Browsing by Author "Ho, Vivian"
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Item 2013 Recommendations for the Obama Administration(2013) Ho, Vivian; James A. Baker III Institute for Public PolicyItem Adherence to treatment guidelines and survival for older patients with stage II or III colon cancer in Texas from 2001 through 2011(Wiley, 2018) Zhao, Hui; Zhang, Ning; Ho, Vivian; Ding, Minming; He, Weiguo; Niu, Jiangong; Yang, Ming; Du, Xianglin; Zorzi, Daria; Chavez-MacGregor, Mariana; Giordano, Sharon H.BACKGROUND: Treatment guidelines for colon cancer recommend colectomy with lymphadenectomy of at least 12 lymph nodes for patients with stage I to stage III disease as surgery adherence (SA) and adjuvant chemotherapy for individuals with stage III disease. Herein, the authors evaluated adherence to these guidelines among older patients in Texas with colon cancer and the associated survival outcomes. METHODS: Using Texas Cancer Registry data linked with Medicare data, the authors included patients with AJCC stage II and III colon cancer who were aged ?66 years and diagnosed between 2001 and 2011. SA and adjuvant chemotherapy adherence rates to treatment guidelines were estimated. The chi-square test, general linear regression, survival probability, and Cox regression were used to identify factors associated with adherence and survival. RESULTS: The rate of SA increased from 47.2% to 84% among 6029 patients with stage II or stage III disease from 2001 to 2011, and the rate of adjuvant chemotherapy increased from 48.9% to 53.1% for patients with stage III disease during the same time period. SA was associated with marital status, tumor size, surgeon specialty, and year of diagnosis. Patient age, sex, marital status, Medicare state buy-in status, comorbidity status, and year of diagnosis were found to be associated with adjuvant chemotherapy. The 5-year survival probability for patients receiving guideline-concordant treatment was the highest at 87% for patients with stage II disease and was 73% for those with stage III disease. After adjusting for demographic and tumor characteristics, improved cancer cause-specific survival was associated with the receipt of stage-specific, guideline-concordant treatment for patients with stage II or stage III disease. CONCLUSIONS: The adherence to guideline-concordant treatment among older patients with colon cancer residing in Texas improved over time, and was associated with better survival outcomes. Future studies should be focused on identifying interventions to improve guideline-concordant treatment adherence.Item Algorithm for analysis of administrative pediatric cancer hospitalization data according to indication for admission(BioMed Central Ltd, 2014) Russell, Heidi V.; Okcu, M. Fatih; Kamdar, Kala; Shah, Mona D.; Kim, Eugene; Swint, J. Michael; Chan, Wenyaw; Du, Xianglin L.; Franzini, Luisa; Ho, Vivian; James A. Baker III Institute for Public PolicyBackground: Childhood cancer relies heavily on inpatient hospital services to deliver tumor-directed therapy and manage toxicities. Hospitalizations have increased over the past decade, though not uniformly across childhood cancer diagnoses. Analysis of the reasons for admission of children with cancer could enhance comparison of resource use between cancers, and allow clinical practice data to be interpreted more readily. Such comparisons using nationwide data sources are difficult because of numerous subdivisions in the International Classification of Diseases Clinical Modification (ICD-9) system and inherent complexities of treatments. This study aimed to develop a systematic approach to classifying cancer-related admissions in administrative data into categories that reflected clinical practice and predicted resource use. Methods: We developed a multistep algorithm to stratify indications for childhood cancer admissions in the Kids Inpatient Databases from 2003, 2006 and 2009 into clinically meaningful categories. This algorithm assumed that primary discharge diagnoses of cancer or cytopenia were insufficient, and relied on procedure codes and secondary diagnoses in these scenarios. Clinical Classification Software developed by the Healthcare Cost and Utilization Project was first used to sort thousands of ICD-9 codes into 5 mutually exclusive diagnosis categories and 3 mutually exclusive procedure categories, and validation was performed by comparison with the ICD-9 codes in the final admission indication. Mean cost, length of stay, and costs per day were compared between categories of indication for admission. Results: A cohort of 202,995 cancer-related admissions was grouped into four categories of indication for admission: chemotherapy (N=77,791, 38%), to undergo a procedure (N=30,858, 15%), treatment for infection (N=30,380, 15%), or treatment for other toxicities (N=43,408, 21.4%). The positive predictive value for the algorithm was >95% for each category. Admissions