Jagpreet Chhatwal

• PhD
• Professor (Assistant) at Harvard Medical School

Sofosbuvir and ledipasvir, which have recently been approved for treatment of chronic hepatitis C virus (HCV) infection, are more efficacious and safer than the old standard of care (oSOC) but are substantially more expensive. Whether and in which patients their improved efficacy justifies their increased cost is unclear. To evaluate the cost-effec...

Background: Chronic hepatitis C virus (HCV) infection causes a substantial health and economic burden in the United States. With the availability of direct-acting antiviral agents, recently approved therapies and those under development, and 1-time birth-cohort screening, the burden of this disease is expected to decrease. Objective: To predict...

Agent-based modelling (ABM) is a relatively new technique, which overcomes some of the limitations of other methods commonly used for economic evaluations. These limitations include linearity, homogeneity and stationarity. Agents in ABMs are autonomous entities, who interact with each other and with the environment. ABMs provide an inductive or 'bo...

Breast cancer is the most common non-skin cancer affecting women in the United States, where every year more than 20 million mammograms are performed. Breast biopsy is commonly performed on the suspicious findings on mammograms to confirm the presence of cancer. Currently, 700,000 biopsies are performed annually in the U.S.; 55%-85% of these biopsi...

10542 Background: Emerging liquid biopsy multi-cancer early detection (MCED) tests have the potential to revolutionize early cancer detection. Using a simulation model, we estimated their impact on cancer incidence and mortality in high-risk groups. Methods: We developed Simulation Model for MCED(SiMCED), a microsimulation model of 14 solid tumor c...

e15600 Background: Colorectal cancer (CRC) is a prevalent solid tumor cancer. Patients remain at risk of recurrence despite curative-intent treatment. Early detection of recurrence allows timely intervention and may improve outcomes, particularly in high-risk patients. Standard-of-care (SoC) guidelines recommend routine surveillance following post-...

e23262 Background: Advances in cancer detection and treatment have contributed to improvement in survival for many cancer types. Quantifying these improvements can help in assessing the progress made so far and inform the value of early cancer detection. We estimated increases in 5-year age-standardized relative survival rates for 17 different canc...

[This corrects the article DOI: 10.1371/journal.pone.0307282.].

Introduction. Generative Artificial Intelligence, particularly large language models (LLMs), offers transformative potential for Health Economics and Outcomes Research (HEOR). However, evaluating the quality, transparency, and rigor of LLM-assisted research lacks standardized guidance. This article introduces the ELEVATE AI LLMs framework and check...

This abstract is being presented as a short talk in the scientific program. A full abstract is printed in the Proffered Abstracts section (PR006) of the Conference Program/Proceedings. Citation Format: Jagpreet Chhatwal, Jade Xiao, Andrew ElHabr, Christopher Tyson, Xiting Cao, Sana Raoof, A. Mark Fendrick, A. Burak Ozbay, Paul Limburg, Tomasz M. Be...

Background: Currently, routine screening is recommended for only four cancer types (i.e., breast, cervical, colorectal, and lung) by the United States Preventive Services Task Force (USPSTF), and two-thirds of incident cancers have no screening guidelines. Emerging liquid biopsy multi-cancer early detection (MCED) tests have the potential to revolu...

Objective: This article offers a taxonomy of generative artificial intelligence (AI) for health economics and outcomes research (HEOR), explores its emerging applications, and outlines methods to enhance the accuracy and reliability of AI-generated outputs. Methods: The review defines foundational generative AI concepts and highlights current HEOR...

Background Previous studies have reported higher circulating bile acid levels in patients with HCC compared to healthy controls. However, the association between prediagnostic bile acid levels and HCC risk among patients with cirrhosis is unclear. Methods We measured total BA (TBA) concentration in serum samples collected from a prospective cohort...

Background Despite advances in cervical cancer (CC) prevention, detection, and treatment in the US, health disparities persist, disproportionately affecting underserved populations or regions. This study analyzes the geographical distribution of both CC and recurrent/metastatic CC (r/mCC) in the US and explores potential risk factors of higher dise...

Introduction: Given suboptimal performance of ultrasound-based surveillance for early hepatocellular carcinoma (HCC) detection in patients with cirrhosis, there is interest in alternative surveillance strategies, including blood-based biomarkers. We aimed to evaluate the cost-effectiveness of biomarker-based surveillance in patients with cirrhosis....

