Benjamin Geisler

Publications

• 2.70

  Impact points

  Trauma and burn education: a global survey.

  David Zonies, Ronald V Maier, Ian Civil, Anas Eid, Benjamin P Geisler, Alejandro Guerrero, Charles Mock

  World journal of surgery. 03/2012; 36(3):548-55.

  The World Health Assembly recently adopted a resolution to urge improved competency in the provision of injury care through medical education. This survey sought to investigate trauma education experience and competency among final year medical students worldwide. An Internet survey was distributed ... [more] The World Health Assembly recently adopted a resolution to urge improved competency in the provision of injury care through medical education. This survey sought to investigate trauma education experience and competency among final year medical students worldwide. An Internet survey was distributed to medical students and conducted from March 2008 to January 2009. Demographic data and questions pertaining to both instruction and attainment of specific skills in burn and trauma care were assessed. There were 776 responses from final year medical students in 77 countries, with at least 10 countries from each economic stratum. Over 93% of final year students reported receiving some form of trauma or burn training, with 79% reporting a minimum compulsory requirement. Students received theoretical instruction without practical exposure. Few felt prepared to undertake basic procedures, such as laceration repair (19%), vascular access (8%), or endotracheal intubation (21%). Over 99% agreed that trauma education should be mandatory, but only half felt prepared to provide basic care. Those from low income and low middle income countries felt better prepared to provide trauma care than students from high middle and high income countries. Trauma education and experience varies among medical students in different countries. Many critical concepts are not formally taught and practical experience with many basic procedures is often lacking. The present study confirms that the trauma care training received by medical students needs to be strengthened in countries at all economic levels.

• Determining health-related quality of life and health state utility values of urinary incontinence in women.

  Danielle Patterson, Benjamin P Geisler, Abraham Morse

  Female pelvic medicine & reconstructive surgery. 11/2011; 17(6):305-7.

  : Health-related quality-of-life estimates currently available for urinary incontinence have largely been derived from population-based studies without physician confirmation of diagnosis. The purpose of this study was to compare the health state utility values for urinary incontinence in women deri... [more] : Health-related quality-of-life estimates currently available for urinary incontinence have largely been derived from population-based studies without physician confirmation of diagnosis. The purpose of this study was to compare the health state utility values for urinary incontinence in women derived from EQ-5D questionnaires and visual analog scale (VAS) with the economic gold standard method, the Standard Gamble (SG) interview. : Subjects were approached for study participation after a diagnosis of stress or urge urinary incontinence was made by the attending urogynecologist. Twenty-eight patients completed the Sandvik Severity Index (SSI), EQ-5D, and VAS. They then participated in the SG conversation. : The median utility (interquartile range) for stress incontinence varied based on the methods: EQ-5D, 0.83 (0.23); VAS, 0.85 (0.15); and SG, 1.00 (0.01). There was a statistically significant difference between the SG assessment and the other 2 methods of assessing utility values, the EQ-5D and VAS in women with urodynamically demonstrated stress urinary incontinence (P = 0.0003 and P < 0.0001, respectively). In the combined group of women with urodynamically proven stress, urge, and mixed urinary incontinence, there was also a statistically significant difference between the SG and the generic methods of assessing utility values, the EQ-5D and VAS (P < 0.0001). Mean SSI scores were similar in women with stress incontinence (6.6 [23.5]) and in the combined group (7.9 [3.8]). : Previous studies may have underestimated the health-related quality of life of urinary incontinence.
• 3.03

  Impact points

  Perspectives on "early dialogue" between a manufacturer and health technology assessment agencies.

  Benjamin P Geisler

  Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. 06/2011; 14(4):607.
• 2.61

  Impact points

  Decision-analytic models to simulate health outcomes and costs in heart failure: a systematic review.

  Alexander Goehler, Benjamin P Geisler, Jennifer M Manne, Beate Jahn, Annette Conrads-Frank, Petra Schnell-Inderst, G Scott Gazelle, Uwe Siebert

  PharmacoEconomics. 05/2011; 29(9):753-69.