for procedures had higher mean hospital costs, longer hospital stays, and higher costs per day compared with other admission reasons (p<0.001). Conclusions: This is the first description of a method for grouping indications for childhood cancer admission within an administrative dataset into clinically relevant categories. This algorithm provides a framework for more detailed analyses of pediatric hospitalization data by cancer type.Item Annual Spending per Patient and Quality in Hospital-Owned Versus Physician-Owned Organizations: an Observational Study(2019) Ho, Vivian; Metcalfe, Leanne; Vu, Lan; Short, Marah Noel; Morrow, Robert; James A. Baker III Institute for Public PolicyBackground: Recent studies that compared patient spending in hospital-owned physician practices versus physician-owned groups did not compare quality of care. Past studies had incomplete measures of physician-hospital integration, or lacked patient-level data. Objective: To measure the association between physician-hospital integration and both spending and quality using patient-level data and explicit physician-hospital contracting information. Design: Retrospective review of claims data from 2014 through 2016. Adjustments were made for patient, physician, and regional characteristics. Patients: Patients aged 19 to 64 enrolled in a Blue Cross Blue Shield Texas Preferred Provider Organization in the four largest metropolitan areas in Texas who could be attributed to a physician practice based on claims. Main Outcomes and Measures: Annual spending per patient was compared for patients treated by a physician practice that is billing through a hospital, versus billing through an independent physician practice; spending was also subdivided by BETOS category, by site and type of care, and percent of patients with positive spending by subcategory. Quality measures included readmission within 30 days of discharge for hospitalized patients, appropriate care for diabetic patients, and screening mammography for women ages 50–64. Results: Estimates suggest that patients in a preferred provider organization incur spending which is 5.8 percentage points higher when treated by doctors in hospital-owned versus physician-owned practices (95% CI 1.7 to 9.9; p = 0.006). Spending is significantly higher for durable medical equipment, imaging, unclassified services, and outpatient care. The spending difference appears attributable to greater service utilization rather than higher prices. There was no consistent difference in care quality for hospital-owned versus physician-owned practices. Conclusions and Relevance: We find that financial integration between physicians and hospitals raises patient spending, but not care quality. Given that higher spending raises the price of health insurance, policy makers should carefully consider policies that limit consolidation of hospitals and physicians.Item Are freestanding emergency departments (EDs) the same as urgent care centers?(2018) Ho, Vivian; James A. Baker III Institute for Public PolicyItem Are Texas Hospitals Practicing Price Transparency?(2022) Ho, Vivian; Solcher, Patrick; Ye, Vivian; Short, Marah Noel; James A. Baker III Institute for Public PolicyItem Association of Hospitalization and Mortality Among Patients Initiating Dialysis With Hemodialysis Facility Ownership and Acquisitions(JAMA, 2019) Erickson, Kevin F.; Zhao, Bo; Niu, Jingbo; Winkelmayer, Wolfgang C.; Bhattacharya, Jay; Chertow, Glenn M.; Ho, Vivian; James A. Baker III Institute for Public PolicyImportance: Mergers and acquisitions among health care institutions are increasingly common, and dialysis markets have undergone several decades of mergers and acquisitions. Objective: To examine the outcomes of hemodialysis facility acquisitions independent of associated changes in market competition resulting from acquisitions. Design, Setting, and Participants: Cohort study using difference-in-differences (DID) analyses to compare changes in health outcomes over time among in-center US dialysis facilities that were acquired by a hemodialysis chain with facilities located nearby but not acquired. Multivariable Cox proportional hazards regression models and negative binomial models with predicted marginal effects were developed to examine health outcomes, controlling for patient, facility, and geographic characteristics. All facility ownership types were examined together and stratified analyses were conducted of facilities that were independently owned and chain owned prior to acquisitions. The study was conducted from January 2001 to September 2015; 174 905 patients starting in-center dialysis in the 3 years before and following dialysis facility acquisitions were included. Data were analyzed from March 2017 to December 2018. Exposures: Acquisition by a hemodialysis chain. Main Outcomes and Measures: Twelve-month hazard of death and hospital days per patient-year were the primary