Background Anal cancer risk is elevated among people with HIV (PWH). Recent anal cancer incidence patterns among PWH in the United States (US) and Canada remain unclear. It is unknown how the incidence patterns may evolve in future years. Methods Using data from the North American AIDS Cohort Collaboration on Research and Design, we investigated a...

During the COVID-19 pandemic, forecasting COVID-19 trends to support planning and response was a priority for scientists and decision makers alike. In the United States, COVID-19 forecasting was coordinated by a large group of universities, companies, and government entities led by the Centers for Disease Control and Prevention and the US COVID-19...

Importance Obesity is a disease with a large socioeconomic burden. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic bariatric procedure with wide global adoption. More recently, new weight-loss medications, such as glucagon-like peptide-1 receptor agonists (eg, semaglutide), have attracted increased attention due to their eff...

Background Prior studies demonstrate that eliminating hepatitis C virus (HCV) in the United States (US) heavily depends on treating incarcerated persons. Knowing the scope of the carceral HCV epidemic by state will help guide national elimination efforts. Methods Between 2019 and 2023, all state prison systems received surveys requesting data on h...

Background Moldova, an upper-middle-income country in Eastern Europe, is facing a high burden of hepatitis C virus (HCV). Our objective was to assist the National Agency of Public Health of Moldova in planning to achieve the World Health Organization’s HCV elimination goals by 2030. Methods This study adapted a previously developed microsimulation...

The 10th Global Forum for Liver Magnetic Resonance Imaging (MRI) was held as a virtual 2-day meeting in October 2021, attended by delegates from North and South America, Asia, Australia, and Europe. Most delegates were radiologists with experience in liver MRI, with representation also from specialists in liver surgery, oncology, and hepatology. Pr...

Introduction: Alcohol-associated liver disease (ALD) is rising in the United States because of an increase in high-risk drinking, but population-level ALD cost is unknown. Our aim was to project the direct and indirect costs associated with ALD in the US population through 2040. Methods: We utilized a previously validated microsimulation model o...

Background Fatal drug overdoses and serious injection-related infections are rising in the US. Multiple concurrent infections in people who inject drugs (PWID) exacerbate poor health outcomes, but little is known about how the synergy among infections compounds clinical outcomes and costs. Injection drug use (IDU) converges multiple epidemics into...

The 10th Global Forum for Liver Magnetic Resonance Imaging was held in October 2021. The themes of the presentations and discussions at this Forum are described in detail in the review by Taouli et al (2023). The focus of this second manuscript developed from the Forum is on multidisciplinary tumor board perspectives in hepatocellular carcinoma (HC...

Importance: In 2021, more than 80 000 US residents died from an opioid overdose. Public health intervention initiatives, such as the Helping to End Addiction Long-term (HEALing) Communities Study (HCS), are being launched with the goal of reducing opioid-related overdose deaths (OODs). Objective: To estimate the change in the projected number of...

Background & aims: Guidelines recommend biannual surveillance for hepatocellular carcinoma (HCC) in hepatitis C individuals with cirrhosis if the HCC incidence rate is above 1.5 per 100 person-years (PY). However, the incidence threshold for surveillance in individuals who achieve a virological cure is unknown. We estimated the HCC incidence rate...

Background: The effectiveness of ultrasound-based surveillance for HCC in patients with cirrhosis is limited by suboptimal sensitivity for early tumor detection and poor adherence. Emerging blood-based biomarkers have been proposed as an alternative surveillance strategy. We aimed to evaluate the comparative effectiveness of a multitarget HCC bloo...

Objective: Cervical cancer (CC) disproportionately affects women based on socioeconomic status and racial/ethnic background. There is limited research in quantifying and visualizing whether substantial geographical disparities in the US exist with respect to CC burden, and especially with respect to recurrent or metastatic CC (r/mCC) disease burde...

Purpose Contemporary, real-world data on eligible patients receiving treatment following progression on first-line (1L) recurrent or metastatic cervical cancer (r/mCC) therapy are needed to inform treatment algorithms and identify potential gaps in the r/mCC care continuum. Methods This study estimated the prevalence and predictors of second-line...

Purpose Contemporary, real-world data on eligible patients receiving treatment following progression on first-line (1L) recurrent or metastatic cervical cancer (r/mCC) therapy are needed to inform treatment algorithms and identify potential gaps in the r/mCC care continuum. Methods This study estimated the prevalence and predictors of second-line...

