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Fernando Alarid-Escudero

Fernando Alarid-Escudero
Stanford University | SU · Stanford Health Policy (Center for Health Policy and Center for Primary Care and Outcomes Research)

Doctor of Philosophy

About

89
Publications
8,803
Reads
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817
Citations
Additional affiliations
November 2018 - present
Center for Research and Teaching in Economics (CIDE)
Position
  • Professor (Assistant)
September 2017 - August 2018
University of Minnesota Twin Cities
Position
  • PostDoc Position
Education
September 2012 - August 2017
University of Minnesota
Field of study
  • Health Decision Sciences
August 2007 - July 2009
September 2002 - July 2006
Metropolitan Autonomous University
Field of study
  • Biomedical Engineering

Publications

Publications (89)
Article
Most decisions are associated with uncertainty. Value of information (VOI) analysis quantifies the opportunity loss associated with choosing a suboptimal intervention based on current imperfect information. VOI can inform the value of collecting additional information, resource allocation, research prioritization, and future research designs. Howev...
Article
Full-text available
Background Clinical trials often report intervention efficacy in terms of the reduction in all-cause mortality between the treatment and control arms (i.e., an overall hazard ratio [oHR]) instead of the reduction in disease-specific mortality (i.e., a disease-specific hazard ratio [dsHR]). Using oHR to reduce all-cause mortality beyond the time hor...
Article
Full-text available
Purpose: Bayesian calibration is generally superior to standard direct-search algorithms in that it estimates the full joint posterior distribution of the calibrated parameters. However, there are many barriers to using Bayesian calibration in health decision sciences stemming from the need to program complex models in probabilistic programming lan...
Article
Helicobacter pylori ( H. pylori) is present in the stomach of half of the world's population. The force of infection describes the rate at which susceptibles acquire infection. In this article, we estimated the age-specific force of infection of H. pylori in Mexico. Data came from a national H. pylori seroepidemiology survey collected in Mexico in...
Article
In an introductory tutorial, we illustrated building cohort state-transition models (cSTMs) in R, where the state transition probabilities were constant over time. However, in practice, many cSTMs require transitions, rewards, or both to vary over time (time dependent). This tutorial illustrates adding 2 types of time dependence using a previously...
Article
Background Historically, correctional facilities have had large outbreaks of respiratory infectious diseases like COVID-19. Hence, importation and exportation of such diseases from correctional facilities raises substantial concern. Methods We developed a stochastic simulation model of transmission of respiratory infectious diseases within and bet...
Article
Decision models can combine information from different sources to simulate the long-term consequences of alternative strategies in the presence of uncertainty. A cohort state-transition model (cSTM) is a decision model commonly used in medical decision making to simulate the transitions of a hypothetical cohort among various health states over time...
Article
Full-text available
Purpose Analyzing and communicating uncertainty is essential in medical decision making. To judge whether risks are acceptable, policy makers require information on the expected outcomes but also on the uncertainty and potential losses related to the chosen strategy. We aimed to compare methods used to represent the impact of uncertainty in decisio...
Article
Full-text available
Background: We evaluated the implications of different approaches to characterize the uncertainty of calibrated parameters of microsimulation decision models (DMs) and quantified the value of such uncertainty in decision making. Methods: We calibrated the natural history model of CRC to simulated epidemiological data with different degrees of uncer...
Preprint
Full-text available
Decision models can combine information from different sources to simulate the long-term consequences of alternative strategies in the presence of uncertainty. Cohort state-transition models (cSTM) are decision models commonly used in medical decision-making to simulate hypothetical cohorts' transitions among various health states over time. This t...
Article
Full-text available
Background Prisons and jails are high-risk settings for COVID-19. Vaccines may substantially reduce these risks, but evidence is needed on COVID-19 vaccine effectiveness for incarcerated people, who are confined in large, risky congregate settings. Methods We conducted a retrospective cohort study to estimate effectiveness of mRNA vaccines, BNT162...
Article
Full-text available
Although people generally want to age in their community, individuals living with dementia are likely to move to a nursing home. In randomized trials, psychosocial interventions reduce the risk of people living with dementia transitioning to a nursing home, but the cost-effectiveness of these interventions is unknown. We used an evidence-based math...
Article
Full-text available
We describe associations of pretreatment drug resistance (PDR) with clinical outcomes such as remaining in care, loss to follow-up (LTFU), viral suppression, and death in Mexico, in real-life clinical settings. We analyzed clinical outcomes after a two-year follow up period in participants of a large 2017–2018 nationally representative PDR survey c...
