medical sciences Groessl, E. J., Kaplan, R. M., Castro Sweet, C. M., Church, T., Espeland, M. A., Gill, T. M., Glynn, N. W., King, A. C., Kritchevsky, S., Manini, T., McDermott, M. M., Reid, K. F., Rushing, J., Pahor, M. 2016; 71 (5): 656-662

  Abstract

  Losing the ability to walk safely and independently is a major concern for many older adults. The Lifestyle Interventions and Independence for Elders study recently demonstrated that a physical activity (PA) intervention can delay the onset of major mobility disability. Our objective is to examine the resources required to deliver the PA intervention and calculate the incremental cost-effectiveness compared with a health education intervention.The Lifestyle Interventions and Independence for Elders study enrolled 1,635 older adults at risk for mobility disability. They were recruited at eight field centers and randomly assigned to either PA or health education. The PA program consisted of 50-minute center-based exercise 2× weekly, augmented with home-based activity to achieve a goal of 150min/wk of PA. Health education consisted of weekly workshops for 26 weeks, and monthly sessions thereafter. Analyses were conducted from a health system perspective, with a 2.6-year time horizon.The average cost per participant over 2.6 years was US$3,302 and US$1,001 for the PA and health education interventions, respectively. PA participants accrued 0.047 per person more Quality-Adjusted Life-Years (QALYs) than health education participants. PA interventions costs were slightly higher than other recent PA interventions. The incremental cost-effectiveness ratios were US$42,376/major mobility disability prevented and US$49,167/QALY. Sensitivity analyses indicated that results were relatively robust to varied assumptions.The PA intervention costs and QALYs gained are comparable to those found in other studies. The ICERS are less than many commonly recommended medical treatments. Implementing the intervention in non-research settings may reduce costs further.

  View details for DOI 10.1093/gerona/glw001

  View details for PubMedID 26888433

• Cost-effectiveness of the LIFE Physical Activity Intervention for Older Adults at Increased Risk for Mobility Disability JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Groessl, E. J., Kaplan, R. M., Sweet, C. M., Church, T., Espeland, M. A., Gill, T. M., Glynn, N. W., King, A. C., Kritchevsky, S., Manini, T., McDermott, M. M., Reid, K. F., Rushing, J., Pahor, M. 2016; 71 (5): 656-662

  Abstract

  Losing the ability to walk safely and independently is a major concern for many older adults. The Lifestyle Interventions and Independence for Elders study recently demonstrated that a physical activity (PA) intervention can delay the onset of major mobility disability. Our objective is to examine the resources required to deliver the PA intervention and calculate the incremental cost-effectiveness compared with a health education intervention.The Lifestyle Interventions and Independence for Elders study enrolled 1,635 older adults at risk for mobility disability. They were recruited at eight field centers and randomly assigned to either PA or health education. The PA program consisted of 50-minute center-based exercise 2× weekly, augmented with home-based activity to achieve a goal of 150min/wk of PA. Health education consisted of weekly workshops for 26 weeks, and monthly sessions thereafter. Analyses were conducted from a health system perspective, with a 2.6-year time horizon.The average cost per participant over 2.6 years was US$3,302 and US$1,001 for the PA and health education interventions, respectively. PA participants accrued 0.047 per person more Quality-Adjusted Life-Years (QALYs) than health education participants. PA interventions costs were slightly higher than other recent PA interventions. The incremental cost-effectiveness ratios were US$42,376/major mobility disability prevented and US$49,167/QALY. Sensitivity analyses indicated that results were relatively robust to varied assumptions.The PA intervention costs and QALYs gained are comparable to those found in other studies. The ICERS are less than many commonly recommended medical treatments. Implementing the intervention in non-research settings may reduce costs further.

  View details for DOI 10.1093/gerona/glw001

  View details for Web of Science ID 000376398400015

• Financial Strain and Cancer Outcomes. Journal of clinical oncology : official journal of the American Society of Clinical Oncology Kaplan, R. M., Milstein, A. n. 2016; 34 (15): 1711–12

  View details for PubMedID 27022120