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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 46 Research Studies Displayed
Greenhawt M, Shaker M
Determining levers of cost-effectiveness for screening infants at high risk for peanut sensitization before early peanut introduction.
The authors sought to identify scenarios in which current early peanut introduction guidelines would be cost-effective. They found that the current screening approach to early peanut introduction could be cost-effective at a particular health utility for an in-clinic reaction, skin prick test sensitivity and specificity, and high baseline peanut allergy prevalence among high-risk infants. However, such conditions are unlikely to be plausible to achieve realistically. They recommend further research to define the health state utility associated with reaction location.
Citation: Greenhawt M, Shaker M . Determining levers of cost-effectiveness for screening infants at high risk for peanut sensitization before early peanut introduction. JAMA Netw Open 2019 Dec 2;2(12):e1918041. doi: 10.1001/jamanetworkopen.2019.18041..
Keywords: Patient-Centered Outcomes Research, Newborns/Infants, Children/Adolescents, Respiratory Conditions, Skin Conditions, Screening, Healthcare Costs, Evidence-Based Practice, Guidelines
Kitsios GD, Yang L, Manatakis DV
Host-response subphenotypes offer prognostic enrichment in patients with or at risk for acute respiratory distress syndrome.
This study examined whether certain plasma biomarkers can be used to help classify mechanically ventilated ICU patients with acute respiratory distress syndrome into hyper- and hypoinflammatory subphenotypes to facilitate more effective targeted therapy. The researchers performed longitudinal measures of 10 plasma biomarkers of host injury and inflammation. They were able to demonstrate that two-class models (hyper- vs hypoinflammatory subphenotypes) fit better than one-class models in patients with acute respiratory distress syndrome or patients at risk for acute respiratory distress (ARFA). Hyperinflammatory classification was associated higher severity of illness, worse clinical outcomes, and persistently elevated biomarkers of host injury and inflammation compared with hypoinflammatory patients.
Citation: Kitsios GD, Yang L, Manatakis DV . Host-response subphenotypes offer prognostic enrichment in patients with or at risk for acute respiratory distress syndrome. Crit Care Med 2019 Dec;47(12):1724-34. doi: 10.1097/ccm.0000000000004018..
Keywords: Respiratory Conditions, Critical Care, Intensive Care Unit (ICU), Risk
Artis KA, Dweik RA, Patel B
Performance measure development, use, and measurement of effectiveness using the guideline on mechanical ventilation in acute respiratory distress syndrome. an official American Thoracic Society workshop report.
This report summarizes the proceedings of a workshop convened to advance the American Thoracic Society’s work in performance measure development and guideline implementation. The example of a low-tidal volume ventilation performance measure created from the 2017 ATS clinical practice guideline is used to illustrate the application of the ATS performance measure development framework, including detailed explanation of the rationale for the specifications chosen, identification of areas in need of further validity testing, and a preliminary strategy for testing the performance measure.
Citation: Artis KA, Dweik RA, Patel B . Performance measure development, use, and measurement of effectiveness using the guideline on mechanical ventilation in acute respiratory distress syndrome. an official American Thoracic Society workshop report. Ann Am Thorac Soc 2019 Dec;16(12):1463-72. doi: 10.1513/AnnalsATS.201909-665ST..
Keywords: Respiratory Conditions, Guidelines, Evidence-Based Practice, Quality Measures, Quality of Care, Provider Performance
Jones YO, Hubbell BB, Thomson J
Things we do for no reason: systemic corticosteroids for wheezing in preschool-aged children.
This installment of the “Things We Do For No Reason” series presents and discusses a case study concerning the administration of systemic corticosteroids in a 4-year-old child presenting with wheezing, tachypnea, and respiratory distress. The authors conclude that current evidence does not support the routine use of systemic corticosteroids for preschool-aged children admitted for mild to moderate wheezing episodes, and that the patient in the introductory case would likely receive no clinical benefit from dexamethasone treatment.
Citation: Jones YO, Hubbell BB, Thomson J . Things we do for no reason: systemic corticosteroids for wheezing in preschool-aged children. J Hosp Med 2019 Dec;14(12):774-76. doi: 10.12788/jhm.3255..
