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Medical Decision Making: An International Journal of the Society for Medical Decision Making

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https://www.readbyqxmd.com/read/28061043/an-overview-of-r-in-health-decision-sciences
#1
Hawre Jalal, Petros Pechlivanoglou, Eline Krijkamp, Fernando Alarid-Escudero, Eva Enns, M G Myriam Hunink
As the complexity of health decision science applications increases, high-level programming languages are increasingly adopted for statistical analyses and numerical computations. These programming languages facilitate sophisticated modeling, model documentation, and analysis reproducibility. Among the high-level programming languages, the statistical programming framework R is gaining increased recognition. R is freely available, cross-platform compatible, and open source. A large community of users who have generated an extensive collection of well-documented packages and functions supports it...
January 1, 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/28061042/assessing-the-expected-value-of-research-studies-in-reducing-uncertainty-and-improving-implementation-dynamics
#2
Sabine E Grimm, Simon Dixon, John W Stevens
BACKGROUND: With low implementation of cost-effective health technologies being a problem in many health systems, it is worth considering the potential effects of research on implementation at the time of health technology assessment. Meaningful and realistic implementation estimates must be of dynamic nature. OBJECTIVE: To extend existing methods for assessing the value of research studies in terms of both reduction of uncertainty and improvement in implementation by considering diffusion based on expert beliefs with and without further research conditional on the strength of evidence...
January 1, 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/28061040/the-role-of-qualitative-research-methods-in-discrete-choice-experiments
#3
Caroline Vass, Dan Rigby, Katherine Payne
BACKGROUND: The use of qualitative research (QR) methods is recommended as good practice in discrete choice experiments (DCEs). This study investigated the use and reporting of QR to inform the design and/or interpretation of healthcare-related DCEs and explored the perceived usefulness of such methods. METHODS: DCEs were identified from a systematic search of the MEDLINE database. Studies were classified by the quantity of QR reported (none, basic, or extensive)...
January 1, 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/28061041/other-ways-of-knowing
#4
Negin Hajizadeh, Melissa J Basile, Andrzej Kozikowski, Meredith Akerman, Tara Liberman, Thomas McGinn, Michael A Diefenbach
BACKGROUND: Patients with advanced-stage chronic obstructive pulmonary disease (COPD) may suffer severe respiratory exacerbations and need to decide between accepting life-sustaining treatments versus foregoing these treatments (choosing comfort care only). We designed the InformedTogether decision aid to inform this decision and describe results of a pilot study to assess usability focusing on participants' trust in the content of the decision aid, acceptability, recommendations for improvement, and emotional reactions to this emotionally laden decision...
December 1, 2016: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/28027027/estimating-state-transitions-for-opioid-use-disorders
#5
Emanuel Krebs, Jeong E Min, Elizabeth Evans, Libo Li, Lei Liu, David Huang, Darren Urada, Thomas Kerr, Yih-Ing Hser, Bohdan Nosyk
AIM: The aim was to estimate transitions between periods in and out of treatment, incarceration, and legal supervision, for prescription opioid (PO) and heroin users. METHODS: We captured all individuals admitted for the first time for publicly funded treatment for opioid use disorder (OUD) in California (2006 to 2010) with linked mortality and criminal justice data. We used Cox proportional hazards and competing risks models to assess the effect of primary PO use (v...
December 1, 2016: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27879412/modeling-individual-patient-preferences-for-colorectal-cancer-screening-based-on-their-tolerance-for-complications-risk
#6
Glen B Taksler, Adam T Perzynski, Michael W Kattan
INTRODUCTION: Recommendations for colorectal cancer screening encourage patients to choose among various screening methods based on individual preferences for benefits, risks, screening frequency, and discomfort. We devised a model to illustrate how individuals with varying tolerance for screening complications risk might decide on their preferred screening strategy. METHODS: We developed a discrete-time Markov mathematical model that allowed hypothetical individuals to maximize expected lifetime utility by selecting screening method, start age, stop age, and frequency...
November 22, 2016: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27856827/maximizing-health-or-sufficient-capability-in-economic-evaluation-a-methodological-experiment-of-treatment-for-drug-addiction
#7
Ilias Goranitis, Joanna Coast, Ed Day, Alex Copello, Nick Freemantle, Emma Frew
Conventional practice within the United Kingdom and beyond is to conduct economic evaluations with "health" as evaluative space and "health maximization" as the decision-making rule. However, there is increasing recognition that this evaluative framework may not always be appropriate, and this is particularly the case within public health and social care contexts. This article presents a methodological case study designed to explore the impact of changing the evaluative space within an economic evaluation from health to capability well-being and the decision-making rule from health maximization to the maximization of sufficient capability...
