Zafar Zafari

Zafar Zafari
University of Maryland School of Pharmacy · Pharmaceutical Health Services Research

M.Sc., PhD

About

74
Publications
4,963
Reads
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890
Citations
Introduction
Zafar Zafari is an Assistant Professor in Department of Pharmaceutical Health Services Research at the University of Maryland School of Pharmacy. His research mainly lies in advance methods of comparative effectiveness and economic evaluation of health technologies and policies.
Additional affiliations
April 2018 - present
University of Maryland School of Pharmacy
Position
  • Professor (Assistant)
January 2017 - April 2018
Columbia University
Position
  • PostDoc Position
June 2014 - December 2016
Center for Clinical Epidemiology and Evaluation
Position
  • Statistical model developer
Education
September 2012 - August 2016
University of British Columbia
Field of study
  • Medicine
September 2010 - May 2012
University of British Columbia
Field of study
  • Mathematics

Publications

Publications (74)
Article
Full-text available
Background Chronic obstructive pulmonary disease (COPD) causes 3 million deaths each year, yet 38% of COPD patients continue to smoke. Despite proof of effectiveness and universal guideline recommendations, smoking cessation interventions are underused in practice. We sought to develop an infographic featuring personalized biomedical risk assessmen...
Article
Background An individualized FEV1 prediction model has recently been developed based on the Lung Health Study (LHS). An ongoing evaluation of the utility of prediction models in representative settings outside the setup of clinical trials is needed. Objective To evaluate the external validity of the LHS FEV1 prediction model in a representative sa...
Article
BACKGROUND: Suboptimal maintenance medication (MM) adherence remains a clinical problem among Medicare beneficiaries with chronic obstructive pulmonary disease (COPD). OBJECTIVE: To inform risk-based personalized decision-making, this study sought to develop and validate prediction models of nonadherence to COPD MMs for Medicare beneficiaries. METH...
Article
Full-text available
Objective Airborne infection from aerosolized SARS-CoV-2 poses an economic challenge for businesses without existing heating, ventilation, and air conditioning (HVAC) systems. The Environmental Protection Agency notes that standalone units may be used in areas without existing HVAC systems, but the cost and effectiveness of standalone units has not...
Article
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BACKGROUND: Chronic obstructive pulmonary disease (COPD) and asthma are common respiratory diseases that impose a significant economic burden on Medicaid. Inhalers are the mainstay treatment for relieving symptoms and improving outcomes for COPD and asthma patients. OBJECTIVE: To describe the total spending and trends of Medicaid expenditures on in...
Article
Objective: To quantify students’ risk tolerance for in-person classes and willingness-to-pay for online-only instruction during the COVID-19 pandemic. Participants: 46 Columbia University public health graduate students. Methods: We developed a survey tool with a “standard gamble” exercise administered online by an interactive chat bot with full an...
Preprint
Full-text available
Objective: Airborne infection from aerosolized SARS-CoV-2 poses an economic challenge for the large number of small businesses without existing heating, ventilation, and air conditioning (HVAC) systems. Standalone units have been recommended, but are costly and may not achieve adequate air exchange to prevent infection. Study design: Cost-effective...
Article
Full-text available
Background Most universities that re-open in the United States (US) for in-person instruction have implemented the Centers for Disease Prevention and Control (CDC) guidelines. The value of additional interventions to prevent the transmission of SARS-CoV-2 is unclear. We calculated the cost-effectiveness and cases averted of each intervention in com...
Article
Introduction : This study quantifies costs associated with comorbid conditions among adults diagnosed with chronic obstructive pulmonary disease (COPD) who experience acute exacerbations (AECOPD) needing inpatient hospitalization. Methods : This retrospective cohort study used 2006-2015 IQVIA PharMetrics® Plus data, a health plan claims database....
Article
Few studies have quantified the multimorbidity burden in older adults with chronic obstructive pulmonary disease (COPD) using large and generalizable data. Such evidence is essential to inform evidence-based research, clinical care, and resource allocation. This retrospective cohort study used a nationally representative sample of Medicare benefici...
Article
Full-text available
Background While forced expiratory volume in 1 s (FEV 1 ) is a hallmark of disease progression in chronic obstructive lung diseases, little is known about the relationship between baseline FEV 1 and future risks of other medical conditions. Objective To study the association between baseline FEV 1 and future risks of diabetes, asthma, myocardial i...