Keywords: Children/Adolescents, Respiratory Conditions, Asthma, Case Study, Decision Making, Medication
Goldstein E, Finelli L, O'Halloran A
AHRQ Author: Karaca Z, Steiner C
Hospitalizations associated with respiratory syncytial virus and influenza in children, including children diagnosed with asthma.
This study examined hospitalization rates in children associated with respiratory syncytial virus (RSV) and influenza, including children with asthma. HCUP hospitalization data and additional data to estimate RSV and influenza-associated hospitalization with a respiratory cause was analyzed in different subpopulations of US children between 2003 and 2010. Annual rates of RSV-associated hospitalization was highest in infants and young children, and declined rapidly with age. Influenza hospitalizations also were highest in young children and declined by age 12-17 years. Higher rates of RSV-related and influenza hospitalization in the youngest children with a prior diagnosis of asthma was also found.
Citation: Goldstein E, Finelli L, O'Halloran A . Hospitalizations associated with respiratory syncytial virus and influenza in children, including children diagnosed with asthma. Epidemiology 2019 Nov;30(6):918-26. doi: 10.1097/ede.0000000000001092..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Asthma, Influenza, Respiratory Conditions, Hospitalization, Chronic Conditions
Mathis MR, Duggal NM, Likosky DS
Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery.
In this study, the authors hypothesized that a bundled intraoperative protective ventilation strategy was independently associated with decreased odds of pulmonary complications after cardiac surgery. They identified an intraoperative lung-protective ventilation bundle as independently associated with pulmonary complications after cardiac surgery. Their findings offer insight into components of protective ventilation associated with adverse outcomes and may serve as targets for future prospective interventional studies investigating the impact of specific protective ventilation strategies on postoperative outcomes after cardiac surgery.
Citation: Mathis MR, Duggal NM, Likosky DS . Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery. Anesthesiology 2019 Nov;131(5):1046-62. doi: 10.1097/aln.0000000000002909..
Keywords: Adverse Events, Cardiovascular Conditions, Patient Safety, Respiratory Conditions, Surgery
Ji W, McKenna C, Ochoa A
Development and assessment of objective surveillance definitions for nonventilator hospital-acquired pneumonia.
The authors sought to propose and assess potentially objective, efficient, and reproducible surveillance definitions for non-ventilator hospital-acquired pneumonia (NV-HAP) using routine clinical data stored in electronic health record systems. They found that objective surveillance for NV-HAP using electronically computable definitions that incorporate common clinical criteria is feasible and generates incidence, mortality, and adjusted odds ratios for hospital mortality similar to estimates from manual surveillance. They concluded that these definitions have the potential to facilitate widespread, automated surveillance for NV-HAP and thus inform the development and evaluation of prevention programs.
Citation: Ji W, McKenna C, Ochoa A . Development and assessment of objective surveillance definitions for nonventilator hospital-acquired pneumonia. JAMA Netw Open 2019 Oct 2;2(10):e1913674. doi: 10.1001/jamanetworkopen.2019.13674..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Respiratory Conditions, Public Health, Electronic Health Records (EHRs), Health Information Technology (HIT)
Sterling MR, Echeverria SE, Commodore-Mensah Y
Health equity and implementation science in heart, lung, blood, and sleep-related research: emerging themes from the 2018 Saunders-Watkins Leadership Workshop.
This article discusses the key themes from a 2-day workshop that was held at the National Institutes of Health in May 2018 to promote health equity and implementation science in heart, lung, and sleep-related research. This inaugural workshop was named the Saunders-Watkins Leadership Workshop. Recommendations are offered for the future direction of this research.
Citation: Sterling MR, Echeverria SE, Commodore-Mensah Y . Health equity and implementation science in heart, lung, blood, and sleep-related research: emerging themes from the 2018 Saunders-Watkins Leadership Workshop. Circ Cardiovasc Qual Outcomes 2019 Oct;12(10):e005586. doi: 10.1161/circoutcomes.119.005586..
Keywords: Implementation, Evidence-Based Practice, Disparities, Patient-Centered Outcomes Research, Cardiovascular Conditions, Heart Disease and Health, Respiratory Conditions, Sleep Problems
Oates GR, Niranjan SJ, Ott C
Adherence to pulmonary rehabilitation in COPD: a qualitative exploration of patient perspectives on barriers and facilitators.
