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Medical Practice Evaluation Center
The Medical Practice Evaluation Center is an interdivisional center dedicated to improving clinical outcomes, increasing value in health policy, and informing global public health through innovative research, collaboration, and education.
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.
Many Medical Practice Evaluation Center research projects utilize the CEPAC (Cost-Effectiveness of Preventing AIDS Complications) model, which simulates a large cohort of patients. For more information on the model, please visit our CEPAC page.
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.
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.
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.
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.
MPEC investigators 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.
Medical Practice Evaluation Center team members are also involved in developing models aside from the CEPAC model. One such model simulates HIV transmission in prevention trials conducted in resource-limited settings. Other models investigate questions around Type 2 Diabetes, drug allergy, tobacco-related diseases, and travel medicine.
Researchers at MPEC MPEC have developed PREDICT-DM (Projection and Evaluation of Disease Interventions, Complications, and Treatments – Diabetes Mellitus), a novel model used to project and evaluate Type 2 Diabetes progression, complications, and treatments. The model incorporates findings from recent randomized clinical trials and population studies of Type 2 Diabetes to evaluate clinical outcomes and has been internally validated (against the ACCORD trial) and externally validated (against the VADT trial). The model will be used to project the impact of alternative diabetes prevention and care and adherence strategies on clinical outcomes, lifetime costs of care, and the incremental cost-effectiveness.
The Drug Allergy Team evaluates true drug hypersensitivity and the impact of drug allergy labels, on patient and healthcare system outcomes by using methods of epidemiology, informatics, economics, and decisions science to study the harms of unverified penicillin allergy labels, including inferior treatment for morbid infections, inferior prophylaxis for surgery, and increased risk of healthcare-associated infections. The Drug Allergy team also designed the Partners Penicillin Allergy Pathway, a uniform inpatient approach to beta-lactam allergy across Partners hospitals, and is studying the health outcome impacts of this innovative program.
As tobacco is now now a leading killer of people with HIV who are on ART, MPEC researchers have expanded the CEPAC model to reflect tobacco use and tobacco-related disease and mortality. We have published studies of the impact of tobacco smoking and smoking cessation on overall life expectancy and on lung cancer mortality among people with HIV. We are developing a detailed model of tobacco use behaviors, diseases, and treatments, with a goal of studying the cost-effectiveness of tobacco treatment and prevention interventions as well as newer, potential “harm reduction” products in people with HIV and in HIV-uninfected people.
MPEC investigators are are collaborating with the Global TravEpiNet Consortium to examine the clinical and economic impact of different aspects of the pretravel evaluation for US international travelers. This team demonstrated (details on the ANNALS MMR paper that got so much press…) Ongoing projects include analyses of attaining measles immunity via MMR vaccination and prescription of empiric antibiotics for traveler's diarrhea. More information on Global TravEpiNet activities at MGH is available here.
Along with extensive modeling projects, Medical Practice Evaluation Center team members are also involved in the collection and analysis of primary data in a multitude of settings, including the South Africa and Uganda.
In South Africa, studies are assessing methods of HIV screening strategies and linkage to care, as well as long-term patterns of HIV care engagement. A new project will evaluate the impact of South Africa’s Central Chronic Medicine Dispensing and Distribution program. Other work in South Africa focuses on the effectiveness of providing healthcare services in community-based settings.
MPEC team members are collaborating with partners from the United Nations High Commissioner for Refugees (UNHCR) and Medical Teams International (MTI) to evaluate and improve engagement in HIV testing and clinical care for refugees living in Uganda. With our refugee-focused research collaboration in Uganda, we are collecting prospective data at three clinical sites in Nakivale Refugee Settlement. Our goal is to develop, implement and evaluate interventions to improve engagement in medical care for refugees and nationals in this unique humanitarian setting.
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