Jeff Sullivan

Author List: Karen Van Nuys, PhD, Andreas Kuznik, PhD, Hemant Phatak, PhD, Uchenna Iloeje, MD, MPH, Jeff Sullivan, MS, Darius Lakdawalla, PhD, Eshan Vasudeva, BA, and William Weintraub, MD, FACC

Objectives: Patients with non-valvular atrial fibrillation (NVAF) are routinely prescribed anticoagulants to prevent stroke. Traditional anticoagulants like warfarin are less expensive and less effective at preventing stroke than some novel oral anti-coagulants (NOACs). This study uses a widely… Show more

Author List: Karen Van Nuys, PhD, Andreas Kuznik, PhD, Hemant Phatak, PhD, Uchenna Iloeje, MD, MPH, Jeff Sullivan, MS, Darius Lakdawalla, PhD, Eshan Vasudeva, BA, and William Weintraub, MD, FACC

Objectives: Patients with non-valvular atrial fibrillation (NVAF) are routinely prescribed anticoagulants to prevent stroke. Traditional anticoagulants like warfarin are less expensive and less effective at preventing stroke than some novel oral anti-coagulants (NOACs). This study uses a widely published microsimulation model to compare population-wide outcomes associated with alternative approaches to preventing stroke among NVAF patients.

Methods: The Health Economics Medical Innovation Simulation (THEMIS) was used to analyze clinical and economic outcomes among a representative sample of Americans age 51+. The lifetime evolution of disease and functional status was modeled for each individual under four scenarios: status quo using current NVAF treatment patterns, and three scenarios where NVAF patients are treated with apixaban, dabigatran, or rivaroxaban, respectively. Markov state transition probabilities were derived from the Health and Retirement Study; published cost estimates for stroke and other adverse events were used. NOAC prices were assumed to fall by 80% at patent expiration. The number of stroke-free years, bleeds and total medical expenditures were calculated for the entire population through 2062.

Findings: Over 50 years, the three NOAC scenarios resulted in 28-31 million more stroke-free years and higher total medical expenditures compared to the status quo. Among NOACs, apixaban and dabigatran resulted in similar stroke outcomes, but apixaban had 1.4 million fewer bleeds and $6.9 billion lower total medical expenditures compared to dabigatran across the age 51+ population. Rivaroxaban resulted in higher stroke incidence, more major bleeds and higher total medical expenditures than the other two NOACs. Show less

Author List: Karen Van Nuys, Denise Globe, Daisy Ng-Mak, Hoiwan Cheung, Jeff Sullivan and Dana Goldman

Purpose. To estimate the employer costs associated with employee obesity.

Design. The study used cross-sectional analysis of employee health-risk assessment, disability, workers' compensation, and medical claims data from 2006 to 2008.

Setting. The study took place in the United States from 2006 to 2008.

Subjects. A panel database with 29,699 employees drawn from a… Show more

Author List: Karen Van Nuys, Denise Globe, Daisy Ng-Mak, Hoiwan Cheung, Jeff Sullivan and Dana Goldman

Purpose. To estimate the employer costs associated with employee obesity.

Design. The study used cross-sectional analysis of employee health-risk assessment, disability, workers' compensation, and medical claims data from 2006 to 2008.

Setting. The study took place in the United States from 2006 to 2008.

Subjects. A panel database with 29,699 employees drawn from a panel of employers and observed for 3 years each (N = 89,097) was used.

Measures. Workdays lost owing to illness and disability; the cost of medical, short-term disability, and workers' compensation claims; and employees' adjusted body mass indices (BMI) were measured.

Analysis. We model the number and probability of workdays lost from illness, short-term disability, and workers' compensation events; short-term disability and workers' compensation payments; and health care spending as a function of BMI. We estimate spline regression models and fit results using a third-degree fractional polynomial.

Results. Probability of disability, workers' compensation claims, and number of days missed owing to any cause increase with BMI above 25, as do total employer costs. The probability of a short-term disability claim increases faster for employees with hypertension, hyperlipidemia, or diabetes. Normal weight employees cost on average $3830 per year in covered medical, sick day, short-term disability, and workers' compensation claims combined; morbidly obese employees cost more than twice that amount, or $8067, in 2011 dollars.