  Chronic heart failure (CHF) is a critical public health issue with increasing effect on the healthcare budgets of developed countries. Various decision-analytic modelling approaches exist to estimate the cost effectiveness of health technologies for CHF. We sought to systematically identify these mo... [more] Chronic heart failure (CHF) is a critical public health issue with increasing effect on the healthcare budgets of developed countries. Various decision-analytic modelling approaches exist to estimate the cost effectiveness of health technologies for CHF. We sought to systematically identify these models and describe their structures. We performed a systematic literature review in MEDLINE/PreMEDLINE, EMBASE, EconLit and the Cost-Effectiveness Analysis Registry using a combination of search terms for CHF and decision-analytic models. The inclusion criterion required 'use of a mathematical model evaluating both costs and health consequences for CHF management strategies'. Studies that were only economic evaluations alongside a clinical trial or that were purely descriptive studies were excluded. We identified 34 modelling studies investigating different interventions including screening (n = 1), diagnostics (n = 1), pharmaceuticals (n = 15), devices (n = 13), disease management programmes (n = 3) and cardiac transplantation (n = 1) in CHF. The identified models primarily focused on middle-aged to elderly patients with stable but progressed heart failure with systolic left ventricular dysfunction. Modelling approaches varied substantially and included 27 Markov models, three discrete-event simulation models and four mathematical equation sets models; 19 studies reported QALYs. Three models were externally validated. In addition to a detailed description of study characteristics, the model structure and output, the manuscript also contains a synthesis and critical appraisal for each of the modelling approaches. Well designed decision models are available for the evaluation of different CHF health technologies. Most models depend on New York Heart Association (NYHA) classes or number of hospitalizations as proxy for disease severity and progression. As the diagnostics and biomarkers evolve, there is the hope for better intermediate endpoints for modelling disease progression as those that are currently in use all have limitations.
• 4.41

  Impact points

  Use of observation care in US emergency departments, 2001 to 2008.

  Arjun K Venkatesh, Benjamin P Geisler, Jennifer J Gibson Chambers, Christopher W Baugh, J Stephen Bohan, Jeremiah D Schuur

  PloS one. 01/2011; 6(9):e24326.

  Observation care is a core component of emergency care delivery, yet, the prevalence of emergency department (ED) observation units (OUs) and use of observation care after ED visits is unknown. Our objective was to describe the 1) prevalence of OUs in United States (US) hospitals, 2) clinical condit... [more] Observation care is a core component of emergency care delivery, yet, the prevalence of emergency department (ED) observation units (OUs) and use of observation care after ED visits is unknown. Our objective was to describe the 1) prevalence of OUs in United States (US) hospitals, 2) clinical conditions most frequently evaluated with observation, and 3) patient and hospital characteristics associated with use of observation. Retrospective analysis of the proportion of hospitals with dedicated OUs and patient disposition after ED visit (discharge, inpatient admission or observation evaluation) using the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2001 to 2008. NHAMCS is an annual, national probability sample of ED visits to US hospitals conducted by the Center for Disease Control and Prevention. Logistic regression was used to assess hospital-level predictors of OU presence and polytomous logistic regression was used for patient-level predictors of visit disposition, each adjusted for multi-level sampling data. OU analysis was limited to 2007-2008. In 2007-2008, 34.1% of all EDs had a dedicated OU, of which 56.1% were under ED administrative control (EDOU). Between 2001 and 2008, ED visits resulting in a disposition to observation increased from 642,000 (0.60% of ED visits) to 2,318,000 (1.87%, p<.05). Chest pain was the most common reason for ED visit resulting in observation and the most common observation discharge diagnosis (19.1% and 17.1% of observation evaluations, respectively). In hospital-level adjusted analysis, hospital ownership status (non-profit or government), non-teaching status, and longer ED length of visit (>3.6 h) were predictive of OU presence. After patient-level adjustment, EDOU presence was associated with increased disposition to observation (OR 2.19). One-third of US hospitals have dedicated OUs and observation care is increasingly used for a range of clinical conditions. Further research is warranted to understand the quality, cost and efficiency of observation care.

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• Automating First- and Second-order Monte Carlo Simulations for Markov Models in TreeAge Pro

  B P Geisler

  01/2011: pages 917-30;

  ISBN: 978-953-307-691-1

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• 3.22

  Impact points

  Treating anemia in heart failure patients: a review of erythropoiesis-stimulating agents.