Adherence to pulmonary rehabilitation (PR) is low. This qualitative study used the PRECEDE model to identify predisposing (intrapersonal), reinforcing (interpersonal), and enabling (structural) factors acting as barriers or facilitators of adherence to PR, and elicit recommendations for solutions from patients with chronic obstructive pulmonary disease (COPD). The investigators concluded that health limitations, social support, transportation and financial difficulties, and program features impact ability of patients to attend PR.
Citation: Oates GR, Niranjan SJ, Ott C . Adherence to pulmonary rehabilitation in COPD: a qualitative exploration of patient perspectives on barriers and facilitators. J Cardiopulm Rehabil Prev 2019 Sep;39(5):344-49. doi: 10.1097/hcr.0000000000000436..
Keywords: Respiratory Conditions, Rehabilitation, Patient Adherence/Compliance, Chronic Conditions
Sobotka SA, Foster C, Lynch E
Attributable delay of discharge for children with long-term mechanical ventilation.
The purpose of this study was to assess the reasons for discharge delays for children with long-term mechanical ventilation. The investigators found that over one-half of children discharged to the community from a large inpatient pediatric long-term mechanical ventilation program had a nonmedical delay of discharge home, most commonly because of home nurse staffing.
Citation: Sobotka SA, Foster C, Lynch E . Attributable delay of discharge for children with long-term mechanical ventilation. J Pediatr 2019 Sep;212:166-71. doi: 10.1016/j.jpeds.2019.04.034..
Keywords: Children/Adolescents, Respiratory Conditions, Hospital Discharge, Home Healthcare
Biener AI, Decker SL, Rohde F
AHRQ Author: Decker SL, Rohde F
Prevalence and treatment of chronic obstructive pulmonary disease (COPD) in the United States.
This infographic depicts MEPS data concerning the prevalence and treatment of chronic obstructive pulmonary disease, including information on costs, medications and other chronic conditions.
Citation: Biener AI, Decker SL, Rohde F . Prevalence and treatment of chronic obstructive pulmonary disease (COPD) in the United States. JAMA 2019 Aug 20;322(7):602. doi: 10.1001/jama.2019.10241..
Keywords: Medical Expenditure Panel Survey (MEPS), Respiratory Conditions, Care Management, Chronic Conditions, Healthcare Costs
Hoonakker PLT, Carayon P, Salwei ME
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
One possible explanation for user resistance to clinical decision support (CDS) procedures may be poor CDS design. This study describes the design of PE Dx, a CDS built to aid in the diagnosis of pulmonary embolism in the emergency department using human factors methods.
Citation: Hoonakker PLT, Carayon P, Salwei ME . The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED. Stud Health Technol Inform 2019 Aug 9;265:134-40. doi: 10.3233/shti190152..
Keywords: Blood Clots, Clinical Decision Support (CDS), Decision Making, Diagnostic Safety and Quality, Emergency Department, Respiratory Conditions
Iyer AS, Dionne-Odom JN, Ford SM
A formative evaluation of patient and family caregiver perspectives on early palliative care in chronic obstructive pulmonary disease across disease severity.
Investigators sought to identify patient and family caregiver early palliative care needs across stages of chronic obstructive pulmonary disease (COPD) severity. They conducted their study as part of the Medical Research Council Framework developmental phase for intervention development. Their results showed that patients with moderate to very severe COPD and their family caregivers found early palliative care acceptable and felt it should be integrated before end-stage. Of the five broad themes of early palliative care needs, coping with COPD and emotional symptoms were the highest priority, followed by respiratory symptoms, illness understanding, and prognostic awareness.
Citation: Iyer AS, Dionne-Odom JN, Ford SM . A formative evaluation of patient and family caregiver perspectives on early palliative care in chronic obstructive pulmonary disease across disease severity. Ann Am Thorac Soc 2019 Aug;16(8):1024-33. doi: 10.1513/AnnalsATS.201902-112OC..
Keywords: Caregiving, Palliative Care, Respiratory Conditions
Simon E, Miake-Lye IM, Smith SW
An evaluation of guideline-discordant ordering behavior for CT pulmonary angiography in the emergency department.