outcomes. Results: Of the 174 905 patients included in the study, 79 705 were women (45.6%), 24 409 (14.0%) were of Hispanic ethnicity, 61 815 (35.3%) were black, 105 272 (60.2%) were white, and 1247 (0.7%) were Native American. Mean (SD) age was 65 (15) years. Before acquisitions, adjusted mortality and hospitalization rates were 10% (95% CI, −16% to −5%) and 2.9 days per patient-year (95% CI, −3.8 to −2.0) lower, respectively, at independently owned facilities that were acquired compared with those that were not acquired, while hospitalization rates were 0.7 days (95% CI, −1.2 to −2.0) lower at chain-owned facilities that were acquired compared with those that were not acquired. In stratified analyses of independently owned facilities, mortality decreases were smaller at acquired (−8.4%; 95% CI, −14% to −25%) vs nonacquired (−20.3%; 95% CI, −25.8% to −14.3%) facilities (DID P < .001). Similarly, hospitalization rates did not change at acquired facilities and decreased by 2.6 days per patient-year (95% CI, −3.6 to −1.7 days) at nonacquired facilities (DID P < .001). Acquisitions were not associated with changes in health outcomes at chain-owned facilities. Slower reductions in mortality and hospitalization rates at independently owned facilities contributed to significant differences in hospitalizations (−2.0 days; 95% CI, −2.5 to −1.6, at nonacquired vs 0.9 days; 95% CI, −1.3 to −0.5, at acquired facilities; DID, P < .001) across all ownership types but not mortality (DID, P = .28) with regard to acquisitions. Conclusions and Relevance: Acquisition of independently owned dialysis facilities by larger dialysis organizations was associated with slower decreases in mortality and hospitalization rates, as nonacquired facilities appeared to experience more rapid improvements in outcomes over time.Item Association of Level I and II Trauma Center Expansion With Insurer Payments in Texas From 2011 to 2019(American Medical Association, 2022) Ho, Vivian; Short, Marah N.; Coughlin, Maura; McClure, Shara; Suliburk, James W.; Baker Institute for Public PolicyItem Association of Statewide Certificate of Need Regulations With Percutaneous Coronary Intervention Appropriateness and Outcomes(2019) Chui, Philip W.; Parzynski, Craig S.; Ross, Joseph S.; Desai, Nihar R.; Gurm, Hitinder S.; Spertus, John A.; Seto, Arnold H.; Ho, Vivian; Curtis, Jeptha P.; James A. Baker III Institute for Public PolicyBackground: Certificate of need (CON) regulations are intended to coordinate new healthcare services, limit expansion of unnecessary new infrastructure, and limit healthcare costs. However, there is limited information about the association of CON regulations with the appropriateness and outcomes of percutaneous coronary interventions (PCI). The study sought to characterize the association between state CON regulations and PCI appropriateness. Methods and Results: We used data from the American College of Cardiology's CathPCI Registry to analyze 1 268 554 PCIs performed at 1297 hospitals between January 2010 and December 2011. We used the Appropriate Use Criteria to classify PCI procedures as appropriate, maybe appropriate, or rarely appropriate and used Chi?square analyses to assess whether the proportions of PCIs in each Appropriate Use Criteria category varied depending on whether the procedure had been performed in a state with or without CON regulations. Analyses were repeated stratified by whether or not the procedure had been performed in the setting of an acute coronary syndrome (ACS). Among 1 268 554 PCI procedures, 674 384 (53.2%) were performed within 26 CON states. The proportion of PCIs classified as rarely appropriate in CON states was slightly lower compared with non?CON states (3.7% versus 4.0%, P<0.01). Absolute differences were larger among non?ACS PCI (23.1% versus 25.0% [P<0.01]) and were not statistically significantly different in ACS (0.62% versus 0.63% [P>0.05]). Conclusions: States with CON had lower proportions of rarely appropriate PCIs, but the absolute differences were small. These findings suggest that CON regulations alone may not limit rarely appropriate PCI among patients with and without ACS.Item Can Centralization of Cardiac Procedures Yield Large Cost Savings?(2007) Ho, Vivian; Petersen, Laura A.; James A. Baker III Institute for Public PolicyItem Can postoperative process of care utilization or complication rates explain the volume-cost relationship for cancer surgery?