Conclusion. Obesity is associated with large employer costs from direct health care and insurance claims and indirect costs from lost productivity owing to workdays lost because of illness and disability. Show less

Author List: Julia Thornton Snider, Katalin Bognar, Denise Globe, Daisy Ng-Mak, Jeff Sullivan, Nicholas Summers, and Dana Goldman
PURPOSE. To develop a risk-scoring tool to identify in a base year patients likely to have high medical spending in the subsequent year and to understand the role obesity and obesity reduction may play in mitigating this risk.
DESIGN. Cross-sectional analysis, using commercial claims and health risk assessment data.
SETTING. United States… Show more

Author List: Julia Thornton Snider, Katalin Bognar, Denise Globe, Daisy Ng-Mak, Jeff Sullivan, Nicholas Summers, and Dana Goldman
PURPOSE. To develop a risk-scoring tool to identify in a base year patients likely to have high medical spending in the subsequent year and to understand the role obesity and obesity reduction may play in mitigating this risk.
DESIGN. Cross-sectional analysis, using commercial claims and health risk assessment data.
SETTING. United States, 2004–2009.
SUBJECTS. Panel of 192,750 person-year observations from 116,868 unique working-age employees of large companies.
MEASURES. Probability of high medical expenses (80th percentile or above) in the following year; adjusted body mass index (BMI).
ANALYSIS. Generate risk scores by modeling the likelihood of high next-year expenses as a function of base-year age, sex, medical utilization, comorbidities, and BMI. Estimate the effect of simulated bariatric intervention on patient risk scores.
RESULTS. Individuals with higher BMI were more likely to be categorized in the very high risk group, in which the average annual medical expense was $8621. A weight-loss intervention transitioning a patient to the next lower obesity class was predicted to reduce this risk by 1.5% to 27.4%—comparable to hypothetically curing a patient of depression or type 2 diabetes.
CONCLUSION. A logistic model was used to capture the effect of BMI on the risk of high future medical spending. Weight-loss interventions for obese patients may generate significant savings by reducing this risk. Show less

Dana P. Goldman, David Cutler, John W. Rowe, Pierre-Carl Michaud, Jeffrey Sullivan, Desi Peneva and S. Jay Olshansky

Recent scientific advances suggest that slowing the aging process (senescence) is now a realistic goal. Yet most medical research remains focused on combating individual diseases. Using the Future Elderly Model—a microsimulation of the future health and spending of older Americans—we compared optimistic “disease specific” scenarios with a hypothetical “delayed aging”… Show more

Dana P. Goldman, David Cutler, John W. Rowe, Pierre-Carl Michaud, Jeffrey Sullivan, Desi Peneva and S. Jay Olshansky

Recent scientific advances suggest that slowing the aging process (senescence) is now a realistic goal. Yet most medical research remains focused on combating individual diseases. Using the Future Elderly Model—a microsimulation of the future health and spending of older Americans—we compared optimistic “disease specific” scenarios with a hypothetical “delayed aging” scenario in terms of the scenarios’ impact on longevity, disability, and major entitlement program costs. Delayed aging could increase life expectancy by an additional 2.2 years, most of which would be spent in good health. The economic value of delayed aging is estimated to be $7.1 trillion over fifty years. In contrast, addressing heart disease and cancer separately would yield diminishing improvements in health and longevity by 2060—mainly due to competing risks. Delayed aging would greatly increase entitlement outlays, especially for Social Security. However, these changes could be offset by increasing the Medicare eligibility age and the normal retirement age for Social Security. Overall, greater investment in research to delay aging appears to be a highly efficient way to forestall disease, extend healthy life, and improve public health. Show less

Author List: Christine Eibner, Dana P. Goldman, Jeffrey Sullivan and Alan M. Garber

With Medicare spending projected to increase to 24 percent of all federal spending and to equal 6 percent of the gross domestic product by 2037, policy makers are again considering ways to curb the program’s spending growth. We used a microsimulation approach to estimate three scenarios: imposing a means-tested premium for Part A hospital insurance, introducing a premium support credit to purchase health… Show more

Author List: Christine Eibner, Dana P. Goldman, Jeffrey Sullivan and Alan M. Garber

