Optimizing patient treatment decisions in an era of rapid technological advances: the case of hepatitis C treatment.
Health Care Manag Sci
; 20(1): 16-32, 2017 Mar.
Article
en En
| MEDLINE
| ID: mdl-26188961
ABSTRACT
How long should a patient with a treatable chronic disease wait for more effective treatments before accepting the best available treatment? We develop a framework to guide optimal treatment decisions for a deteriorating chronic disease when treatment technologies are improving over time. We formulate an optimal stopping problem using a discrete-time, finite-horizon Markov decision process. The goal is to maximize a patient's quality-adjusted life expectancy. We derive structural properties of the model and analytically solve a three-period treatment decision problem. We illustrate the model with the example of treatment for chronic hepatitis C virus (HCV). Chronic HCV affects 3-4 million Americans and has been historically difficult to treat, but increasingly effective treatments have been commercialized in the past few years. We show that the optimal treatment decision is more likely to be to accept currently available treatment-despite expectations for future treatment improvement-for patients who have high-risk history, who are older, or who have more comorbidities. Insights from this study can guide HCV treatment decisions for individual patients. More broadly, our model can guide treatment decisions for curable chronic diseases by finding the optimal treatment policy for individual patients in a heterogeneous population.
Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Hepatitis C Crónica
Tipo de estudio:
Etiology_studies
/
Health_economic_evaluation
/
Health_technology_assessment
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Health Care Manag Sci
Asunto de la revista:
SERVICOS DE SAUDE
Año:
2017
Tipo del documento:
Article
País de afiliación:
Estados Unidos