Article
Objective Hospitalized patients undergoing evaluation for pulmonary tuberculosis (TB) require airborne isolation while testing for Mycobacterium tuberculosis (MTB) to reduce risk of nosocomial transmission. GeneXpert MTB/RIF (Xpert) is more rapid and accurate than sputum smear microscopy, but it is not routinely used to ‘rule out’ infectious pulmon...
Article
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Background: The COVID-19 pandemic has led to widespread implementation of public health measures, such as stay-at-home orders, social distancing, and masking mandates. In addition to decreasing spread of SARS-CoV2, these measures also impact the transmission of seasonal viral pathogens, which are common triggers of COPD exacerbations. Whether reduc...
Preprint
Full-text available
Background: The COVID-19 pandemic has led to widespread implementation of public health measures, such as stay-at-home orders, social distancing, and masking mandates. In addition to decreasing spread of SARS-CoV2, these measures also impact the transmission of seasonal viral pathogens, which are common triggers of COPD exacerbations. Whether reduc...
Preprint
Full-text available
Background. As universities around the world decide whether to remain open or to close their campuses because of the COVID-19 pandemic, they often are doing so without objective information on the preferences and risk tolerance of their students. In this study, we aim to quantify students’: 1) risk tolerance for in-person instruction; 2) willingnes...
Article
Full-text available
Introduction: With the Safety Ensuring Lives Future Deployment and Research in Vehicle Evolution (SELF DRIVE) Act in the United States, there is a growing interest in autonomous vehicles (AVs). One avenue of innovation would be to use them to mobilize and coordinate response efforts during natural disasters. This study uses an earthquake response...
Article
Background: In the United States (US), chronic obstructive pulmonary disease (COPD) is a leading cause of mortality with a substantial societal health and economic burden. With anticipated population growth, it is important for different stakeholders to have an estimate for the projected burden of disease. Research question: To model the 20-year...
Article
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Objectives: Material well-being, beliefs, and emotional states are believed to influence one's health and longevity. In this paper, we explore racial differences in self-rated health, happiness, trust in others, feeling that society is fair, believing in God, frequency of sexual intercourse, educational attainment, and percent in poverty and their...
Preprint
Full-text available
Importance. As universities around the world decide whether to remain open or to close their campuses because of the COVID-19 pandemic, they often are doing so without objective information on the preferences and risk tolerance of their students. Objectives. To quantify: 1) risk tolerance for in-person instruction; 2) willingness to pay for in-pers...
Preprint
Full-text available
Background. As universities re-open, it is imperative to understand the added value of measures to prevent the transmission of SARS-CoV-2, the virus that causes COVID-19. Methods. We conducted a cost-effectiveness analysis of common public health interventions used by universities to reduce SARS-CoV-2 transmission. We use a Markov model with Monte...
Article
Full-text available
Shifts in migration and border control policies may increase the likelihood of trauma exposure related to child–parent separation and result in costs to the health system and society. In the present study, we estimated direct and indirect costs per child as well as overall cohort costs of border control policies on migrant children and adolescents...
Article
Full-text available
Purpose To quantify the heterogeneity of Health-related Quality of Life (HRQoL), and identify subgroups with the lowest HRQoL, in chronic obstructive pulmonary disease (COPD) patients in the United States (US). Methods Data from 2008-2015 Medical Expenditure Panel Survey were used to examine the heterogeneity of HRQoL between different COPD subgro...
Article
Introduction The US has among the world’s strictest automobile emissions standards, but it is now loosening them. It is unclear where a nation should draw the line between the associated cost burden imposed by regulations and the broader societal benefits associated with having cleaner air. Our study examines the health benefits and cost-effectiven...
Article
Full-text available
Background: Asthma diagnosis in the community is often made without objective testing. Objective: The aim of this study was to evaluate the cost-effectiveness of implementing a stepwise objective diagnostic verification algorithm among patients with community-diagnosed asthma in the United States (US). Methods: We developed a probabilistic tim...
Preprint
Full-text available
Background: Asthma diagnosis in the community is often made without objective testing. Objective: The aim of this study was to evaluate the cost-effectiveness of implementing a stepwise objective diagnostic verification algorithm among patients with community-diagnosed asthma in the United States (US). Methods: We developed a probabilistic time-in-...