Article
Objectives Adjuvant chemotherapy is not recommended for patients with average-risk stage II (T3N0) colon cancer. Nevertheless, a subgroup of these patients who are CDX2-negative might benefit from adjuvant chemotherapy. We evaluated the cost-effectiveness of testing for the absence of CDX2 expression followed by adjuvant chemotherapy (fluorouracil...
Article
Full-text available
Background. Mexico City Metropolitan Area (MCMA) has the largest number of COVID-19 (coronavirus disease 2019) cases in Mexico and is at risk of exceeding its hospital capacity in early 2021. Methods. We used the Stanford-CIDE Coronavirus Simulation Model (SC-COSMO), a dynamic transmission model of COVID-19, to evaluate the effect of policies consi...
Preprint
Full-text available
This tutorial shows how to implement time-dependent cohort state-transition models (cSTMs) to conduct cost-effectiveness analyses (CEA) in R, where transition probabilities and rewards vary by time. We account for two types of time dependency: time since the start of the simulation (simulation-time dependency) and time spent in a health state (stat...
Preprint
Full-text available
Background Prisons and jails are high-risk settings for COVID-19 transmission, morbidity, and mortality. COVID-19 vaccines may substantially reduce these risks, but evidence is needed of their effectiveness for incarcerated people, who are confined in large, risky congregate settings. Methods We conducted a retrospective cohort study to estimate ef...
Article
Full-text available
Background Residents of prisons have experienced disproportionate COVID-19-related health harms. To control outbreaks, many prisons in the USA restricted in-person activities, which are now resuming even as viral variants proliferate. This study aims to use mathematical modelling to assess the risks and harms of COVID-19 outbreaks in prisons under...
Article
Background Over the previous two decades, the lifetime prevalence of cannabis use has risen among Mexico’s population. Aims Estimate the sex- and age-specific rates of onset of cannabis use over time. Design Five nationally representative cross-sectional surveys, the Mexican National Surveys of Addictions (1998, 2002, 2008, 2012) and the Mexican...
Article
Background: Correctional institutions nationwide are seeking to mitigate COVID-19-related risks. Objective: To quantify changes to California's prison population since the pandemic began and identify risk factors for COVID-19 infection. Design: For California state prisons (March 1-October 10, 2020), we described residents' demographic charact...
Article
Introduction Guidelines for routine antibiotic prophylaxis (AP) before dental procedures to prevent periprosthetic joint infection (PJI) have been hampered by the lack of prospective clinical trials. Objectives To apply value-of-information (VOI) analysis to quantify the value of conducting further clinical research to reduce decision uncertainty...
Preprint
Full-text available
Background Residents of correctional facilities have experienced disproportionately higher rates of SARS-CoV-2 infection and Covid-19-related mortality. To protect against outbreaks, many prisons and jails imposed heavy restrictions on in-person activities, which are now beginning to lift. Uncertainty surrounds the safety of these moves. Methods a...
Preprint
Full-text available
Background: Correctional institutions nationwide are seeking to mitigate Covid-19-related risks. Objective: To quantify changes to California's prison population since the pandemic began and identify risk factors for Covid-19 infection. Design: We described residents' demographic characteristics, health status, Covid-19 risk scores, room occupancy,...
Article
Gastric cancer (GC) is a significant global health problem, with Helicobacter pylori infection estimated to be responsible for 89% of non-cardiac GC cases, or 78% of all GC cases. The International Agency for Research on Cancer has called for Helicobacter pylori test-and-treat strategies in countries with high rates of GC. However, for countries wi...
Preprint
Full-text available
Background With more than 20 million residents, Mexico City Metropolitan Area (MCMA) has the largest number of Covid-19 cases in Mexico and is at risk of exceeding its hospital capacity in late December 2020. Methods We used SC-COSMO, a dynamic compartmental Covid-19 model, to evaluate scenarios considering combinations of increased contacts durin...
Preprint
Full-text available
Background Over the previous two decades, the prevalence of cannabis use has risen among the population in Mexico. Aims To estimate the sex- and age-specific rates of onset of cannabis use over time. Design Time-to-event flexible parametric models with spline specifications of the hazard function. Stratified analysis by sex, and control for tempo...
Preprint
Full-text available
Published version: https://www.frontiersin.org/articles/10.3389/fphys.2021.662314/full Purpose: Bayesian calibration is theoretically superior to standard direct-search algorithm because it can reveal the full joint posterior distribution of the calibrated parameters. However, to date, Bayesian calibration has not been used often in health decisio...