November 17, 2016: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27803362/toward-optimal-decision-making-among-vulnerable-patients-referred-for-cardiac-surgery-a-qualitative-analysis-of-patient-and-provider-perspectives
#8
Ryan A Gainer, Janet Curran, Karen J Buth, Jennie G David, Jean-Francois Légaré, Gregory M Hirsch
OBJECTIVES: Comprehension of risks, benefits, and alternative treatment options has been shown to be poor among patients referred for cardiac interventions. Patients' values and preferences are rarely explicitly sought. An increasing proportion of frail and older patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care. We sought input from patients and caregivers to determine the optimal approach to decision making in this vulnerable patient population...
November 1, 2016: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/28076183/markov-influence-diagrams
#9
Francisco J Díez, Mar Yebra, Iñigo Bermejo, Miguel A Palacios-Alonso, Manuel Arias Calleja, Manuel Luque, Jorge Pérez-Martín
Markov influence diagrams (MIDs) are a new type of probabilistic graphical model that extends influence diagrams in the same way that Markov decision trees extend decision trees. They have been designed to build state-transition models, mainly in medicine, and perform cost-effectiveness analyses. Using a causal graph that may contain several variables per cycle, MIDs can model various patient characteristics without multiplying the number of states; in particular, they can represent the history of the patient without using tunnel states...
February 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27803361/a-markov-decision-process-model-for-cervical-cancer-screening-policies-in-colombia
#10
Raha Akhavan-Tabatabaei, Diana Marcela Sánchez, Thomas G Yeung
Cervical cancer is the second most common cancer in women around the world, and the human papillomavirus (HPV) is universally known as the necessary agent for developing this disease. Through early detection of abnormal cells and HPV virus types, cervical cancer incidents can be reduced and disease progression prevented. We propose a finite-horizon Markov decision process model to determine the optimal screening policies for cervical cancer prevention. The optimal decision is given in terms of when and what type of screening test to be performed on a patient based on her current diagnosis, age, HPV contraction risk, and screening test results...
February 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27681992/sensitivity-analysis-in-sequential-decision-models
#11
Qiushi Chen, Turgay Ayer, Jagpreet Chhatwal
BACKGROUND: Sequential decision problems are frequently encountered in medical decision making, which are commonly solved using Markov decision processes (MDPs). Modeling guidelines recommend conducting sensitivity analyses in decision-analytic models to assess the robustness of the model results against the uncertainty in model parameters. However, standard methods of conducting sensitivity analyses cannot be directly applied to sequential decision problems because this would require evaluating all possible decision sequences, typically in the order of trillions, which is not practically feasible...
February 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27681989/understanding-the-effects-of-competition-for-constrained-colonoscopy-services-with-the-introduction-of-population-level-colorectal-cancer-screening
#12
Leslie Anne Campbell, John T Blake, George Kephart, Eva Grunfeld, Donald MacIntosh
BACKGROUND: Median wait times for gastroenterology services in Canada exceed consensus-recommended targets and have worsened substantially over the past decade. Meanwhile, efforts to control colorectal cancer have shifted their focus to screening asymptomatic, average-risk individuals. Along with increasing prevalence of colorectal cancer due to an aging population, screening programs are expected to add substantially to the existing burden on colonoscopy services, and create competition for limited services among individuals of varying risk...
February 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27646567/progression-and-transmission-of-hiv-aids-path-2-0
#13
Chaitra Gopalappa, Paul G Farnham, Yao-Hsuan Chen, Stephanie L Sansom
BACKGROUND: HIV transmission is the result of complex dynamics in the risk behaviors, partnership choices, disease stage and position along the HIV care continuum-individual characteristics that themselves can change over time. Capturing these dynamics and simulating transmissions to understand the chief sources of transmission remain important for prevention. METHODS: The Progression and Transmission of HIV/AIDS (PATH 2.0) is an agent-based model of a sample of 10,000 people living with HIV (PLWH), who represent all men who have sex with men (MSM) and heterosexuals living with HIV in the U...
February 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27553208/determinants-of-change-in-the-cost-effectiveness-threshold
#14
Mike Paulden, James O'Mahony, Christopher McCabe
The cost-effectiveness threshold in health care systems with a constrained budget should be determined by the cost-effectiveness of displacing health care services to fund new interventions. Using comparative statics, we review some potential determinants of the threshold, including the budget for health care, the demand for existing health care interventions, the technical efficiency of existing interventions, and the development of new health technologies. We consider the anticipated direction of impact that would affect the threshold following a change in each of these determinants...
