Ira Leeds

15 statements · 1 topic · summaries given as host listed separately

Featured statements

▶ Ep 3 · 1:04
In conclusion, regionalized rectal cancer surgery is the dominant cost-effective strategy compared to local rectal cancer surgery. Local rectal cancer surgery is rarely cost-effective in this model under even the most extreme sensitivity scenarios.
quote · Rectal Cancer
▶ Ep 3 · 1:04
The quadrant 4 is where regionalization is the dominant strategy, having both lower costs, but also better effectiveness than local care.
quote · Rectal Cancer

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Ira's statements about Rectal Cancer 15 statements

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Best of the Best Gen Surg - How Far is Too Far Cost-effectiveness Analysis of Regionalized Rectal Cancer Surgery - Dr. Leeds

▶ Ep 3 · 1:04
quote The quadrant 4 is where regionalization is the dominant strategy, having both lower costs, but also better effectiveness than local care. ↗
▶ Ep 3 · 1:04
clinical The marginal cost per patient in the decision tree model was cheaper with regionalized care compared to local care ↗
▶ Ep 3 · 1:04
clinical Clinical outcomes showed a mortality benefit in the regionalized arm versus the local arm, creating economic dominance where costs are cheaper in the same arm with better clinical benefit ↗
▶ Ep 3 · 1:04
clinical Sensitivity analysis of over 10,000 scenarios showed nearly all scenarios clustered in quadrant 4, where regionalization is the dominant strategy with both lower costs and better effectiveness than local care ↗
▶ Ep 3 · 1:04
opinion Cost-effectiveness methodologies are particularly helpful for population level decision making, averaging expectations and outcomes across all patients rather than individual patient selection ↗
▶ Ep 3 · 1:04
clinical Regionalized rectal cancer surgery is the dominant cost-effective strategy compared to local rectal cancer surgery ↗
▶ Ep 3 · 1:04
clinical Local rectal cancer surgery is rarely cost-effective in this model under even the most extreme sensitivity scenarios ↗
▶ Ep 3 · 1:04
quote This is a cost effectiveness condition called economic dominance, or where the costs of care are cheaper in the same arm that also has better clinical benefit. ↗
▶ Ep 3 · 1:04
quote In conclusion, regionalized rectal cancer surgery is the dominant cost-effective strategy compared to local rectal cancer surgery. Local rectal cancer surgery is rarely cost-effective in this model under even the most extreme sensitivity scenarios. ↗
▶ Ep 3 · 7:00
quote The fact that we ran through 10,000 iterations with very wide confidence bars around each of those estimates is the best answer that we can say as to why we think our model is better than just chance alone. ↗
▶ Ep 3 · 7:00
clinical The model ran through 10,000 iterations with very wide confidence bars around each estimate to test robustness ↗
▶ Ep 3 · 9:44
clinical In 97.8% of the model scenarios, the regionalized case won out over local care when including downstream costs of cancer recurrence and early death ↗
▶ Ep 3 · 11:27
clinical In some healthcare systems, a community oncologist an hour and a half away presents every single rectal cancer case to an entire board across the entire system ↗
▶ Ep 3 · 11:27
quote I think the secret untested sauce here is what is a regionalized decentralized model actually look like ↗
▶ Ep 3 · 11:27
opinion The data is not good enough yet to support a regionalized decentralized model using technology to export expertise ↗

Summaries Ira gave as host · 9 summaries

Recaps of other experts' statements, not Ira's own clinical position.

Summaries Ira gave as host · Rectal Cancer 9 summaries

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Best of the Best Gen Surg - How Far is Too Far Cost-effectiveness Analysis of Regionalized Rectal Cancer Surgery - Dr. Leeds

▶ Ep 3 · 1:04
host summary Ira Leeds summarizing the discussion: Regionalization of rectal cancer surgery increases lymph node yield ↗
▶ Ep 3 · 1:04
host summary Ira Leeds summarizing the discussion: Regionalization of rectal cancer surgery increases the use of neoadjuvant therapy ↗
▶ Ep 3 · 1:04
host summary Ira Leeds summarizing the discussion: Regionalization of rectal cancer surgery decreases 30 and 90-day mortality ↗
▶ Ep 3 · 1:04
host summary Ira Leeds summarizing the discussion: Regionalization of rectal cancer surgery is associated with a 34% decrease in 5-year mortality ↗
▶ Ep 3 · 1:04
host summary Ira Leeds summarizing the discussion: More than 3 times the number of patients would have to travel more than 50 miles to achieve regionalized care compared to local care ↗
▶ Ep 3 · 1:04
host summary Ira Leeds summarizing the discussion: Patients who travel for regionalized rectal cancer surgery tend to be more white and more privately insured, raising healthcare equity issues ↗
▶ Ep 3 · 1:04
host summary Ira Leeds summarizing the discussion: Regionalization of rectal cancer surgery has well-recognized associated advantages. It increases lymph node yield, it increases the use of neoadjuvant therapy, it decreases 30 and 90-day mortality, and then presumably through these benefits, it is also associated with a 34% decrease in 5-year mortality. ↗
▶ Ep 3 · 9:44
host summary Ira Leeds summarizing the discussion: Regionalized care per case is more expensive than local care when looking at case costs alone ↗
▶ Ep 3 · 9:44
host summary Ira Leeds summarizing the discussion: Many argue that regionalization benefits come from the system of care rather than one amazing surgeon with greatest experience ↗