Article
Full-text available
Background Although much of the public health effort to combat COVID-19 has focused on disease control strategies in public settings, transmission of SARS-CoV-2 within households remains an important problem. The nature and determinants of household transmission are poorly understood. Methods To address this gap, we gathered and analyzed data from...
Article
Background: Population-based metastatic recurrence rates for patients diagnosed with nonmetastatic colorectal cancer cannot be estimated directly from population-based cancer registries because recurrence information is not reported. We derived population-based colorectal cancer recurrence rates using disease-specific survival data based on our un...
Article
Full-text available
Background: Colorectal cancer (CRC) screening with colonoscopy and the fecal immunochemical test (FIT) is underutilized. Innovative tests could increase screening acceptance. This study determined which of the available alternatives is most promising from a cost-effectiveness perspective. Methods: The previously-validated MISCAN-Colon model was...
Article
Objective In 2007, the Ministry of Health (MoH) in Mexico implemented a multidisciplinary health-care model (MHC) for patients with type-2 diabetes (T2D), which has proven more effective in controlling this condition than the conventional health-care model (CHC). Research design and methods We compared the cost-effectiveness of the MHC vs. the CHC...
Chapter
This chapter discusses validation of simulation models used to inform health policy. Confidence in a model’s validity can be weaker or stronger depending on several factors. These factors include verifying whether model specifications were implemented correctly, evaluating the extent to which model-predicted results are consistent with empirical re...
Article
Full-text available
Purpose. In 2018, the US Preventive Services Task Force (USPSTF) endorsed three strategies for cervical cancer screening in women ages 30 to 65: cytology every 3 years, testing for high-risk types of human papillomavirus (hrHPV) every 5 years, and cytology plus hrHPV testing (co-testing) every 5 years. It further recommended that women discuss with...
Article
Value of information (VOI) analyses can help policy makers make informed decisions about whether to conduct and how to design future studies. Historically a computationally expensive method to compute the expected value of sample information (EVSI) restricted the use of VOI to simple decision models and study designs. Recently, 4 EVSI approximation...
Article
Background. Investing efficiently in future research to improve policy decisions is an important goal. Expected value of sample information (EVSI) can be used to select the specific design and sample size of a proposed study by assessing the benefit of a range of different studies. Estimating EVSI with the standard nested Monte Carlo algorithm has...
Article
Full-text available
Objective: Low-risk pregnant women cared for by midwives have similar birth outcomes to women cared for by physicians, although experiencing fewer medical procedures. However, limited research has assessed cost implications in the United States. Using national data, we assessed costs and resource use of midwife-led care vs obstetrician-led care fo...
Article
Full-text available
Cost-effectiveness analyses often rely on cohort state-transition models (cSTMs). The cohort trace is the primary outcome of cSTMs, which captures the proportion of the cohort in each health state over time (state occupancy). However, the cohort trace is an aggregated measure that does not capture information about the specific transitions among he...
Article
Background: The natural history of human papillomavirus (HPV)-induced cervical cancer (CC) is not directly observable, yet the age of HPV acquisition and duration of preclinical disease (dwell time) impacts the effectiveness of alternative preventive policies. We performed a Cancer Intervention and Surveillance Modeling Network (CISNET) comparativ...
Poster
Full-text available
In the past several decades, there has been significant progress in colorectal cancer (CRC) care, including treatment and post-treatment surveillance. Progress in overall care for CRC patients has led to substantial improvements in relative survival since the 1970s. The impact of CRC care advances on population-based distant disease recurrence in t...
Poster
Full-text available
Value of information (VOI) analyses can help policy-makers make more informed decisions about whether to conduct and how to design future studies. The Expected Value of Sample Information (EVSI) can be used to prioritize research and design future studies to reduce decision uncertainty for policy-makers. Four recently published methods have overcom...
Preprint
Full-text available
Objectives: Value of information (VOI) analyses can help policy-makers make informed decisions about whether to conduct and how to design future studies. Historically, a computationally expensive method to compute the Expected Value of Sample Information (EVSI) restricted the use of VOI to simple decision models and study designs. Recently, four EV...
Article
The use of open-source programming languages, such as R, in health decision sciences is growing and has the potential to facilitate model transparency, reproducibility, and shareability. However, realizing this potential can be challenging. Models are complex and primarily built to answer a research question, with model sharing and transparency rel...
Article
Objectives The 21-gene assay Oncotype DX (21-GA) shows promise as a guide in deciding when to initiate adjuvant chemotherapy in women with hormone receptor–positive early-stage breast cancer. Nevertheless, its routine use remains controversial, owing to insufficient evidence of its clinical utility and cost-effectiveness. Accordingly, we aim to qua...