The aim of this study was to determine rates of and possible reasons for guideline-discordant ordering of CT pulmonary angiography for the evaluation of suspected pulmonary embolism (PE) in the emergency department. The investigators concluded that many of the guideline-discordant orders were placed for patients who presented with evidence-based risk factors for PE that are not included in the risk stratification scores. They suggest that guideline-discordant ordering may indicate that in the presence of these factors, the assessment of risk made by current scoring systems may not align with clinical suspicion.
Citation: Simon E, Miake-Lye IM, Smith SW . An evaluation of guideline-discordant ordering behavior for CT pulmonary angiography in the emergency department. J Am Coll Radiol 2019 Aug;16(8):1064-72. doi: 10.1016/j.jacr.2018.12.015..
Keywords: Respiratory Conditions, Emergency Department, Guidelines, Evidence-Based Practice, Blood Clots
Duarte AG, Tung L, Zhang W
Spirometry measurement of peak inspiratory flow identifies suboptimal use of dry powder inhalers in ambulatory patients with COPD.
The purpose of this study was to determine the prevalence of suboptimal peak inspiratory flow rate (PIFR) and associated patient characteristics and compare PIFR measurements obtained with spirometry and In-Check DIAL((R)) device in ambulatory patients with COPD. Results showed that suboptimal PIFR was present in 1 in 5 stable patients with COPD; PIFR was more frequent in short statured females. Spirometry-determined maximal forced inspiratory flow was associated with PIFR based on gender and height.
AHRQ-funded; HS020642; HS022134.
Citation: Duarte AG, Tung L, Zhang W . Spirometry measurement of peak inspiratory flow identifies suboptimal use of dry powder inhalers in ambulatory patients with COPD. Chronic Obstr Pulm Dis 2019 Jul 24;6(3):246-55. doi: 10.15326/jcopdf.6.3.2018.0163..
Keywords: Respiratory Conditions
Feemster K, Localio R, Grundmeier R
Incidence of healthcare-associated influenza-like illness after a primary care encounter among young children.
The authors evaluated whether exposure to a pediatric clinic visit was associated with subsequent influenza-like illness (ILI) using electronic health record data. They found that pediatric clinic visits during a respiratory virus season were significantly associated with an increased incidence of subsequent ILI among children aged 2 to 6 years but not among those aged less than 2 years. They concluded that their findings support the hypothesis that respiratory virus transmission in a pediatric clinic can result in healthcare-associated ILI in young children.
Citation: Feemster K, Localio R, Grundmeier R . Incidence of healthcare-associated influenza-like illness after a primary care encounter among young children. J Pediatric Infect Dis Soc 2019 Jul 1;8(3):191-96. doi: 10.1093/jpids/piy023..
Keywords: Children/Adolescents, Healthcare-Associated Infections (HAIs), Infectious Diseases, Influenza, Primary Care, Healthcare Delivery, Ambulatory Care and Surgery, Respiratory Conditions
Cios K, Cohen B, Quittell LM
Impact of colonizing organism in the respiratory tract on the incidence, duration, and time between subsequent hospitalizations among patients with cystic fibrosis.
The purpose of this study was to examine the association between colonizing respiratory tract organism and frequency, duration, and time between subsequent hospitalizations among hospitalized patients with cystic fibrosis (CF). A retrospective cohort study of 312 CF patients from two New York City hospitals found that CF patients with P aeruginosa alone experienced more hospitalizations, longer length of stay, and shorter time to readmission versus patients with S aureus or both organisms.
Citation: Cios K, Cohen B, Quittell LM . Impact of colonizing organism in the respiratory tract on the incidence, duration, and time between subsequent hospitalizations among patients with cystic fibrosis. Am J Infect Control 2019 Jul;47(7):750-54. doi: 10.1016/j.ajic.2018.12.021..
Keywords: Hospitalization, Respiratory Conditions
Ulrich RJ, McClung D, Wang BR
Introduction of procalcitonin testing and antibiotic utilization for acute exacerbations of chronic obstructive pulmonary disease.
