About

Professor Jim M. Koeller, M.S., is a full professor of Pharmacotherapy and Translational Sciences at the College of Pharmacy at The University of Texas at Austin. He holds the Eli Lilly and C. R. Sublett Centennial Fellowship in Pharmacy and is a clinical professor of medicine and oncology at the University of Texas Health Science Center in San Antonio. His research primarily focuses on cancer care economics, including the economic analysis of cancer treatment strategies and disease management. Professor Koeller has published over 250 articles, abstracts, and book chapters related to oncology practice, pharmacoeconomics, new drug development, and supportive care issues for cancer patients. He has also delivered more than 500 presentations on topics such as oncology, supportive care, pharmacoeconomics, and healthcare economics. His work involves collaboration with private practice and hospital clinics, and his research group has developed disease treatment maps for various cancers, including lung, colon, and breast cancer, with a current focus on the economics of standardized cancer treatment strategies.

Research topics

• Pediatrics
• Internal medicine
• Medicine
• Emergency medicine
• Family medicine
• Demography

Selected publications

• The Impact of Uncontrolled Gout on Healthcare Utilization and Health Outcomes for United States Veterans Affairs Patients

  Rheumatology and Therapy · 2025-09-19

  articleOpen access

  INTRODUCTION: Gout is an inflammatory arthritis that, when uncontrolled, can lead to chronic pain, disability, increased demand for healthcare, and poor health outcomes. This study sought to identify patients with gout and to describe the differences in epidemiology, pharmacotherapy, healthcare utilization, and outcomes for patients with controlled and uncontrolled gout in the United States (US) Veterans Affairs (VA) healthcare system. METHODS: This retrospective cohort study used electronic health record (EHR) data from VA patients from all US states and territories with gout from 1/1/2016 to 12/31/2022. The study included adult VA patients (18 +) with a diagnosis code for gout (ICD10 codes M10 or M1A) and two or more encounters 30 or more days apart. Uncontrolled gout was defined as one serum uric acid level (sUA) level > 8 mg/dl, tophi, or both in the study period. RESULTS: Of the 331,664 patients who met study criteria, 42% (138,068) were considered to have uncontrolled gout and 58% (193,596) were controlled. The uncontrolled group was younger (mean age 64 vs. 70 years, p < 0.01), and both groups were predominantly white non-Hispanic (58% and 70%) and male (99% and 99%). Specialist visits were more common in the uncontrolled group during follow-up: podiatry (38% vs. 30%, p < 0.01), rheumatology (24% vs. 9%, p < 0.01), and nephrology (24% vs. 12%, p < 0.01). Patients with uncontrolled gout were also significantly more likely to be seen in the emergency room (55% vs. 38%, p < 0.01) or admitted to the hospital (47% vs. 37%, p < 0.01) during follow-up. CONCLUSIONS: Nearly half of VA patients with gout met criteria for uncontrolled gout, and these patients experienced greater healthcare utilization and worse health outcomes than patients with controlled gout. Patients with uncontrolled gout could benefit from additional/alternative approaches such as the adoption of a treat-to-target strategy and increasing referrals to a specialist.

  PublisherOA PDFDOI

• Diverse Role of blaCTX-M and Porins in Mediating Ertapenem Resistance among Carbapenem-Resistant Enterobacterales

  Antibiotics · 2024-02-13 · 9 citations

  articleOpen access

  Among carbapenem-resistant Enterobacterales (CRE) are diverse mechanisms, including those that are resistant to meropenem but susceptible to ertapenem, adding further complexity to the clinical landscape. This study investigates the emergence of ertapenem-resistant, meropenem-susceptible (ErMs) Escherichia coli and Klebsiella pneumoniae CRE across five hospitals in San Antonio, Texas, USA, from 2012 to 2018. The majority of the CRE isolates were non-carbapenemase producers (NCP; 54%; 41/76); 56% of all NCP isolates had an ErMs phenotype. Among ErMs strains, E. coli comprised the majority (72%). ErMs strains carrying blaCTX-M had, on average, 9-fold higher copies of blaCTX-M than CP-ErMs strains as well as approximately 4-fold more copies than blaCTX-M-positive but ertapenem- and meropenem-susceptible (EsMs) strains (3.7 vs. 0.9, p &lt; 0.001). Notably, carbapenem hydrolysis was observed to be mediated by strains harboring blaCTX-M with and without a carbapenemase(s). ErMs also carried more mobile genetic elements, particularly IS26 composite transposons, than EsMs (37 vs. 0.2, p &lt; 0.0001). MGE- ISVsa5 was uniquely more abundant in ErMs than either EsMs or ErMr strains, with over 30 more average ISVsa5 counts than both phenotype groups (p &lt; 0.0001). Immunoblot analysis demonstrated the absence of OmpC expression in NCP-ErMs E. coli, with 92% of strains lacking full contig coverage of ompC. Overall, our findings characterize both collaborative and independent efforts between blaCTX-M and OmpC in ErMs strains, indicating the need to reappraise the term “non-carbapenemase (NCP)”, particularly for strains highly expressing blaCTX-M. To improve outcomes for CRE-infected patients, future efforts should focus on mechanisms underlying the emerging ErMs subphenotype of CRE strains to develop technologies for its rapid detection and provide targeted therapeutic strategies.

