Johns Hopkins University Template

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Introduction to decision analysis modeling
Alice Zwerling, Postdoctoral fellow, JHSPH
[email protected]
McGill TB Research Methods Course
July 7, 2015
Overview of Decision Analysis models
• Understand why we use decision analysis models & what
these models can and cannot do
• Examples of decision analysis and simple decision trees
• Understand key decision analysis concepts and terminology
2
Decision Analysis Models
• Some decisions are
easier than others
3
Decision Analysis
• Provides a systematic approach to decision-making under
conditions of uncertainty
• Is employed across many diverse fields: healthcare, business,
economics, law, engineering…..
• Helps decision makers think clearly about many elements of
complex decisions
4
Decision Analysis Modeling
• Requires defining events in terms of their logical and temporal
significance
• Disaggregating a complex problem into smaller steps or
events simpler to understand
5
What is a model?
• Representation of real world phenomena, object or
behaviours
• Theoretical construct
• Simplification of real world
• Model needs to be simple enough to be understood but
complex enough to capture essential elements of problem or
question to be addressed
• Many simplifying assumptions are needed…
6
Decision Trees
• Branching structure used to represent
different kinds of events including decisions
and uncertainties, and the
associated outcomes
or alternatives
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Decision Trees
Chance Node
A
Decision Node
Branches
(alternative pathways)
B
Time
Time (sequence of events) moves from left to right
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Terminal Node
(Outcomes or
pay-offs)
Decision Trees
Pathway probabilities
(probability of going down
each branch)
p =0.1
p =0.9
•
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User defined probabilities are entered at each chance node, need to add to 1
Decision Trees
Outcomes: Costs
& Effectiveness
(DALYs/QALYs or
cases 0/1)
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Decide what sequences/events are important to include/ model
11
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Vassall et al PlosMed, 2011
Steps in Decision Analysis
• Define the problem
• Define alternatives to be assessed
• Identify clinical outcomes of interest
•
•
•
•
Build the tree structure
Assign probabilities to all chance events
Assign costs and outcomes
Estimate expected average values of each strategy (Folding
back)
• Assess uncertainty and variability (sensitivity analyses)
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A simple problem…
Evaluate a new treatment
Cure
Standard Tx
Failure
Patients with TB
diagnosis
Cure
New Tx
Failure
• Create structure
14
A simple problem…
Evaluate a new treatment
Cure p=0.6
Standard Tx
Failure p=0.4
Patients with TB
diagnosis
Cure p=0.8
New Tx
Failure p= 0.2
• Assign probabilities
15
A simple problem…
Evaluate a new treatment
Cure p=0.6
$100
Saves 10 life years
Standard Tx
Failure p=0.4
$100
Saves 1 life year
Cure p=0.8
$500
Saves 10 life years
Patients with TB
diagnosis
New Tx
Failure p= 0.2
• Assign values and outcomes
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$500
Saves 1 life year
Calculations
Cure p=0.6
$100
Saves 10 life years
Standard Tx
Failure p=0.4
$200
Saves 1 life year
Cure p=0.8
$500
Saves 10 life years
Patients with TB
diagnosis
New Tx
Failure p= 0.2
$600
Saves 1 life year
Outcome
Standard Treatment
New Treatment
Expected cost
(0.6 x $100) + (0.4 x $200)
=$60 + $80 = $140
(0.8 x $500) + (0.2 x $600)
=$400 + $120 = $520
Expected life years saved
(0.6 x 10) + (0.4 x 1) = 6.4
(0.8 x 10) + (0.2 x 1 ) = 8.1
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Calculations
Expected Outcomes
Standard Treatment
New Treatment
Expected cost
(0.6 x $100) + (0.4 x $200)
=$60 + $80 = $140
(0.8 x $500) + (0.2 x $600)
=$400 + $120 = $520
Expected life years saved
(0.6 x 10) + (0.4 x 1) = 6.4
(0.8 x 10) + (0.2 x 1 ) = 8.1
• Incremental cost: $520 - $140 = $380
• Incremental life years saved: 8.1 – 6.4 = 1.7
• Cost per life year saved = $380/1.7
= $223.53
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Decision analysis
• Final model outcomes are calculated based on the
probability of entering into a particular node and the price
tag or effectiveness measure associated with that node
• Individuals move through the decision trees for a
specified amount of time
• Costs and rewards accrue over the simulation
• At end of simulation get a tally of specified outcomes (eg.