This study measured the amount of procalcitonin testing (PCT) done for hospital inpatients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). PCT tests for presence of bacterial infection, which the majority of AECOPD inpatients did not have. Out of 238 AECOPD admissions, 31% had PCT performed. The patients who were tested were more likely to meet systemic inflammatory response syndrome (SIRS) criteria, require intensive-care unit (ICU)-level care, and have a longer length of stay compared with those not tested. However, testing was not associated with a decrease in total antibiotic days of therapy.
Citation: Ulrich RJ, McClung D, Wang BR . Introduction of procalcitonin testing and antibiotic utilization for acute exacerbations of chronic obstructive pulmonary disease. Infect Dis 2019 Jun 12;12:1178633719852626. doi: 10.1177/1178633719852626..
Keywords: Antibiotics, Chronic Conditions, Respiratory Conditions, Medication
Toy D, Braga MS, Greenhawt M
An update on allergic emergencies.
The purpose of this review was to provide an updated framework of management for allergic emergencies. The authors suggest that although fatalities resulting from anaphylaxis and asthma are rare, patient education serves an important role in preparing for unexpected emergencies, instituting prompt and appropriate treatment, and incorporating effective strategies into the lives of children and families.
Citation: Toy D, Braga MS, Greenhawt M . An update on allergic emergencies. Curr Opin Pediatr 2019 Jun;31(3):426-32. doi: 10.1097/mop.0000000000000769..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Emergency Department, Patient-Centered Outcomes Research, Evidence-Based Practice
Gong CL, Zangwill KM, Hay JW
Behavioral economics interventions to improve outpatient antibiotic prescribing for acute respiratory infections: a cost-effectiveness analysis.
Researchers sought to determine the cost-effectiveness of three behavioral economic interventions designed to reduce inappropriate antibiotic prescriptions for acute respiratory infections (ARIs). Provider education on guidelines for the appropriate ARI treatment is compared with suggested alternatives, which use computerized clinical decision support to suggest non-antibiotic treatment choices; accountable justification, which mandates free-text justification into the patient's electronic health record when antibiotics are prescribed; and peer comparison. The authors concluded that behavioral economics interventions can be cost-effective strategies for reducing inappropriate antibiotic prescriptions by reducing healthcare resource utilization.
Citation: Gong CL, Zangwill KM, Hay JW . Behavioral economics interventions to improve outpatient antibiotic prescribing for acute respiratory infections: a cost-effectiveness analysis. J Gen Intern Med 2019 Jun;34(6):846-54. doi: 10.1007/s11606-018-4467-x..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Practice Patterns, Healthcare Costs, Respiratory Conditions
Parikh K, Hinds PS, Teach SJ
Using stakeholder engagement to develop a hospital-initiated, patient-centered intervention to improve hospital-to-home transitions for children with asthma.
The authors demonstrated that multidisciplinary stakeholder engagement can meaningfully influence intervention design. They presented a model of efficient yet substantive engagement of parents and health professionals in developing a hospital-to-home transition intervention for children hospitalized with asthma. Their results suggest that multidimensional stakeholder engagement can meaningfully shape intervention development, and they hope that these tools can be used or adapted to other hospital-based quality improvement, education, or research efforts.
Citation: Parikh K, Hinds PS, Teach SJ . Using stakeholder engagement to develop a hospital-initiated, patient-centered intervention to improve hospital-to-home transitions for children with asthma. Hosp Pediatr 2019 Jun;9(6):460-63. doi: 10.1542/hpeds.2018-0261.
Keywords: Children/Adolescents, Patient-Centered Healthcare, Patient and Family Engagement, Hospital Discharge, Transitions of Care, Asthma, Respiratory Conditions
Heintzman J, Kaufmann J, Ezekiel-Herrera D
Asthma/COPD disparities in diagnosis and basic care utilization among low-income primary care patients.
Obstructive pulmonary disease outcomes in the United States differ between Latinos and non-Hispanic whites. There is little objective data about diagnosis prevalence and primary care visit frequency in these disease processes. In this study, the investigators used electronic health record data to perform a retrospective cohort analysis of 34,849 low-income patients seen at Oregon community health centers between 2009 and 2013 to assess joint racial/ethnic and insurance disparities in diagnosis and visit rates between Latino and non-Hispanic white patients.