  PublisherOA PDFDOI

• Diverse Role of blaCTX-M and Porins in Mediating Ertapenem Resistance Among Carbapenem Resistant Enterobacterales

  Preprints.org · 2024-01-03 · 5 citations

  preprintOpen access

  This study investigates the emergence of ertapenem-resistant, meropenem-susceptible (ErMs) among non-carbapenemase producing (NCP) and carbapenemase producing (CP) Escherichia coli and Klebsiella pneumoniae. As mutations for ertapenem resistance establish the genetic background for non-carbapenemase meropenem resistance, there is a great need for antibiotic stewards and researchers to understand the determinants of a strain’s propensity to become resistant. Whole genome sequencing was conducted on clinical carbapenem-resistant E. coli (CREC) and K. pneumoniae (CRKP) across 5 hospitals in San Antonio, U.S. from 2012-2018. The majority of carbapenem resistant Enterobacterales (CRE) were NCP (54%; 41/76). The blaCTX-M was found to be most prevalent among NCP isolates (p = 0.02). LC-MS/MS analysis of carbapenem hydrolysis revealed that blaCTX-M-mediated carbapenem hydrolysis, indicating the need to reappraise the term, “non-carbapenemase (NCP)” for quantitatively uncharacterized CRE strains harboring blaCTX-M. Antimicrobial susceptibility results showed that 56% of all NCPE isolates had an ErMs phenotype (NCPE vs. CPE, p &amp;amp;lt; 0.001), with E. coli driving the phenotype (E. coli vs. K. pneumoniae, p &amp;amp;lt; 0.001). ErMs strains carrying blaCTX-M, had approximately 4-fold more copies of blaCTX-M than ceftriaxone-resistant but ertapenem and meropenem susceptible (EsMs) isolates (3.7 v. 0.9, p &amp;amp;lt; 0.001). ErMs also carried more mobile genetic elements (MGEs), particularly IS26 composite transposons, than EsMs (37 vs. 0.2, p &amp;amp;lt; 0.0001). Immunoblot analysis demonstrated the absence of OmpC expression in NCP-ErMs E. coli, with 92% of strains lacking full contig coverage of ompC. Overall, this work provides evidence of a collaborative effort between blaCTX-M and OmpC in NCP strains that confer resistance to ertapenem but not meropenem. To thwart potential mismanagement of CRE infected patients, future efforts should focus on understanding the mechanism(s) underlying OmpC loss, developing rapid methods to detect blaCTX-M copy number variants, and targeted antimicrobials for NCPE and ErMs strains.

  PublisherOA PDFDOI

• EPH138 Pneumococcal Vaccine Trends Among Older Adults in the United States from 2008 to 2022

  Value in Health · 2024-06-01

  articleOpen access
  PublisherOA PDFDOI

• EE92 Trends in Incidence and Economic Burden of Pneumonia in the United States from 2016-2021

  Value in Health · 2024-06-01

  articleOpen access
  PublisherOA PDFDOI

• CO211 Gout Epidemiology, Pharmacotherapy, Healthcare Utilization, and Outcomes for United States Veterans Affairs Patients From 2016 to 2022

  Value in Health · 2024-06-01

  article
  PublisherDOI

• 469 Diverse Role of blaCTX-M and Porins in Mediating Ertapenem Resistance Among Carbapenem Resistant Enterobacterales