  Benjamin P Geisler

  Expert opinion on biological therapy. 08/2010; 10(8):1209-16.

  Prevalence of chronic heart failure (CHF) is increasing, and despite improvements in the past decade the prognosis in terms of mortality and health-related quality of life remains poor. Anemia is often found concomitantly in CHF patients. Erythropoiesis-stimulating agents (ESAs) are a new treatment ... [more] Prevalence of chronic heart failure (CHF) is increasing, and despite improvements in the past decade the prognosis in terms of mortality and health-related quality of life remains poor. Anemia is often found concomitantly in CHF patients. Erythropoiesis-stimulating agents (ESAs) are a new treatment option for these anemic CHF patients, promising to decrease mortality and hospitalizations, and increase health-related quality of life. CHF epidemiology is briefly discussed. Currently available clinical efficacy and safety data are critically appraised. Health care utilization by CHF patients, particularly hospitalizations, are reviewed in order predict cost-effectiveness of ESAs. TAKE HOME MESSAGES: The efficacy for the most pertinent endpoints has not been proven by a pivotal trial or a meta-analysis free of bias, and there might be increased cardiovascular events and cancer incidence rates above a currently unknown target value or with multiple doses. However, subgroups should be identified in which ESAs might prove to be more efficacious and as safe as usual care and either cost-saving or cost-effective. Nevertheless, depending on the subgroup, the budget effect for payors might be dramatic due to the large number of CHF patients.
• 4.41

  Impact points

  Estimates of electronic medical records in U.S. Emergency departments.

  Benjamin P Geisler, Jeremiah D Schuur, Daniel J Pallin

  PloS one. 01/2010; 5(2):e9274.

  Policymakers advocate universal electronic medical records (EMRs) and propose incentives for "meaningful use" of EMRs. Though emergency departments (EDs) are particularly sensitive to the benefits and unintended consequences of EMR adoption, surveillance has been limited. We analyze data f... [more] Policymakers advocate universal electronic medical records (EMRs) and propose incentives for "meaningful use" of EMRs. Though emergency departments (EDs) are particularly sensitive to the benefits and unintended consequences of EMR adoption, surveillance has been limited. We analyze data from a nationally representative sample of US EDs to ascertain the adoption of various EMR functionalities. We analyzed data from the National Hospital Ambulatory Medical Care Survey, after pooling data from 2005 and 2006, reporting proportions with 95% confidence intervals (95% CI). In addition to reporting adoption of various EMR functionalities, we used logistic regression to ascertain patient and hospital characteristics predicting "meaningful use," defined as a "basic" system (managing demographic information, computerized provider order entry, and lab and imaging results). We found that 46% (95% CI 39-53%) of US EDs reported having adopted EMRs. Computerized provider order entry was present in 21% (95% CI 16-27%), and only 15% (95% CI 10-20%) had warnings for drug interactions or contraindications. The "basic" definition of "meaningful use" was met by 17% (95% CI 13-21%) of EDs. Rural EDs were substantially less likely to have a "basic" EMR system than urban EDs (odds ratio 0.19, 95% CI 0.06-0.57, p = 0.003), and Midwestern (odds ratio 0.37, 95% CI 0.16-0.84, p = 0.018) and Southern (odds ratio 0.47, 95% CI 0.26-0.84, p = 0.011) EDs were substantially less likely than Northeastern EDs to have a "basic" system. EMRs are becoming more prevalent in US EDs, though only a minority use EMRs in a "meaningful" way, no matter how "meaningful" is defined. Rural EDs are less likely to have an EMR than metropolitan EDs, and Midwestern and Southern EDs are less likely to have an EMR than Northeastern EDs. We discuss the nuances of how to define "meaningful use," and the importance of considering not only adoption, but also full implementation and consequences.

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• Leadership in health care: developing a post-merger strategy for Europe's largest university hospital.

  B P Geisler, K F Widerberg, A Berghöfer, S N Willich

  Journal of health organization and management. 01/2010; 24(3):258-76.