With Medicare spending projected to increase to 24 percent of all federal spending and to equal 6 percent of the gross domestic product by 2037, policy makers are again considering ways to curb the program’s spending growth. We used a microsimulation approach to estimate three scenarios: imposing a means-tested premium for Part A hospital insurance, introducing a premium support credit to purchase health insurance, and increasing the eligibility age to sixty-seven. We found that the scenarios would lead to reductions in cumulative Medicare spending in 2012–36 of 2.4–24.0 percent. However, the scenarios also would increase out-of-pocket spending for enrollees and, in some cases, cause millions of seniors not to enroll in the program and to be left without coverage. To achieve substantial cost savings without causing substantial lack of coverage among seniors, policy makers should consider benefit changes in combination with other options, such as some of those now being contemplated by the Obama administration and Congress. Show less

Author List: Darius N. Lakdawalla, PhD; Michael R. Eber, BSE; Felicia M. Forma, BSc; Jeffrey Sullivan, MS; Pierre-Carl Michaud, PhD; Lily A. Bradley, MBA; and Dana P. Goldman, PhD

The growing burden of type 2 diabetes mellitus has outpaced the modest progress in the efficacy of diabetes medications. However, it is unclear whether we are using our existing medications optimally. This article quantifies the value of addressing underuse of existing diabetes medications in the United… Show more

Author List: Darius N. Lakdawalla, PhD; Michael R. Eber, BSE; Felicia M. Forma, BSc; Jeffrey Sullivan, MS; Pierre-Carl Michaud, PhD; Lily A. Bradley, MBA; and Dana P. Goldman, PhD

The growing burden of type 2 diabetes mellitus has outpaced the modest progress in the efficacy of diabetes medications. However, it is unclear whether we are using our existing medications optimally. This article quantifies the value of addressing underuse of existing diabetes medications in the United States. Interventions—new technologies, public policies, or clinical approaches—that double the rate of initiation of insulin generate a value on average of more than $15,000 over the lifetime of a patient developing diabetes between ages 51 and 60 years, or $12.6 billion in the aggregate. Interventions that improve adherence would generate a value of more than $13,000 on average for the same patients, or $10.7 billion in the aggregate. The value of such interventions is on par with highly optimistic projections of technological progress in medication efficacy. Show less

Author list: Lance Menthe, Amado Cordova, Carl Rhodes, Rachel Costello, and Jeffrey Sullivan.

Author List: Kenneth Horn, Elvira N. Loredo, Steven Cram, Lewis Jamison, Christopher McLaren, William Phillips, and Jeffrey Sullivan.

The Army believes that it needs a replacement for the C-23 Sherpa aircraft that provides transport of mission critical, time sensitive (MCTS) cargo and passengers to brigade combat teams conducting combat operations. This issue is particularly relevant in counterinsurgency operations in Iraq and Afghanistan where ground forces are widely dispersed across… Show more

Author List: Kenneth Horn, Elvira N. Loredo, Steven Cram, Lewis Jamison, Christopher McLaren, William Phillips, and Jeffrey Sullivan.

The Army believes that it needs a replacement for the C-23 Sherpa aircraft that provides transport of mission critical, time sensitive (MCTS) cargo and passengers to brigade combat teams conducting combat operations. This issue is particularly relevant in counterinsurgency operations in Iraq and Afghanistan where ground forces are widely dispersed across long resupply distances. This occasional paper concludes that the C-27J Spartan is a reasonable replacement for the MCTS cargo and passenger mission in all performance categories. The Army's direct support approach for moving MCTS shipments using its organic aircraft is inherently more responsive than that of the Air Force. But both services should be able to improve the responsiveness of delivering MCTS shipments, but the Army should be in a better position to do so if it retains direct control of its fixed-wing and rotary-wing aircraft. Show less

Author List: Claude Berrebi, Stephen J. Carroll, and Jeffrey Sullivan.

The employment of illegal aliens is a crime in the United States, and federal law provides for forfeiture of the proceeds from this offense. However, statutory law does not specify how to calculate such proceeds. This report presents an economic model, and a software program based on the model, that can assist law enforcement officials in determining the appropriate penalty to be levied on firms that knowingly employ… Show more

Author List: Claude Berrebi, Stephen J. Carroll, and Jeffrey Sullivan.