  Journal of Clinical and Translational Science · 2024-04-01

  articleOpen access

  OBJECTIVES/GOALS: In this study, we aim to report the role of porins and bla CTX-M β-lactamases among Escherichia coli and Klebsiella pneumoniae, focusing on emerging carbapenem resistant Enterobacterales (CRE) subtypes, including non-carbapenemase producing Enterobacterales (NCPE) and ertapenem-resistant but meropenem-susceptible (ErMs) strains. METHODS/STUDY POPULATION: Whole genome sequencing was conducted on 76 carbapenem-resistant isolates across 5 hospitals in San Antonio, U.S. Among these, NCP isolates accounted for the majority of CRE (41/76). Identification and antimicrobial susceptibility testing (AST) results were collected from the clinical charts. Repeat speciation was determined through whole genome sequencing (WGS) analysis and repeat AST, performed with microdilution or ETEST®. Minimum inhibitory concentrations (MIC) were consistent with Clinical and Laboratory Standards Institute (CLSI M100, ED33). WGS and qPCR were used to characterize the resistome of all clinical CRE subtypes, while western blotting and liquid chromatography with tandem mass spectrometry (LC-MS-MS) were used to determine porin expression and carbapenem hydrolysis, respectively. RESULTS/ANTICIPATED RESULTS: bla CTX-M was found to be most prevalent among NCP isolates (p = 0.02). LC-MS/MS analysis of carbapenem hydrolysis revealed that bla CTX-M -mediated carbapenem hydrolysis, indicating the need to reappraise the term, “non-carbapenemase (NCP)®” for quantitatively uncharacterized CRE strains harboring bla CTX-M . Susceptibility results showed that 56% of all NCPE isolates had an ErMs phenotype (NCPE vs. CPE, p &lt; 0.001), with E. coli driving the phenotype (E. coli vs. K. pneumoniae, p &lt; 0.001). ErMs strains carrying bla CTX-M , had 4-fold more copies of bla CTX-M than ceftriaxone-resistant but ertapenem-susceptible isolates (3.7 v. 0.9, p &lt; 0.001). Immunoblot analysis demonstrated the absence of OmpC expression in NCP-ErMs E. coli, with 92% of strains lacking full contig coverage ofompC. DISCUSSION/SIGNIFICANCE: Overall, this work provides evidence of a collaborative effort between bla CTX-M and OmpC in NCP strains that confer resistance to ertapenem but not meropenem. Clinically, CRE subtypes are not readily appreciated, potentially leading to mismanagement of CRE infected patients. A greater focus on optimal treatments for CRE subtypes is needed.

  PublisherOA PDFDOI

• A Survey of Vaping Use, Perceptions, and Access in Adolescents from South-Central Texas Schools

  International Journal of Environmental Research and Public Health · 2023-09-15 · 6 citations

  articleOpen access

  Despite efforts to dissuade major manufacturers and retailers from marketing and selling vape products to adolescents, the practice of vaping continues to increase in this population. Few studies have assessed adolescent perceptions of vaping, access to vaping, and use of vaping, and most rely, at least in part, on inferential conclusions drawn from data on smoking traditional combustible cigarettes. A novel electronic survey was created to assess the use of vapes, perceptions of vaping, and access to vaping among a convenience sample of adolescents (ages 12–20 years) in eleven schools in South-Central Texas from May to August 2021. The students’ perceived threat of negative health outcomes due to vaping was calculated based on questions soliciting perceptions of severity (perceived danger) and susceptibility (perceived likelihood of illness). Trends were identified using descriptive and bivariate statistical tests. A total of 267 respondents were included; 26% had tried vaping. A majority (63%) did not believe vaping and smoking were synonymous. Most (70%) thought it was easy to obtain supplies and (76%) vape before and after (88%) or even during (64%) school. Respondents who vaped had a 34% lower perceived threat when compared to respondents who did not vape. In this sample of adolescents from South-Central Texas, one in four reported that they had tried vaping. Easy access to vapes and misperceptions regarding the safety of vaping might create a false sense of security with respect to vaping as an alternative to smoking, particularly among those who reported vaping, and is likely contributing to the increased use of vapes.