  This paper's aim is to identify existing and developing new concepts of organization, management, and leadership at a large European university hospital; and to evaluate whether mixed qualitative-quantitative methods with both internal and external input can provide helpful views of the possible... [more] This paper's aim is to identify existing and developing new concepts of organization, management, and leadership at a large European university hospital; and to evaluate whether mixed qualitative-quantitative methods with both internal and external input can provide helpful views of the possible future of large health care providers. Using the Delphi method in semi-structured, semi-quantitative interviews, with managers and employees as experts, the authors performed a vertical and a horizontal internal analysis. In addition, input from innovative faculties in other countries was obtained through structured power questions. These two sources were used to create three final scenarios, which evaluated using traditional strategic planning methods. There is found a collaboration scenario in which faculty and hospital are separated; a split scenario which divides the organization into three independent hospitals; and a corporation scenario in which corporate activities are bundled in three separate entities. In complex mergers of knowledge-driven organizations, the employees of the own organization (in addition to external consultants) might be tapped as a knowledge resource to successful future business models. The paper uses a real world consulting case to present a new set of methods for strategic planning in large health care provider organizations.

• Adequacy of Dialysis in Inpatients

  Geisler BP, Mutter WP, S Wright, Roshan B, Sands K, MD Robert S. Brown

  IHI Annual Forum; 12/2009
• 3.03

  Impact points

  Health State Survey-Derived Utilities in Cost-Utility Analysis-A Call to Action.

  Benjamin P Geisler

  Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. 11/2009;

• Modeling Variability in Hepatocellular Carcinoma Growth

  Miksad RA, Geisler BP, Gaughan EM, Wei JL, Brennan DD, Lai KC, Stadler ZK, Gill BM, Lai M, Stuart KE

  AASLD 2009 Annual Liver Meeting; 11/2009
• 5.39

  Impact points

  Risk of bias in meta-analysis on erythropoietin-stimulating agents in heart failure.

  B P Geisler, R M van Dam, G S Gazelle, A Goehler

  Heart (British Cardiac Society). 09/2009; 95(15):1278-9; author reply 1279.

• Gesundheitsökonomische Evaluation der INH (interdisziplinäres Netzwerk Herzinsuffizienz)-Studie

  S. Mostardt, A. Neumann, G. Gelbrich, A. Göhler, U. Siebert, B. Geisler, S. Störk, G. Ertl, C. Angermann, J. Wasem

  Kongress der Deutschen Gesellschaft für Sozialmedizin und Prävention; 09/2009
• 16.23

  Impact points

  Additional factors that could improve cost-effectiveness of pharmacogenetic-guided dosing in warfarin therapy.

  Benjamin P Geisler, Jeffrey K Levin-Scherz

  Annals of internal medicine. 08/2009; 151(1):71; author reply 71.

• Cost-effectiveness and cost-utility of a heart failure management program

  A Neumann, S Mostardt, G Gelbrich, A Goehler, B Geisler, U Siebert, S Stork, G Ertl, C Angermann, J Wasem

  7th World Congress, International Health Economics Assocation; 07/2009

• THE IMPACT OF LEGISLATION AND PRICING ON GENERIC DRUG UTILIZATION: AN ANALYSIS OF 26 COUNTRIES

  E Patorno, A Margulis, S Cai, JJ Gagne, BP Geisler, Q Li, SW Lin, W Liu, K Palmsten, WP Yau, JM Polinski