The employment of illegal aliens is a crime in the United States, and federal law provides for forfeiture of the proceeds from this offense. However, statutory law does not specify how to calculate such proceeds. This report presents an economic model, and a software program based on the model, that can assist law enforcement officials in determining the appropriate penalty to be levied on firms that knowingly employ undocumented workers. The model is based on the assumption that firms that employ illegal aliens do so because they would have to pay higher wages to attract sufficient legal workers to meet their needs; therefore, firms profit from the employment of illegal workers. The model estimates how much profit a firm would have realized if it had employed only legal workers; the difference between this and the firm's actual profit is the portion of the firm's profit that is attributable to the employment of illegal aliens. In addition to detailing this conceptual model, the authors describe a decision-support software program that incorporates the model's calculations. Show less

Author List: Federico Girosi, Amado Cordova, Christine Eibner, Carole Roan Gresenz, Emmett B. Keeler, Jeanne S. Ringel, Jeffrey Sullivan, John Bertko, Melinda Beeuwkes Buntin, and Raffaele Vardavas.

Concerns about the rates of uninsurance in the United States, coupled with rising health care costs, have made changes in health policy a priority on the U.S. public policy agenda. In the 2008 presidential race, candidates proposed a variety of policies aimed at expanding health care access… Show more

Author List: Federico Girosi, Amado Cordova, Christine Eibner, Carole Roan Gresenz, Emmett B. Keeler, Jeanne S. Ringel, Jeffrey Sullivan, John Bertko, Melinda Beeuwkes Buntin, and Raffaele Vardavas.

Concerns about the rates of uninsurance in the United States, coupled with rising health care costs, have made changes in health policy a priority on the U.S. public policy agenda. In the 2008 presidential race, candidates proposed a variety of policies aimed at expanding health care access and affordability, including individual mandates requiring all individuals to purchase health insurance, employer mandates requiring most businesses to offer insurance, changes in the tax treatment of insurance, and safety-net expansions. However, there is little prior experience on which to gauge the likely effect of these policies on costs, coverage, population health, and individual and employer behaviors. In response, RAND researchers created the COMPARE microsimulation model, which projects how households and firms would respond to health care policy changes based on economic theory, national survey data, and existing evidence from smaller-scale changes (e.g., changes in Medicaid eligibility) by using computer software to develop a synthetic U.S. population and simulating the likely effects of a variety of insurance-enrollment scenarios. The model currently addresses four types of coverage-oriented policy options: individual mandates, employer mandates, expansions of public programs, and tax incentives. However, it is flexible to permit expansion of the number and variety of policy options. Show less

Author List: Lance Menthe and Jeffrey Sullivan.

The RAND Corporation's Collection Operations Model (COM) is a stochastic, agent-based simulation tool designed to support the analysis of command, control, communications, intelligence, surveillance, and reconnaissance (C3ISR) processes and scenarios. Written for the System Effectiveness Analysis Simulation modeling environment, the COM is used to study processes that require the real-time interaction of many players and to answer questions… Show more

Author List: Lance Menthe and Jeffrey Sullivan.

The RAND Corporation's Collection Operations Model (COM) is a stochastic, agent-based simulation tool designed to support the analysis of command, control, communications, intelligence, surveillance, and reconnaissance (C3ISR) processes and scenarios. Written for the System Effectiveness Analysis Simulation modeling environment, the COM is used to study processes that require the real-time interaction of many players and to answer questions about force mix, system effectiveness, concepts of operations, basing and logistics, and capability-based assessment. It can represent thousands of autonomous, interacting platforms and explore the capabilities of a wide range of intelligence, surveillance, and reconnaissance assets. Through its flexible and friendly text-based input tables, the model represents a wide array of sensor capabilities, target properties, terrain and weather effects, and resource limitations. Its final output is a minute-by-minute account of each agent's changing operational picture. Since 2005, the COM has been used to model counterinsurgency, counterpiracy, and maritime surveillance scenarios and two major combat operations, and to study ad hoc collections, sensor cueing, dynamic retasking, and resource allocation.

RAND has planned a number of upgrades to the COM, including the addition of space-based assets; a more robust model of sensor data fusion; communications modules that more accurately represent the advantages of a networked force; a more realistic representation of C3ISR workflow; sensor capability to generate false positives; and agent capability to practice deception. These extensions and enhancements are intended to result in a COM that can represent the entire C3ISR process specifically and network-centric operations in general. Show less