Preprint
Full-text available
Cost-effectiveness analyses often rely on cohort state-transition models (cSTMs). The cohort trace is the primary outcome of cSTMs, which captures the proportion of the cohort in each health state over time (state occupancy). However, the cohort trace is an aggregated measure that does not capture the information about the specific transitions amon...
Preprint
Full-text available
We evaluated the implications of different approaches to characterize uncertainty of calibrated parameters of stochastic decision models (DMs) in the quantified value of such uncertainty in decision making. We used a microsimulation DM of colorectal cancer (CRC) screening to conduct a cost-effectiveness analysis (CEA) of a 10-year colonoscopy scree...
Preprint
Full-text available
Investing efficiently in future research to improve policy decisions is an important goal. Expected Value of Sample Information (EVSI) can be used to select the specific design and sample size of a proposed study by assessing the benefit of a range of different studies. Estimating EVSI with the standard nested Monte Carlo algorithm has a notoriousl...
Article
Importance Many cervical cancer screening strategies are now recommended in the United States, but the benefits, harms, and costs of each option are unclear. Objective To estimate the cost-effectiveness of 12 cervical cancer screening strategies. Design, Setting, and Participants The cross-sectional portion of this study enrolled a convenience sa...
Article
Background: Cost-effectiveness acceptability curves (CEACs) and the cost-effectiveness acceptability frontier (CEAF) are the recommended graphical representations of uncertainty in a cost-effectiveness analysis (CEA). Nevertheless, many limitations of CEACs and the CEAF have been recognized by others. Expected loss curves (ELCs) overcome these lim...
Article
Value of information (VOI) analysis quantifies the opportunity cost associated with decision uncertainty, and thus informs the value of collecting further information to avoid this cost. VOI can inform study design, optimal sample size selection, and research prioritization. Recent methodological advances have reduced the computational burden of co...
Article
Background: Following the recent publication of results from randomized trials that have demonstrated a survival benefit for the addition of docetaxel or abiraterone acetate to androgen deprivation therapy (ADT) in the treatment of metastatic prostate cancer, it is important to assess whether the benefits of treatment with these agents outweigh th...
Article
Background: Active surveillance (AS) has become the recommended management strategy for men with low-risk prostate cancer. However, there is considerable uncertainty about the optimal follow-up schedule in terms of the tests to perform and their frequency. Objective: To assess the costs and benefits of different AS follow-up strategies compared...
Presentation
Human papillomavirus transmission-dynamic mathematical models are used to evaluate and compare vaccination policies. However, most models only represent a heterosexual population. We found that a heterosexual-only model underestimates the number of infections in men prevented by male vaccination.
Article
Background. Calibration is the process of estimating parameters of a mathematical model by matching model outputs to calibration targets. In the presence of nonidentifiability, multiple parameter sets solve the calibration problem, which may have important implications for decision making. We evaluate the implications of nonidentifiability on the o...
Poster
Full-text available
The 21-gene assay Oncotype DX (ODX) helps chemotherapy decision-making for women with node-negative, estrogen-receptor-positive, human epidermal growth factor 2-negative breast cancer; however, routine ODX use for these patients is controversial. In addition, existing ODX cost-effectiveness analyses (CEAs) might incorporate inappropriate assumption...
Article
Background: Sexual mixing between heterogeneous population subgroups is an integral component of mathematical models of sexually transmitted infections (STIs). This study compares the fit of different mixing representations to survey data and the impact of different mixing assumptions on the predicted benefits of hypothetical human papillomavirus...
Article
Purpose: To perform a cost-effectiveness analysis of using Prostate Health Index (PHI), 4Kscore, SelectMDx and ExoDx Prostate IntelliScore (EPI) in men with an elevated PSA value to determine the need for biopsy. Methods: We developed a decision-analytic model for men with an elevated PSA values (≥ 3ng/mL) where one of the biomarker tests was to...
Article
Force of infection of Helicobacter pylori in Mexico: evidence from a national survey using a hierarchical Bayesian model – CORRIGENDUM - Volume 146 Issue 8 - F. Alarid-Escudero, E. A. Enns, R. F. MacLehose, J. Parsonnet, J. Torres, K. M. Kuntz
Article
Microsimulation models are becoming increasingly common in the field of decision modeling for health. Because microsimulation models are computationally more demanding than traditional Markov cohort models, the use of computer programming languages in their development has become more common. R is a programming language that has gained recognition...