  ISPOR 14th Annual International Meeting; 05/2009

  OBJECTIVES Across countries with varying political, socioeconomic and cultural environments, we sought to identify predictors of generic drug utilization. METHODS Data were collected from national and international regulatory agencies, MEDLINE and internet searches for 37 countries classified as “a... [more] OBJECTIVES Across countries with varying political, socioeconomic and cultural environments, we sought to identify predictors of generic drug utilization. METHODS Data were collected from national and international regulatory agencies, MEDLINE and internet searches for 37 countries classified as “advanced” or “emerging” economies by the International Monetary Fund: Argentina, Australia, Austria, Belgium, Brazil, Canada, China, Cyprus, Denmark, Finland, France, Germany, Greece, Iceland, India, Ireland, Israel, Italy, Japan, Luxembourg, Malta, Mexico, Netherlands, New Zealand, Norway, Portugal, Russia, San Marino, Singapore, Slovenia, South Korea, Spain, Sweden, Switzerland, Taiwan, United Kingdom, United States. We compared the presence of generic policies, first year of generic legislation, branded drug patent duration, proportion of generic drug utilization, and pricing for generics (government control, free market, or other), gross domestic product, and population across countries. Only independent variables with p<0.20 in univariate regression were included in the multivariate model: population, year of generic legislation, patent life, and pricing for generics (market vs. government control). RESULTS Of 37 countries, data was available for 26, 70% [Table 1]. Most countries enacted generic drug legislation in the 1990s, 9 (35%) introduced legislation before 1990, and 3 (12%) after 2000. Branded drug patent duration was 15-20 years for 65% of countries. Government controls the price for generic drugs in 17 countries (65%), 5 countries have free pricing, while for 4 countries both the government and the market play a role in the determination of generics’ price. At the univariate analysis, just population, year of generic legislation, patent life, and pricing for generics (market and mixed vs. government generic drug pricing system) had a p<0.20. The multivariate model revealed that among countries with generic drug laws, only free market and mixed generic pricing system, compared to government-controlled pricing, were associated with a significant increase in generic drug utilization (B=0.21, 95% CI 0.05, 0.37; p=0.02) [Table 2]. CONCLUSIONS Countries with free market or mixed (market and government) pricing policies had greater diffusion of generic drugs compared to countries with government pricing controls. Further investigation of other characteristics, namely the political and social climates that foster greater generic drug utilization is planned.
• 3.71

  Impact points

  Decision-analytic evaluation of the clinical effectiveness and cost-effectiveness of management programmes in chronic heart failure.

  Alexander Göhler, Annette Conrads-Frank, Stewart S Worrell, Benjamin P Geisler, Elkan F Halpern, Rainer Dietz, Stefan D Anker, G Scott Gazelle, Uwe Siebert

  European journal of heart failure : journal of the Working Group on Heart Failure of the European Society of Cardiology. 09/2008;

  BACKGROUND AND AIMS: While management programmes (MPs) for chronic heart failure (CHF) are clinically effective, their cost-effectiveness remains uncertain. Thus, this study sought to determine the cost-effectiveness of MPs. METHODS AND RESULTS: We developed a Markov model to estimate life expectanc... [more] BACKGROUND AND AIMS: While management programmes (MPs) for chronic heart failure (CHF) are clinically effective, their cost-effectiveness remains uncertain. Thus, this study sought to determine the cost-effectiveness of MPs. METHODS AND RESULTS: We developed a Markov model to estimate life expectancy, quality-adjusted life expectancy, lifetime costs, and the incremental cost-effectiveness of MPs as compared to standard care. Standard care was defined by the EuroHeart Failure Survey for Germany, MP efficacy was derived from our recent meta-analysis and cost estimates were based on the German healthcare system. For a population with a mean age 67 years (35% female) at onset of CHF, our model predicted an average quality-adjusted life expectancy of 2.64 years for standard care and 2.83 years for MP. MP yielded additional lifetime costs of euro1700 resulting in an incremental cost-utility ratio (ICUR) of euro8900 (95% CI: dominant to 177,100) per quality-adjusted life year (QALY) gained. Sensitivity analyses demonstrated that the ICUR was sensitive to age and sex. CONCLUSION: MPs increase life expectancy in patients with CHF by an average of 84 days and increase lifetime cost of care by approximately euro1700. MPs improve outcomes in a cost-effective manner, although they are not cost-saving on a lifetime horizon.

• Value of Information Analysis on Erythropoiesis-stimulating Agents in Anemic Heart Failure – Gauging the Value of Future Research Directions

  B P Geisler, U Siebert, G S Gazelle, D J Cohen, A Göhler

  30th Annual Meeting of the Society for Medical Decision Making Comparative Effectiveness Research: Practice and Policy; Challenges and Opportunities; 09/2008