Article
Objective: Residents of low-income neighborhoods are exposed to relatively higher rates of crime, fewer opportunities to exercise, poorer schools, and few opportunities to eat healthy foods than residents of middle-class neighborhoods. Policies that influence neighborhood context could therefore serve as health interventions. We seek to inform the...
Article
We examined the association between sexually transmitted disease (STD) and depressive symptoms. Our analysis utilized the 2015 cross-sectional Washington Heights Community Survey. Multivariable binary logistic regression analysis was used to examine the primary association between having a history of STD and patient health questionnaire-9 (PHQ-9) s...
Article
Objective: To demonstrate the landscape of model-based economic studies in asthma and highlight where there is room for improvement in the design and reporting of studies. Design: A systematic review of the methodologies of model-based, cost-effectiveness analyses of asthma-related interventions was conducted. Models were evaluated for adherence...
Article
Full-text available
The “Citi Bike” bike share program in New York City is the largest bike share program in the USA. We ask whether expanding this program to lower-income communities is cost-effective means of encouraging exercise and reducing pollution in New York City. We built a stochastic Markov model to evaluate the cost-effectiveness of the Citi Bike expansion...
Article
Global medical travel has had an increasing trend without a comprehensive, evidence-driven policy to ensure safe and effective practice. To identify key factors that influence medical travel, we conducted a series of studies culminating with a preference and decision-making component of over 500 prospective medical travelers from a number of countr...
Article
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Objective The aim of this study was to determine the preferences of parents with children with medulloblastoma and clinicians who manage this condition and their trade-offs between survival and disability using a best–worst scaling (BWS) choice experiment. Methods Mixed methods were used to develop a BWS tool. Health professionals involved in the...
Article
Although recent declines in life expectancy among non-Hispanic Whites, coined "deaths of despair," grabbed the headlines of most major media outlets, this is neither a recent problem nor is it confined to Whites. The decline in America's health has been described in the public health literature for decades and has long been hypothesized to be attri...
Article
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Objectives: Airports in the U.S. have gradually been transitioning to automated flight systems. These systems generate new flight paths over populated areas. While they can improve flight efficiency, the increased noise associated with these novel flight patterns potentially pose serious health threats to the overflown communities. In this case stu...
Article
The current body of evidence on the efficacy and safety of aflibercept for age‐related macular degeneration (AMD) is steadily growing as large clinical trials and observational studies are continually completed. Our aim was to analyse 1‐year visual acuity (VA) outcomes in response to aflibercept therapy and identify factors affecting treatment resp...
Article
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Purpose: Receiver operating characteristic (ROC) curve analysis is a popular method for evaluating the performance of (bio)markers. However, the standard ROC curve does not directly connect marker performance to patient-related outcomes. Our aim was to fill this gap by proposing a conceptually similar graphical tool that carries information about...
Article
Background: Employment is one of the less studied but a significant outcome of medication-assisted treatment. Thus, we aimed to explore employment outcomes of medication-assisted treatment with hydromorphone (HDM) or diacetylmorphine (DAM). The secondary aim was to estimate characteristics of this population as well as treatment-related factors as...
Article
Background Using the 140 speed cameras in New York City (NYC) as a case study, we explore how to optimise the number of cameras such that the most lives can be saved at the lowest cost. Methods A Markov model was built to explore the economic and health impacts of speed camera installations in NYC as well as the optimal number and placement. Both...
Article
Background Achieving optimal control is the primary objective of asthma management. However, despite the existence of effective treatments, many patients experience periods of sub-optimal asthma control. The objective of this study was to quantify and project the future economic and health burden of sub-optimal asthma control in Canada. Methods A...
Article
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Background A significant minority of asthma patients remain uncontrolled despite the use of inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA). A number of add-on therapies, including monoclonal antibodies (namely omalizumab) and more recently tiotropium bromide have been recommended for this subgroup of patients. The purpose of thi...
Article
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Objectives: To examine health benefits and cost-effectiveness of implementing a freeway deck park to increase urban green space. Methods: Using the Cross-Bronx Expressway in New York City as a case study, we explored the cost-effectiveness of implementing deck parks. We built a microsimulation model that included increased exercise, fewer accide...
Article
Purpose: The clinical efficacy of ranibizumab has been examined by a large number of prospective and retrospective studies to date. This meta-analysis was conducted to summarize the current body of evidence on visual acuity (VA) changes with use of ranibizumab in the treatment of neovascular age-related macular degeneration (wAMD). Methods: A li...