February 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27491558/risk-assessment-for-venous-thromboembolism-in-chemotherapy-treated-ambulatory-cancer-patients
#15
Patrizia Ferroni, Fabio Massimo Zanzotto, Noemi Scarpato, Silvia Riondino, Umberto Nanni, Mario Roselli, Fiorella Guadagni
OBJECTIVE: To design a precision medicine approach aimed at exploiting significant patterns in data, in order to produce venous thromboembolism (VTE) risk predictors for cancer outpatients that might be of advantage over the currently recommended model (Khorana score). DESIGN: Multiple kernel learning (MKL) based on support vector machines and random optimization (RO) models were used to produce VTE risk predictors (referred to as machine learning [ML]-RO) yielding the best classification performance over a training (3-fold cross-validation) and testing set...
February 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27465113/using-simulation-to-model-and-validate-invasive-breast-cancer-progression-in-women-in-the-study-and-control-groups-of-the-canadian-national-breast-screening-studies-i-and-ii
#16
Sharareh Taghipour, Laurent N Caudrelier, Anthony B Miller, Bart Harvey
BACKGROUND: Modeling breast cancer progression and the effect of various risk is helpful in deciding when a woman should start and end screening, and how often the screening should be undertaken. METHODS: We modeled the natural progression of breast cancer using a hidden Markov process, and incorporated the effects of covariates. Patients are women aged 50-59 (older) and 40-49 (younger) years from the Canadian National Breast Screening Studies. We included prevalent cancers, estimated the screening sensitivities and rates of over-diagnosis, and validated the models using simulation...
February 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27317437/why-do-health-economists-promote-technology-adoption-rather-than-the-search-for-efficiency-a-proposal-for-a-change-in-our-approach-to-economic-evaluation-in-health-care
#17
Graham Scotland, Stirling Bryan
At a time of intense pressure on health care budgets, the technology management challenge is for disinvestment in low-value technologies and reinvestment in higher value alternatives. The aim of this article is to explore ways in which health economists might begin to redress the observed imbalance between the evaluation of new and existing in-use technologies. The argument is not against evaluating new technologies but in favor of the "search for efficiency," where the ultimate objective is to identify reallocations that improve population health in the face of resource scarcity...
February 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27105651/how-to-invest-in-getting-cost-effective-technologies-into-practice-a-framework-for-value-of-implementation-analysis-applied-to-novel-oral-anticoagulants
#18
Rita Faria, Simon Walker, Sophie Whyte, Simon Dixon, Stephen Palmer, Mark Sculpher
Cost-effective interventions are often implemented slowly and suboptimally in clinical practice. In such situations, a range of implementation activities may be considered to increase uptake. A framework is proposed to use cost-effectiveness analysis to inform decisions on how best to invest in implementation activities. This framework addresses 2 key issues: 1) how to account for changes in utilization in the future in the absence of implementation activities; and 2) how to prioritize implementation efforts between subgroups...
February 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27005521/cost-recommendation-under-uncertainty-in-iqwig-s-efficiency-frontier-framework
#19
Isaac Corro Ramos, Stefan K Lhachimi, Andreas Gerber-Grote, Maiwenn J Al
BACKGROUND: The National Institute for Quality and Efficiency in Health Care (IQWiG) employs an efficiency frontier (EF) framework to facilitate setting maximum reimbursable prices for new interventions. Probabilistic sensitivity analysis (PSA) is used when yes/no reimbursement decisions are sought based on a fixed threshold. In the IQWiG framework, an additional layer of complexity arises as the EF itself may vary its shape in each PSA iteration, and thus the willingness-to-pay, indicated by the EF segments, may vary...
February 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27005520/using-cart-to-identify-thresholds-and-hierarchies-in-the-determinants-of-funding-decisions
#20
Chris Schilling, Duncan Mortimer, Kim Dalziel
There is much interest in understanding decision-making processes that determine funding outcomes for health interventions. We use classification and regression trees (CART) to identify cost-effectiveness thresholds and hierarchies in the determinants of funding decisions. The hierarchical structure of CART is suited to analyzing complex conditional and nonlinear relationships. Our analysis uncovered hierarchies where interventions were grouped according to their type and objective. Cost-effectiveness thresholds varied markedly depending on which group the intervention belonged to: lifestyle-type interventions with a prevention objective had an incremental cost-effectiveness threshold of $2356, suggesting that such interventions need to be close to cost saving or dominant to be funded...
February 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
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