Citation: Heintzman J, Kaufmann J, Ezekiel-Herrera D . Asthma/COPD disparities in diagnosis and basic care utilization among low-income primary care patients. J Immigr Minor Health 2019 Jun;21(3):659-63. doi: 10.1007/s10903-018-0798-2..
Keywords: Asthma, Respiratory Conditions, Chronic Conditions, Disparities, Healthcare Utilization, Low-Income, Primary Care
Pandian V, Zhen G, Stanley S
Management of difficult airway among patients with oropharyngeal angioedema.
This study assessed the impact of a quality improvement program to manage patients with difficult airway associated with oropharyngeal angioedema patients called DART (difficult airway response team). This retrospective review compared patient charges from July 2003 to June 2008 (pre-DART) to charges from July 2008 to June 2013 (post-DART). Patient characteristics, airway evaluation, and interventions were compared. There was a higher incidence of patients requiring intubation in the post-DART cohort (67%) versus the pre-DART cohort (39%). The results showed the approach offers adequate time and resources for airway evaluation prior to intervention and allows fewer numbers of attempts to secure an airway.
Citation: Pandian V, Zhen G, Stanley S . Management of difficult airway among patients with oropharyngeal angioedema. Laryngoscope 2019 Jun;129(6):1360-67. doi: 10.1002/lary.27622..
Keywords: Care Management, Quality of Care, Quality Improvement, Respiratory Conditions, Teams
Sanders R, Edwards L, Nishisaki A
Tracheal intubations for critically Ill children outside specialized centers in the United Kingdom-patient, provider, practice factors, and adverse events.
This editorial discusses a research study on outcomes of performing pediatric trachael intubations (TIs) and how the results can be applied to performing intubations on critically ill children in the United Kingdom outside of specialized centers. One of the authors is from a U.S. site that submits its airway management data to the National Emergency Airway Registry for Children (NEAR4KIDS). The results from the registry were compared to the results from the study. A total of 1,051 patients out of 1,237 eligible patients were analyzed. The results came from 47 nonspecialized local hospitals in the North Thames and East Anglia region of the UK. Adverse TI-associated events (TIAEs) occurred in 22.7% of the patients, which is higher than those in PICUs and cardiac ICUs. The majority of intubations were performed by the anesthesiologist in the team. The results were similar to those in the NEAR4KIDS registry. There were more complications with children with a higher grade of airway difficulties and comorbidities. The authors believe that pediatric airway management for acutely ill children would benefit from new strategies. They recommend a system change using Plan, Do, Study, Act (PDSA) cycles.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Sanders R, Edwards L, Nishisaki A . Tracheal intubations for critically Ill children outside specialized centers in the United Kingdom-patient, provider, practice factors, and adverse events. Pediatr Crit Care Med 2019 Jun;20(6):572-73. doi: 10.1097/pcc.0000000000001946..
Keywords: Adverse Events, Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Outcomes, Patient Safety, Registries, Respiratory Conditions
Shaker M, Greenhawt M
Estimation of health and economic benefits of commercial peanut immunotherapy products: a cost-effectiveness analysis.
The goal of this study was to evaluate critical inputs associated with the cost-effectiveness of epicutaneous peanut immunotherapy (EPIT) and peanut oral immunotherapy (POIT) from a societal perspective. In microsimulations with Markov modeling, virtual children aged 4 years over received EPIT, POIT, or no immunotherapy treatment. The main outcomes and measures were rates of therapy-associated adverse reactions; quality-of-life improvements associated with changes in tolerated peanut doses were modeled along with quality-adjusted life-years (QALY), anaphylaxis, therapy-associated anaphylaxis, and fatalities. The findings of this simulated analysis indicate that EPIT and POIT may be cost-effective, but the authors note that further research is needed.
Citation: Shaker M, Greenhawt M . Estimation of health and economic benefits of commercial peanut immunotherapy products: a cost-effectiveness analysis. JAMA Netw Open 2019 May 3;2(5):e193242. doi: 10.1001/jamanetworkopen.2019.3242..
Keywords: Healthcare Costs, Outcomes, Respiratory Conditions, Treatments