Article
Full-text available
Aircraft noise increases the risk of cardiovascular diseases and mental illness. The allowable limit for sound in the vicinity of an airport is 65 decibels (dB) averaged over a 24-hour ‘day and night’ period (DNL) in the United States. We evaluate the trade-off between the cost and the health benefits of changing the regulatory DNL level from 65 dB...
Article
Purpose: Medulloblastoma is the most prevalent childhood brain cancer. Children with medulloblastoma typically receive a combination of surgery, radiation, and chemotherapy. The survival rate is high but survivors often have sequelae from radiotherapy of the entire developing brain and spinal cord. Ongoing genetic studies have suggested that decre...
Article
Full-text available
Exacerbations are a hallmark of chronic obstructive pulmonary disease (COPD). Evidence suggests the presence of substantial between-individual variability (heterogeneity) in exacerbation rates. The question of whether individuals vary in their tendency towards experiencing severe (versus mild) exacerbations, or whether there is an association betwe...
Article
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Background: Medication management (MM) services are being provided by pharmacists across Canada in various forms, but pharmacist-physician collaboration is still not a routine practice in most jurisdictions. This survey aimed to gather pharmacists' and physicians' opinions and preferences for MM provision. Methods: Two parallel, cross-sectional...
Article
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Background: Many decision-analytic models with varying structures have been developed to inform resource allocation in chronic obstructive pulmonary disease (COPD). Objectives: To review COPD models for their adherence to the best practice modeling recommendations and their assumptions regarding important aspects of the natural history of COPD....
Article
Full-text available
Background: The rate of lung-function decline in chronic obstructive pulmonary disease (COPD) varies substantially among individuals. We sought to develop and validate an individualized prediction model for forced expiratory volume at 1 second (FEV1) in current smokers with mild-to-moderate COPD. Methods: Using data from a large long-term clinic...
Article
Full-text available
Background: Bronchial thermoplasty (BT) is a recently developed treatment for patients with moderate-to-severe asthma. A few studies have suggested the clinical efficacy of this intervention. However, no study has evaluated the cost-effectiveness of BT compared to other alternative treatments for moderate-to-severe allergic asthma, which currently...
Data
Additional descriptions for estimating model parameters. (DOCX)
Article
Background: Severe asthma is associated with disproportionately high morbidity, but little is known about its natural history and how risk factors at first year of diagnosis modify its subsequent development. Methods: Using administrative health data, we retrospectively followed patients 14-55 years of age with newly diagnosed severe asthma in B...
Article
Full-text available
The combination of asthma and chronic obstructive pulmonary disease (COPD), or ACOS is a recently defined syndrome. The epidemiology of the condition is poorly described and previous research has suggested ACOS is associated with worse outcomes than either condition alone. We therefore decided to complete a systematic review of the published litera...
Article
Up-to-date estimates of burden of diseases are required for evidence-based policy making. The objectives of this study were to determine the excess costs of chronic obstructive pulmonary disease (COPD) and its trend from 2001 to 2010 in British Columbia, Canada. We used British Columbia's administrative health data to construct a cohort of patients...
Article
Much of the evidence on the early use of inhaled controllers after severe asthma exacerbations is about their short-term benefit, leaving a gap in evidence on their longer-term outcomes. We used administrative health data from British Columbia, Canada (2001-2012) to evaluate readmission rate (primary outcome), adherence to controller medications, a...
Article
Full-text available
The evidence on the association between pioglitazone use and bladder cancer is contradictory, with many studies subject to allocation bias. The aim of our study was to examine the effect of exposure to pioglitazone on bladder cancer risk internationally across several cohorts. The potential for allocation bias was minimised by focusing on the cumul...
Article
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Objective: To evaluate the impact of using two evidence-synthesis paradigms, pairwise meta-analysis (PMA) vs. network meta-analysis (NMA), on the expected value of information (EVI) outcomes, using pharmacotherapy of chronic obstructive pulmonary disease as a case study. Methods: Bayesian random-effects PMAs were performed for each pharmacothera...
Article
Full-text available
Background: Adherence to evidence-based controller treatments for asthma is disappointingly low in many jurisdictions. Quantifying the burden associated with suboptimal adherence in patients with uncontrolled asthma will help establish the priorities for policymakers. Objective: We sought to quantify the benefits in the United States of improvin...