Background Metamodels can address some of the limitations of complex simulation models by formulating a mathematical relationship between input parameters and simulation model outcomes. Our objective was to develop and compare the performance of a machine learning (ML)–based metamodel against a conventional metamodeling approach in replicating the...

Importance: Quantitative assessment of disease progression in patients with nonalcoholic fatty liver disease (NAFLD) has not been systematically examined using competing liver-related and non-liver-related mortality. Objective: To estimate long-term outcomes in NAFLD, accounting for competing liver-related and non-liver-related mortality associa...

Introduction: There are limited data on the effect and evolution of risk factors for hepatocellular carcinoma (HCC) in patients with virologically cured hepatitis C virus (HCV) infection. Methods: We conducted a retrospective cohort study of patients with HCV who achieved sustained virological response with direct-acting antivirals from 130 Vete...

Importance: Undiagnosed atrial fibrillation (AF) is an important cause of stroke. Screening for AF using wrist-worn wearable devices may prevent strokes, but their cost-effectiveness is unknown. Objective: To evaluate the cost-effectiveness of contemporary AF screening strategies, particularly wrist-worn wearable devices. Design setting and par...

Ultrasound‐based surveillance has suboptimal sensitivity for early detection of hepatocellular carcinoma (HCC) in patients with cirrhosis. There are several emerging alternatives, including a novel multitarget HCC blood test (Mt‐HBT). We compared performance of mt‐HBT against ultrasound with or without alpha‐fetoprotein (AFP) for early HCC detectio...

5523 Background: Examining geographic distributions of high and low proportions of recurrent or metastatic cervical cancer (r/mCC) can identify regions with high need of intervention and advance our understanding of r/mCC community-specific risk factors. Previous studies of epidemiologic or geographic clusters in late-stage cervical cancer were con...

5532 Background: There is limited real-world data on the proportion of eligible patients who received second-line (2L) treatment following progression on first-line (1L) systemic therapy for recurrent or metastatic cervical cancer (r/mCC). In addition, factors impacting selection of 2L are not well-understood. The objective of this study was to det...

e17520 Background: Recent data showed that a substantial proportion of second-line (2L)-eligible recurrent or metastatic cervical cancer (r/mCC) patients do not receive therapy. Additionally, although higher direct medical costs has been demonstrated with increasing r/mCC disease severity, there is no data on the impact of 2L treatment choices on s...

Importance: A key question for policy makers and the public is what to expect from the COVID-19 pandemic going forward as states lift nonpharmacologic interventions (NPIs), such as indoor mask mandates, to prevent COVID-19 transmission. Objective: To project COVID-19 deaths between March 1, 2022, and December 31, 2022, in each of the 50 US state...

Objectives Hepatitis C virus (HCV) affects 58 million worldwide and > 79% of people remain undiagnosed. Rapid diagnostic tests (RDTs) for HCV can help improve diagnosis and treatment rates. Nevertheless, the high price and infrastructure needed to use current molecular HCV RDT options present a barrier to widespread use—particularly in low- and mid...

405 Background: Hepatocellular carcinoma (HCC) is the fastest rising cause of cancer mortality in the United States. Although clinical guidelines recommend ultrasound (U/S), with or without the serum biomarker alpha fetoprotein (AFP) for HCC surveillance in at-risk patients, only 24% of patients adhere to surveillance and only one-third of HCCs are...

Background & Aims Successful treatment of chronic hepatitis C with oral direct-acting antiviral (DAA) leads to virological cure, however, the subsequent risk of hepatocellular carcinoma (HCC) persists. Our objective was to evaluate the cost-effectiveness of biannual surveillance for HCC in patients cured of hepatitis C and the optimal age to stop s...

Background and aims: Alcohol consumption increased during the coronavirus disease-2019 (COVID-19) pandemic in 2020 in the U.S. We projected the effect of increased alcohol consumption on alcohol-related liver disease (ALD) and mortality. Approach and results: We extended a previously validated microsimulation model that estimated the short- and...

Background Oropharyngeal cancer (OPC) incidence is rising rapidly among men in the United States of America (USA). We aimed to project the impact of maintaining the current HPV vaccination uptake and achieving 80% national (Healthy People) goal on OPC incidence and burden. Methods We developed an open-cohort micro-simulation model of OPC natural h...

Introduction To achieve the elimination of hepatitis C virus (HCV), substantial scale-up in access to testing and treatment is needed. This will require innovation and simplification of the care pathway, through decentralisation of testing and treatment to primary care settings and task-shifting to non-specialists. The objective of this study was t...