(Elsevier, 2017) Ho, Vivian; Short, Marah N.; Aloia, Thomas A.Background: Past studies identify an association between provider volume and outcomes, but less is known about the volume-cost relationship for cancer surgery. We analyze the volume-cost relationship for 6 cancer operations and explore whether it is influenced by the occurrence of complications and/or utilization of processes of care. Methods: Medicare hospital and inpatient claims for the years 2005 through 2009 were analyzed for 6 cancer resections: colectomy, rectal resection, pulmonary lobectomy, pneumonectomy, esophagectomy, and pancreatic resection. Regressions were first estimated to quantify the association of provider volume with costs, excluding measures of complications and processes of care as explanatory variables. Next, these variables were added to the regressions to test whether they weakened any previously observed volume-cost relationship. Results: Higher hospital volume is associated with lower patient costs for esophagectomy but not for other operations. Higher surgeon volume reduces costs for most procedures, but this result weakens when processes of care are added to the regressions. Processes of care that are frequently implemented in response to adverse events are associated with 14% to 34% higher costs. Utilization of these processes is more prevalent among low-volume versus high-volume surgeons. Conclusion: Processes of care implemented when complications occur explain much of the surgeon volume–cost relationship. Given that surgeon volume is readily observed, better outcomes and lower costs may be achieved by referring patients to high-volume surgeons. Increasing patient access to surgeons with lower rates of complications may be the most effective strategy for avoiding costly processes of care, controlling expenditure growth.Item Cardiac Certificate of Need regulations and the availability and use of revascularization services?(Elsevier, 2007) Ho, Vivian; Ross, Joseph S.; Nallamothu, Brahmajee K.; Krumholz, Harlan M.; James A. Baker III Institute for Public PolicyBackground: Many states enforce Certificate of Need (CON) regulations for cardiac procedures, but little is known about how CON affects utilization. We assessed the association between cardiac CON regulations, availability of revascularization facilities, and revascularization rates. Methods: We determined when state cardiac CON regulations were active and obtained data for Medicare beneficiaries ≥65 years old who received coronary artery bypass graft surgery (CABG) or a percutaneous coronary intervention (PCI) between 1989 and 2002. We compared the number of hospitals performing revascularization and patient utilization in states with and without CON regulations, and in states which discontinued CON regulations during 1989 to 2002. Results: Each year, the per capita number of hospitals performing CABG and PCI was higher in states without CON (3.7 per 100 000 elderly for CABG, 4.5 for PCI in 2002), compared with CON states (2.5 for CABG, 3.0 for PCI in 2002). Multivariate regressions that adjusted for market and population characteristics found no difference in CABG utilization rates between states with and without CON (P = .7). However, CON was associated with 19.2% fewer PCIs per 1000 elderly (P = .01), equivalent to 322 526 fewer PCIs for 1989 to 2002. Among most states that discontinued CON, the number of hospitals performing PCI rose in the mid 1990s, but there were no consistent trends in the number of hospitals performing CABG or in PCIs or CABGs per capita. Conclusions: Certificate of Need restricts the number of cardiac facilities, but its effect on utilization rates may vary by procedure.Item CDC Case Report Data for COVID-19: Characterizing the Pandemic with Limited Information(James A. Baker III Institute for Public Policy, 2021) Ho, Vivian; Short, Marah Noel; Tapaneeyakul, Sasathorn; James A. Baker III Institute for Public PolicyNationwide standardized surveillance of COVID-19 using the U.S. Center for Disease Control (CDC)'s COVID-19 case report forms could yield invaluable information on disease burden and the nature of virus transmission. If respondents provided comprehensive responses to the form’s queries, public health officials, policymakers, and business leaders would have a wealth of data when making critical decisions on where to direct testing and treatment resources, and how to conduct safe reopenings. We obtained CDC case reports through July 19, 2020 through an expedited Freedom of Information Act request. We examined data from May 5 through July 19 to determine completeness of CDC case counts relative to more accurate counts reported by the New York Times (NYT). We found that the CDC’s case reports contained surprisingly incomplete information relative to the amount that the agency’s official form was intended to collect. Only seven states had sufficient data to characterize cases by ethnicity or race, or exposure type. People age 20 to 39 accounted for more COVID-19 cases than their share of the population. The most infections for all ages tended to occur during the third time period (June 24 through July 19) in our sample. White people were infected in proportion to their share of the population, while Hispanic cases were overrepresented. The most common sources of exposure were workplaces and households.Item Certificate of Need for Cardiac Care: Controversy Over the