TB related costs per person, number of TB cases,
number of TB deaths, etc for each intervention
considered (outcomes)
Comparing scenarios!!!
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21
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Brief note on sensitivity analyses
• Systematically asking how would decision results change if
parameters/probabilities were different
• Determines how robust model result may be
• Vary probabilities and/or outcomes across possible ranges
• Can produce tornado diagrams
23
Decision Analysis Models
• Not designed to capture transmission
• Static, not dynamic models
• Typically deterministic (can be stochastic)
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Decision Analysis Models
• STATIC models:
(as opposed to dynamic transmission models)
• The annual risk of infection (ARI) is not sensitive to the
changing number of infectious cases in the population
• Does not account for ongoing transmission in a population
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Population vs. Individual models
Population based
Individual based
• Follows populations
• Divides population into mutually
exclusive groups
• Homogeneity within groups, but
can be subdivided
• Individual level factors are
averaged together, model shows
changes in average
characteristics of whole
population
• Follows individuals
• Characteristics of each individual
are tracked through time
• Can explore complex
relationships, social/spatial
interactions, heterogeneity
• May include approaches such as
agent-based models, or queue
model
Decision analysis are most commonly population based, but can track individuals
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Population based
Individual based
• 25% of population has TB HIV
co-infection
• Each individual tracked
• 45% of cohort is female
• Pt 1 of 10,000 simulated pts
Is a female 45 years old, HIV+
• Cohort comprised of persons on
average 45 years old
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Deterministic models
Stochastic models
• All parameters are fixed, no
random element
• Incorporate chance into the
model
• Model predictions are fixed,
same answer with every run
• Results vary with every run
• Describes what happens on
average to whole population
• More frequent in literature
• Important in small populations or
where chance might play a role
• Require many simulations (more
computing power)
Decision analysis can use either approach, but are most commonly deterministic models
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Decision Analysis: Advantages
•
•
•
•
•
Easy to learn & user friendly
Intuitive, visual representation of problem
Can take advantage of average data (e.g. meta-analyses)
Low cost and faster (relative to empirical studies)
Can consider hypothetical situations or specific
populations/scenarios for whom a trial is not ethical or feasible
• Can capture more complex pathways
• Can be used to generalize/extrapolate trial findings
(time/pop’n)
• Integrated costing capability and can be easily modified for
cost-effectiveness (common form of modeling methods in
economic evaluation)
Decision analysis: Disadvantages
• Decision analysis describes what happens to a cohort of
selected individuals
– By design does not incorporate pop’n outside of cohort
• Population level impact not accounted for
• Transmission effects not typically incorporated in decision
analysis models
• The annual risk of infection is not sensitive to changing number of infectious cases in the
population
• Can be partially addressed using Markov models and
introducing assumptions around transmission parameters
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Decision Analysis Models CAN….
• Compare relative impact and cost of two different well defined
interventions
• Understand problems in a logical and transparent fashion
• Identify weakness in our conceptualization of problem
• Make assumptions explicit
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Summary: Models are not so good for…
•
•
•
•
Predicting the future
Giving precise estimates
Working magic with bad/limited data
Can only work to level of complexity that we understand/ have
data to support
• Models rely on assumptions, may be limited by poor data (can
test these…)
• Struggle to capture heterogeneity/phenomenon that we are
not aware of or do not understand
Summary…
• Different types of models are available
Choice depends on :
• The research question
• The data that we have to work with
• The assumptions that we are willing to make
• How quickly we need the results
• The expertise of the modelling “team”
Reproduced from xkcd.com
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