Vilija R Joyce

U.S. Department of Veterans Affairs | VA · VA Palo Alto Health Care Center

Introduction Little is known about access to and use of prenatal care by veterans using U.S. Department of Veterans Affairs (VA) maternity benefits. We compared the timeliness and adequacy of prenatal care by veteran status and payor. Study Design We used VA clinical and admistrative data linked with California vital statistics patient discharge d...

Importance Opioid use disorder (OUD) is a significant cause of morbidity and mortality in the US, yet many individuals with OUD do not receive treatment. Objective To assess the cost-effectiveness of OUD treatments and association of these treatments with outcomes in the US. Design and Setting This model-based cost-effectiveness analysis included...

The treatment of missing data in comparative effectiveness studies with right‐censored outcomes and time‐varying covariates is challenging because of the multilevel structure of the data. In particular, the performance of an accessible method like multiple imputation (MI) under an imputation model that ignores the multilevel structure is unknown an...

Objective To describe variation in payer and outcomes in Veterans’ births. Data/Setting Secondary data analyses of deliveries in California, 2000–2012. Study Design We performed a retrospective, population‐based study of all live births to Veterans (confirmed via U.S. Department of Veterans Affairs (VA) enrollment records), to identify payer and...

Objectives To determine whether implementation of interferon-free treatment for hepatitis C virus (HCV) reached groups less likely to benefit from earlier therapies, including patients with genotype 1 virus or contraindications to interferon treatment, and groups that faced treatment disparities: African Americans, patients with HIV co-infection, a...

Congressional and Veterans Affairs (VA) leaders have recommended the VA become more of a purchaser than a provider of health care. Fee-for-service Medicare provides an example of how purchased care differs from the VA's directly provided care. Using established indicators of overly intensive end-of-life care, we compared the quality of care provide...

Simulation studies are useful for evaluating and developing statistical methods for the analyses of complex problems. Performance of methods may be affected by multiple complexities present in real scenarios. Generating sufficiently realistic data for this purpose, however, can be challenging. Our study of the comparative effectiveness of HIV proto...

Objectives: The Medical Outcomes Study HIV Health Survey (MOS-HIV) is frequently used in HIV clinical trials; however, scores generated from the MOS-HIV are not suited for cost-effectiveness analyses as they do not assign utility values to health states. Our objective was to estimate and externally validate several mapping algorithms to predict Hea...

Background: Chronic hepatitis C viral (HCV) infection affects millions of Americans. Healthcare systems face complex choices between multiple highly efficacious, costly treatments. This study assessed the cost-effectiveness of HCV treatments for chronic, genotype 1 HCV monoinfected, treatment-naïve individuals in the Department of Veterans Affairs...

Background: To characterize the association of antiretroviral drug combinations on risk of cardiovascular events. Methods: Certain antiretroviral medications for human immunodeficiency virus (HIV) have been implicated in increasing risk of cardiovascular disease. However, antiretroviral drugs are typically prescribed in combination. We character...

Objectives: To determine the association between preexisting characteristics and current health and the cost of different types of advanced human immunodeficiency virus (HIV) care. Methods: Treatment-experienced patients failing highly active antiretroviral treatment (ART) in the United States, Canada, and the United Kingdom were factorial rando...

To estimate the cost effectiveness of a supported employment (SE) intervention that had been previously found effective in Veterans with spinal cord injuries (SCI). Cost effectiveness analysis, using cost and quality of life data gathered in a trial of SE for Veterans with SCI. Setting: SCI centers in the Veterans Health Administration. Subjects (N...

Newer antiretroviral drugs provide substantial benefits but are expensive. We determined the cost-effectiveness of using antiretroviral drugs in combination for patients with multi-drug resistant HIV disease. We built a cohort state-transition model representing treatment-experienced patients with low CD4 counts, high viral load levels, and multi-d...

This study examined the relationship between health-related quality of life and subsequent mortality among AKI survivors treated with renal replacement therapy. Multivariable Cox regression models were used to assess the associations between Health Utilities Index Mark 3 (HUI3) and ambulation, emotion, cognition, and pain scores at 60 days and all-...

The effect of adherence, treatment failure, and comorbidities on the cost of HIV care is not well understood. To characterize the cost of HIV care including combination antiretroviral treatment (ART). Observational study of administrative data. Total 1896 randomly selected HIV-infected patients and 288 trial participants with multidrug-resistant HI...

The effect of antiretroviral therapy (ART) interruption or intensification on health-related quality of life (HRQoL) in advanced HIV patients is unknown. To assess the impact of temporary treatment interruption and intensification of ART on HRQoL. A 2 x 2 factorial open label randomized controlled trial. Hospitals in the United States, Canada, and...

Purpose: Five novel drugs introduced since 2006 improve outcomes for patients with advanced Human Immunodeficiency Virus (HIV) infection virus at a median annual cost of US $11,800 each. We compared the cost-effectiveness of a treatment strategy using these new antiretrovirals compared with a strategy using conventional antiretrovirals in patients...

Purpose: We evaluated the cost incurred by patients with multi drug resistant HIV who participated in OPTIMA, a randomized factorial trial of two interventions: a 12 week structured treatment interruption and intensification of anti-retroviral therapy (ART) to a target of 5 or more drugs. Method: Information on anti-retroviral medications, inpati...

Purpose: Effective antiretroviral therapy (ART) improves survival in HIV-infected patients; however, the optimal management of multi-drug resistant (MDR) HIV in treatment-experienced patients with limited retreatment options remains uncertain. We evaluated whether ART interruption and/or intensification improved health-related quality of life (HRQo...

Objective: To investigate the relative magnitude and duration of impact of AIDS-defining events (ADEs) and non-AIDS serious adverse events (SAEs) on health-related quality of life (HRQoL) among patients with advanced HIV/AIDS. Methods: We use data from OPTIMA (OPTions In Management with Antiretrovirals), a multinational, randomized, open, control,...

To assess the concurrent validity and responsiveness of the Health Utility Index 3 (HUI3) in patients with advanced HIV/AIDS, and to determine the responsiveness of this measure, the MOS-HIV and EQ-5D to HIV-related clinical events. Data from the OPTIMA (OPTions In Management with Antiretrovirals) trial was analyzed. Two aspects of the validity of...

To assess and compare alternative approaches of measuring preference-based health-related quality of life (HRQoL) in treatment-experienced HIV patients and evaluate their association with health status and clinical variables. Cross-sectional study. Twenty-eight Veterans Affairs hospitals in the United States, 13 hospitals in Canada, and 8 hospitals...