Contributions of CON(James A. Baker III Institute for Public Policy, 2009) Ho, Vivian; Ku-Goto, Meei-Hsiang; Jollis, James; James A. Baker III Institute for Public PolicyObjective: To test whether state Certificate of Need (CON) regulations influence procedural mortality or the provision of coronary artery bypass graft surgery (CABG) and percutaneous coronary interventions (PCI). Data Sources: Medicare inpatient claims obtained for 1989-2002 for patients age 65+ who received CABG or PCI. Study Design: We used differences-in-differences regression analysis to compare states that dropped CON during the sample period, versus states that kept the regulations. We examined procedural mortality, the number of hospitals in the state performing CABG or PCI, mean hospital volume, and statewide procedure volume for CABG and PCI. Principal Findings: States that dropped CON experienced lower CABG mortality rates relative to states that kept CON, although the differential is not permanent. No such mortality difference is found for PCI. Dropping CON is associated with more providers statewide and lower mean hospital volume for both CABG and PCI. However, statewide procedure counts remain the same. Conclusions: We find no evidence that CON regulations are associated with higher quality CABG or PCI. The regulations may limit the number of facilities performing these procedures, and the potential cost savings from this restriction should be investigated.Item Certificate of Need Regulations and the Availability and Use of Cancer Resections(2008) Short, Marah Noel; Aloia, Thomas A.; Ho, Vivian; James A. Baker III Institute for Public PolicyBackground: Several states use certificate of need regulations (CON) to control the growth of acute-care services, but the possible association between these restrictions and the provision of cancer surgery has not been assessed. This study examines the association between acute-care CON, the availability of cancer surgery hospitals, and provision of six cancer operations. Methods: Medicare data were collected for beneficiaries treated with one of six cancer resections and an associated cancer diagnosis from 1989 to 2002. Hospital, procedure, and incidence rates for each cancer diagnosis were stratified by state and year. The number of hospitals performing each operation per cancer incident, the number of procedures performed per cancer incident, and hospital volume were compared between states with and without CON, and those that discontinued CON during the sample period were noted. Results: The number of hospitals per cancer incident was lower in CON states versus non-CON states for colectomy (P = .022), rectal resection (P = .026), and pulmonary lobectomy (P = .032). Hospital volume was significantly higher in CON states versus non-CON states for colectomy (P = .006) and pulmonary lobectomy (P = .043). There were no differences between states with and without CON in the number of procedures per cancer incident. Conclusion: Although use of cancer procedures was similar in CON and non-CON states, those with acute-care CON had fewer facilities performing oncologic resections per cancer patient. Correspondingly, average hospital procedure volume tended to be higher in CON states. These differences may have important implications for patient outcomes and costs.Item Community Benefit Spending and the Tax-Exempt Status of Nonprofit Hospitals(James A. Baker III Institute for Public Policy, 2018) Alexander, Alex; Short, Marah Noel; Ho, Vivian; James A. Baker III Institute for Public PolicyItem Comparing Prices and Price Transparency Among Top-Ranked Hospitals and Close Competitors(2022) Ho, Vivian; Lara, Alan Beltran; Ruiz, David; Cram, Peter; Short, Marah Noel; James A. Baker III Institute for Public PolicyA regulation from the Centers for Medicare and Medicaid Services (CMS) required that, starting January 1, 2021, all U.S. hospitals publicly display the cash price as well as the minimum and maximum negotiated charge for 300 “shoppable services.” During July and August 2021 we evaluated compliance with these requirements among the U.S. News & World Report’s 20 honor roll hospitals in 2020-21 and 41 high-quality hospitals in the same cities. We compared prices for three imaging studies (brain MRI, abdominal ultrasound, and chest x-ray) and three hospital services (basic metabolic panel, electrocardiogram [ECG], and lower joint replacement). Within each of the studied procedures, at most 7 of the 14 cities with top-20 hospitals had minimum negotiated prices that were reported by at least one top-20 hospital and a competitor that was comparable in quality. The top-20 hospital was the highest priced for 5 of 7 cities for ECGs. Yet a top-20 hospital was the highest priced facility in only 1 of 5 cities for both MRIs and joint replacements. For a handful of cities and procedures, the top-20 hospital was priced much lower than its competitor(s), or there was