  PublisherOA PDFDOI

• Economic Evaluation of Three BRAF + MEK Inhibitors for the Treatment of Advanced Unresectable Melanoma With BRAF Mutation From a US Payer Perspective

  Annals of Pharmacotherapy · 2023-01-13 · 5 citations

  article

  BACKGROUND: The combinations of BRAF + MEK inhibitors-encorafenib (ENC) + binimetinib (BIN), cobimetinib (COB) + vemurafenib (VEM), and dabrafenib (DAB) + trametinib (TRA)-are recommended for the treatment of BRAF-mutated advanced melanoma. OBJECTIVE: To assess the cost-effectiveness and cost-utility of ENC + BIN versus COB + VEM versus DAB + TRA from a US payer perspective. METHODS: A Markov model was constructed to simulate a hypothetical cohort over a time horizon of 10 years. The overall survival (OS) and progression-free survival (PFS) curves were independently digitized from a randomized controlled trial for ENC + BIN and fitted using R software. Published and indirectly estimated hazard ratios were used to fit OS and PFS curves for COB + VEM and DAB + TRA. Costs, life-year gains, and quality-adjusted life years (QALYs) associated with the 3 treatment combinations were estimated. A base case analysis and probabilistic sensitivity analysis (PSA) were conducted to estimate the incremental cost-utility ratio (ICUR). A discount rate of 3.5% was applied on cost and outcomes. RESULTS: The ENC + BIN versus COB + VEM comparison was associated with an ICUR of $656 233 per QALY gained. The ENC + BIN versus DAB + TRA comparison was associated with an ICUR of $3 135 269 per QALY gained. The DAB + TRA combination dominated COB + VEM. The base case analysis estimates were confirmed by the PSA estimates. ENC + BIN was the most cost-effective combination at a high willingness-to-pay (WTP) threshold of $573 000 per QALY and $1.5 million/QALY when compared to COB + VEM and DAB + TRA, respectively. CONCLUSION AND RELEVANCE: Given current prices and acceptable WTP thresholds, our study suggests that DAB + TRA is the optimum treatment. In this study, ENC + BIN was cost-effective only at a very high WTP per QALY threshold.

  PublisherDOI

• Pilot study evaluating feasibility and utility of pharmacist-driven oral antineoplastic agent monitoring program

  Journal of Oncology Pharmacy Practice · 2023-07-11

  articleSenior author

  INTRODUCTION: Oncologists are increasingly prescribing oral antineoplastic agents which have benefits and challenges impacting patient outcomes. Practice guidelines recommend monitoring symptoms and adherence without outlining any specific tools or methods for monitoring. Pharmacists are successful in monitoring patients on therapy and improving outcomes. We aimed to assess the feasibility and utility of a pharmacist-delivered and medical record-integrated adherence and symptom monitoring program for patients on oral antineoplastic agents. METHODS: This single-center, prospective, interventional study designed and implemented an adherence and monitoring program. A pharmacist contacted patients twice between clinic visits for three months. During telephone encounters, patients were verbally screened for medication adherence and assessed for new or changing symptoms using the Edmonton Symptom Assessment System as a signal of possible adverse events. We measured feasibility via patient enrollment, completed proportion of scheduled contacts, and pharmacist time. Utility was assessed through patient adherence, satisfaction surveys, healthcare resource utilization, and pharmacist interventions (i.e., patient education, adherence assistance, and symptom management). RESULTS: Fifty-one patients participated. Ninety-one percent of scheduled patient contacts were completed. Edmonton Symptom Assessment System was administered by pharmacy personnel 102 times. Patient-reported adherence was 100%. Overall satisfaction was 85% and 100%, for patients and physicians, respectively. Fifty-one (98%) pharmacist recommendations were accepted. There were 14 total utilizations of healthcare resources-5.2 per 1000 patient days. CONCLUSIONS: This study suggests a pharmacist monitoring program for patients taking oral antineoplastic agents is feasible and provides utility. Further research is needed to evaluate whether this program improves safety, adherence, and outcomes in patients using oral antineoplastic agents.

  PublisherDOI

Frequent coauthors

• Christopher R. Frei

  The University of Texas Health Science Center at San Antonio

  232 shared

• Kelly R. Reveles

  The University of Texas at Austin

  138 shared

• Grace C. Lee

  South Texas Veterans Health Care System

  120 shared

• Eric M. Mortensen

  University of Connecticut

  92 shared

• Steven D. Dallas

  The University of Texas Health Science Center at San Antonio

  80 shared

• M. J. Labreche

  Alameda Health System

  66 shared

• Russell T. Attridge

  University of the Incarnate Word

  65 shared

• Sylvia Treviño

  Research Network (United States)

  64 shared

Awards & honors

• Eli Lilly/CR Sublett Endowed Fellowship in Pharmacy