  Purpose: In a model-based cost-utility analysis investigating the effect of erythropoiesis-stimulating agents (ESAs) in the treatment of anemic heart failure (HF) patients, we found the incremental cost-utility ratio of ESAs compared to standard therapy without treatment of anemia to be $35,900/QALY... [more] Purpose: In a model-based cost-utility analysis investigating the effect of erythropoiesis-stimulating agents (ESAs) in the treatment of anemic heart failure (HF) patients, we found the incremental cost-utility ratio of ESAs compared to standard therapy without treatment of anemia to be $35,900/QALY (95% credibility interval: $14,000/QALY to infinity). The results were sensitive to ESA costs and efficacy. Because of the remaining uncertainty we sought to elucidate the potential value of additional research. Methods: We used a probabilistic 5-state microsimulation Markov model based on hemoglobin strata that compares standard therapy without ESA to standard therapy plus use of ESA. Input parameters were derived from HF registries and trials including STAMINA-HFP, SOLVD, EPHESUS, Medicare reimbursement rates, and the published literature. The expected value of perfect information (EVPI) regarding all parameters was computed using a 2nd-order Monte Carlo simulation with 1,000 outside iterations that included 50,000 nested 1st-order MC-simulations per cycle. Expected Values of Partially Perfect Information (EVPPIs) were calculated in three-dimensional analyses with 50 iterations for the distributions representing the partially perfect information and using 1,000 2nd-order MC simulations with nested 50,000 1st order simulations. Results: Considering a population of 2.5 million eligible patients, a 3% discount rate, a technology duration time of 10 years, and willingness to pay (WTP) values of $50,000/QALY, $100,000/QALY, and $200,000/QALY, the population EVPIs were $7.09 billion, $8.70 billion, and $13.72 billion, respectively. The EVPPI for the same population and WTP values are $8.85 billion, $10.72 billion, and $17.33 billion for the clinical parameters employed in modeling (1.) the natural disease progression of HF, and (2.) treatment efficacy of ESAs in anemic HF patients, while it was insignificant for both the cost and health-related quality of life parameters. Conclusions: Potential avenues for further increasing the certainty about cost effectiveness of ESA treatment in anemic HF patients are: (1.) conducting cohort studies to elucidate the underlying epidemiological association between hemoglobin level and morbidity and mortality, and (2.) performing randomized controlled trials to assess the efficacy of ESA treatment. However, future research to better assess the health-related quality of life and cost parameters would increase the certainty around this decision only marginally.

• Erythropoiesis-stimulating Proteins in the Treatment of Anemic Heart Failure Patients – A Cost-utility Analysis

  A Göhler, B P Geisler, J J Kim, T Bower, I Khan, U Siebert, D J Cohen

  30th Annual Meeting of the Society for Medical Decision Making Comparative Effectiveness Research: Practice and Policy; Challenges and Opportunities; 09/2008

  Objectives: Previous studies have suggested that anemia is common in patients with heart failure (HF) and is associated with both impaired quality of life and prognosis. The goal of this study was to assess the economic burden of anemia in HF patients and the potential clinical benefits of treatment... [more] Objectives: Previous studies have suggested that anemia is common in patients with heart failure (HF) and is associated with both impaired quality of life and prognosis. The goal of this study was to assess the economic burden of anemia in HF patients and the potential clinical benefits of treatment with erythropoiesis stimulating agents (ESAs). Methods: Design: Cost-utility analysis using a 5-state microsimulation Markov Model. Data sources: Model parameters were based on the studies STAMINA-HFP, SOLVD, EPHESUS, Medicare reimbursement estimates, and published literature. Target population: Patients with HF and a Hb level of 12 g/dl or less. Intervention: Standard care for HF according to AHA/ACC guidelines vs. ESA for twelve months + standard care. Outcome measures: Quality-adjusted life-years gained (QALY), life-years gained (LYG), lifelong medical costs, and incremental cost-utility ratio (ICUR). Results: We estimated a life expectancy of 2.38 years or 1.69 QALYs for standard treatment and 2.41 life-years or 1.72 QALYs for standard treatment plus ESA. Costs were estimated to be $7,500 for standard treatment and $8,700 for standard treatment plus ESA. This resulted in an ICUR of $35,900/QALY (95% credibility interval: $14,000/QALY to infinity). The ICUR is sensitive to the relative treatment benefit and the costs of ESA. Conclusions: Based on our model, treatment of anemic CHF patients with ESA appears to be cost-effective when compared with other well-accepted medical interventions. However, these results assume that treatment of anemia in HF patients will produce the clinical benefits predicted by epidemiologic models, and should therefore be verified in RCTs.