wide price disparity between top-20 hospitals in the same city. Top-20 hospitals were more likely to report cash prices, but they were orders of magnitude higher than their minimum negotiated price. Many highly respected U.S. hospitals are not in compliance with new price transparency legislation, even though the prices of reporting top-20 hospitals are not systematically higher than competitors with comparable quality. Full price transparency by all hospitals would aid patients and payers in identifying price outliers and choosing the most cost-effective providers.Item Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers(Elsevier, 2017) Ho, Vivian; Metcalfe, Leanne; Dark, Cedric; Vu, Lan; Weber, Ellerie; Shelton, George; Underwood, Howard R.Study objective: We compare utilization, price per visit, and the types of care delivered across freestanding emergency departments (EDs), hospital-based EDs, and urgent care centers in Texas. Methods: We analyzed insurance claims processed by Blue Cross Blue Shield of Texas from 2012 to 2015 for patient visits to freestanding EDs, hospital-based EDs, or urgent care centers in 16 Texas metropolitan statistical areas containing 84.1% of the state’s population. We calculated the aggregate number of visits, average price per visit, proportion of price attributable to facility and physician services, and proportion of price billed to Blue Cross Blue Shield of Texas versus out of pocket, by facility type. Prices for the top 20 diagnoses and procedures by facility type are compared. Results: Texans use hospital-based EDs and urgent care centers much more than freestanding EDs, but freestanding ED utilization increased 236% between 2012 and 2015. The average price per visit was lower for freestanding EDs versus hospital-based EDs in 2012 ($1,431 versus $1,842), but prices in 2015 were comparable ($2,199 versus $2,259). Prices for urgent care centers were only $164 and $168 in 2012 and 2015. Out-of-pocket liability for consumers for all these facilities increased slightly from 2012 to 2015. There was 75% overlap in the 20 most common diagnoses at freestanding EDs versus urgent care centers and 60% overlap for hospital-based EDs and urgent care centers. However, prices for patients with the same diagnosis were on average almost 10 times higher at freestanding and hospital-based EDs relative to urgent care centers. Conclusion: Utilization of freestanding EDs is rapidly expanding in Texas. Higher prices at freestanding and hospital-based EDs relative to urgent care centers, despite substantial overlap in services delivered, imply potential inefficient use of emergency facilities.Item Cost-effectiveness analysis of cholecystectomy during Roux-en-Y gastric bypass for morbid obesity(2012) Benarroch-Gampel, Jaime; Lairson, David R.; Boyd, Casey A.; Sheffield, Kristin M.; Ho, Vivian; Riall, Taylor S.; James A. Baker III Institute for Public PolicyBackground: Controversy exists regarding the use of concurrent cholecystectomy during Roux-en-Y gastric bypass performed for morbid obesity. Methods: A decision model was developed to evaluate the cost-effectiveness of current strategies: routine concurrent cholecystectomy, Roux-en-Y gastric bypass alone with or without postoperative ursodiol therapy, and selective cholecystectomy based on preoperative findings on ultrasonography. Probabilities were obtained from a comprehensive literature review. Costs and hospital days were obtained from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. One-way sensitivity analyses were performed. Results: The least expensive strategy was to perform RYGB alone without preoperative ultrasonography, with an average cost (over RYGB costs) of $537 per patient. RYGB with concurrent cholecystectomy had a cost of $631. Selective cholecystectomy based on preoperative ultrasonography was dominated by the other 2 strategies. Our model was most sensitive to the probability of developing gallbladder-related symptoms after RYGB alone. When the incidence of gallbladder-related symptoms was <4.6%, the dominant strategy was to perform a RYGB alone without preoperative ultrasonography. For values >6.9%, performing concurrent cholecystectomy at the time of the RYGB was superior to other strategies. When ursodiol was used, the least expensive strategy was to perform a concurrent cholecystectomy during RYGB. Conclusion: The main factor determining the most cost-effective strategy is the incidence of gallbladder-related symptoms after RYGB. The use of ursodiol was associated with an increase in cost that does not justify its use after RYGB. Finally, selective cholecystectomy based on preoperative ultrasonography was dominated by the other strategies in the scenarios evaluated.Item Could substantial health care savings be achieved by reducing complications from cancer surgery?(2014) Short, Marah Noel; Ho, Vivian; Aloia, Thomas A.; James A. Baker III Institute for Public Policy