Background and aims India has a significant burden of hepatitis C virus (HCV) infection and has committed to achieving national elimination by 2030. This will require a substantial scale-up in testing and treatment. The “HEAD-Start Project Delhi” aimed to enhance HCV diagnosis and treatment pathways among the general population. Methods A prospect...

Introduction: Screening of atrial fibrillation (AF) using contemporary wrist-worn wearable devices may prevent strokes, but false positive diagnoses could also lead to unnecessary bleeding and utilization of healthcare resources. Aim: To assess the cost-effectiveness of contemporary AF screening strategies and identify optimal conditions for the de...

The cost of testing can be a substantial contributor to hepatitis C virus (HCV) elimination program costs in many low- and middle-income countries such as Georgia, resulting in the need for innovative and cost-effective strategies for testing. Our objective was to investigate the most cost-effective testing pathways for scaling-up HCV testing in Ge...

Background Atrial fibrillation (AF) screening is endorsed by certain guidelines for individuals aged ≥65 years. Yet many AF screening strategies exist, including the use of wrist‐worn wearable devices, and their comparative effectiveness is not well‐understood. Methods and Results We developed a decision‐analytic model simulating 50 million indivi...

Coronavirus disease 2019 (COVID‐19), a global pandemic, has disproportionately inflicted deaths and affected the US economy. With the recent emergency use authorization of COVID‐19 vaccines, ongoing non‐pharmaceutical interventions (NPIs) could be lifted in the future. Our objective was to quantify the impact of the timing of the lifting of NPIs on...

Importance In 2020 and early 2021, the National Football League (NFL) and National Collegiate Athletic Association (NCAA) opted to host football games in stadiums across the country. The in-person attendance of games varied with time and from county to county. There is currently no evidence on whether limited in-person attendance of games is associ...

Background Optimal management of asymptomatic Brugada syndrome (BrS) with spontaneous type I electrocardiographic pattern is uncertain. Methods and Results We developed an individual‐level simulation comprising 2 000 000 average‐risk individuals with asymptomatic BrS and spontaneous type I electrocardiographic pattern. We compared (1) observation,...

With the recent emergence of the B.1.617.2 (Delta) variant of SARS-CoV-2 in the U.S., many states are seeing rising cases and hospitalizations after a period of steady decline. As We used the COVID-19 Simulator, an interactive online tool that utilizes a validated mathematical model, to simulate the trajectory of COVID-19 at the state level in the...

Hepatitis C virus (HCV) affects 58 million worldwide and more than 79% people remain undiagnosed. 1 • Rapid diagnostic tests (RDTs) for HCV can help improve diagnosis and treatment rates. • The high price and infrastructure needed to use current molecular HCV RDT options present a barrier to widespread use-particularly in low-and middle-income coun...

In order to meet the World Health Organization goal of eliminating hepatitis C virus (HCV) as a public health threat by 2030, HCV testing must be scaled up. Most countries do not have widespread testing programs in place, and cost is a burden to implementation. We created an interactive online tool to allow countries to assess the cost-effectivene...

Objectives: The burden of alcohol-related liver disease (ALD) is surging in the US. There is evidence that alcohol consumption increased during the early periods of the coronavirus disease-2019 (COVID19) pandemic. We describe the impact of increased alcohol consumption on alcohol-related liver disease. Design: Microsimulation model Setting: Model p...

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Importance: In 2020 and early 2021, the National Football League (NFL) and National Collegiate Athletic Association (NCAA) had opted to host games in stadiums across the country. The in-person attendance of games has varied with time and from county to county. There is currently no evidence on whether limited in-person attendance of games has cause...

Background The United Nations Sustainable Development Goals (SDGs) target a one-third reduction in non-communicable disease (NCD) mortality between the years 2015 and 2030. Cancer accounts for 22% of NCD deaths, and breast cancer is the leading global cause of female cancer mortality, despite its high survivability. Therefore, reducing female breas...

Coronavirus disease 2019 (COVID-19) will have a lasting impact on public health. In addition to the direct effects of COVID-19 infection, physical distancing and quarantine interventions have indirect effects on health. While necessary, physical distancing interventions to control the spread of COVID-19 could have multiple impacts on people living...

Background: The American Thyroid Association (ATA) published the 2015 Management Guidelines for patients with thyroid nodules and differentiated thyroid cancer, recommending a shift to less aggressive diagnostic, surgical, and postoperative treatment strategies. At the same time and perhaps related to the new guidelines, there has been a shift to o...