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INF > INFECTIOUS DISEASE MODELLING AND HEALTH ECONOMICS > Flashcards

INFECTIOUS DISEASE MODELLING AND HEALTH ECONOMICS Flashcards

1
Q

WHAT IS INFECTIOUS DISEASE MODELLING?

A

A TOOL THAT CAN BE USED TO STUDY THE MECHANISMS BY WHICH DISEASES SPREAD, PREDICT FUTURE OUTBRAKS AND/OR TO EVALUATE STRATEGIES TO CONTROL/PREVENT DISEASE

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2
Q

WHAT IS AN (INFECTIOUS DISEASE) MODEL?

A
  • MODEL IS A SET OF MATHEMATICAL AND STATISTICAL TECHNIQUES DESIGNED FOR THE ANALYTICAL EVALUATION OF DECISION MAKING UNDER UNCERTAINTY
  • UNCERTAINTY IS REPRESENTED BY EVENT PROBABILITIES AND ASSOCIATED DISTRIBUTIONS
  • MODELS USED WHEN THERE IS LIMITED OR INCOMPLETE CLINICL TRIAL DATA OR WHEN WE WANT TO EXPAND ON THE KNOWLEDGE FROM TRIALS
  • MODELS SOMETIMES USED TO COMPARE ALTERNATIVE COURSES OF ACTION INSTEAD OF RELYING ON CLINICAL TRIALS (WHICH ARE EXPENSIVE AND TIME CONSUMING)
  • MODELS COMBINE MEDICAL AND ECONOMICAL EVIDENCE, INFORMING BEST DECISION/OUTPUT WITH LIMITED RESOURCES
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3
Q

EXMPLES OF MODELS?

A
  • DECISION TREE
  • MARKOV MODEL
  • OTHERS (PATIENT LEVEL SIMULATION, DISCRETE EVENT SIMULATION, DYNAMIC MODELS)
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4
Q

DYNAMIC MODELS ARE USUALLY USED FOR INFECTIOUS OR NON INFECTIOUS DISEASE?

A

INFECTIOUS D

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5
Q

DESCRIBE THE MODEL: DECISION TREE

A
  • PRESENTS SERIES OF POSSIBLE CONSEQUENCES AND COST ASSOCIATED WITH EACH ONE
  • MOVE FROM LEFT TO RIGHT
  • USED FOR E.G. A SCREENING PROGRAM OR VACCINATION PROGRAM
  • USUALLY FOR INTERVENTIONS WITH SHORT DURATION (UNDER A YEAR)
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6
Q

DECISION TREE MODEL IS USED FOR INTERVENTIONS WHICH LAST LESS THAN?

A

1 YEAR

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7
Q

MARKOV MODEL VS DECISION TREE MODEL; WHICH ONE IS USED FOR INTERVENTIONS WITH LONGER DURATIONS?

A

MARKOV M

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8
Q

WHAT ARE ‘EXTERNALITIES’ IN DISEASE MODELLING?

A
  • ANY COST OR BENEFIT OF ONE PARTY THAT MIGHT IMPACT ON OTHERS
  • IGNORING EXTERNALITIES IN MODELLING MAY LEAD TO INCORRECT RESULTS AND THUS WRONG DECISION
  • CAN BE NEGATIVE (LIKE SMOKING) OR POSITIVE (PERSON VACCINATED, PERSON SCREENED ASYMPTOMATICALLY, TREATMENT FOR SYMPTOMATIC PEOPLE..)
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9
Q

WHY HERD IMMUNITY FOR COVID MIGHT BE IMPOSSIBLE?

A
  • VACCINE ROLLOUT UNEVEN
  • NEW VARIANTS CHANGE ERD IMMUNITY
  • IMMUNITY MAY NOT LAST FOREVER
  • VACCINES CHANGE HUMAN BEHAVIOUR
  • VACCINES NOT COMPLETEY EFFECTIVE
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10
Q

HERD IMMUNITY?

A

THE DIRECT PROTECTION EXPERIENCED BY UNVACCINATED INDIVIDUALS RESULTING FROM PRESENCE OF IMMUNE INDIVIDUALS IN A POPULATION

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11
Q

STEPS: HOW ARE MODELS SET UP?

A
  • MODELS ARE SIMPLIFICATIONS OF REALITY
  • SET UP USING A SOFTWARE OF ONE’S CHOICE
  • MODEL BUILDING IS AN ITERATIVE PROCESS: STEPS CAN BE REVISITED
    STEPS:
  • IDENTIFY THE RESEARCH QUESTION
  • IDENTIFY RELEVANT FACTS ABOUT THE INFECTION
  • CHOOSE THE MODEL STRUCTURE
  • IDENTIFY MODEL INPUT PARAMETERS
  • SET-UP MODEL
  • MODEL VALIDATION
  • PREDICTION AND OPTIMIZATION
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12
Q

WHICH RELEVANT FACTS ABOUT THE INFECTION NEED TO BE IDENTIFIED FOR INFECTIOUS DISEASE MODELLING?

A
  • WHAT IS THE LATENT/PREINFECTIOUS PERIOD (TIME FROM BEING INFECTED TO BECOMING INFECTIOUS)
  • HOW LONG ARE PEOPLE INFECTED
  • WHAT IS THE BASIC REPRODUCTION NUMBER, R0
  • ARE ALL AGE GROUPS AFFECTED EQUALLY
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13
Q

WHAT HAS TO BE COONSIDERED WHEN CHOOSING THE MODEL STRUCTURE FOR INFECTIOUS DISEASE MODELLING?

A
  • NATURAL HISTORY OF THE INFECTION (MODEL STRUCTURE SHOULD REFLECT THE NATURAL HISTORY OF A DISEASE, SHOWING ALL PERIODS!!!!!!!!!!!)
  • ACCURACY AND TIME PERIOD OVER WHICH MODEL PREDICITIONS ARE REQUIRED (MAY NEED TO INCORPORATE KEY ASPECTS OF DEMOGRAPHY LIKE BIRTH DATE, DEATHS AND MIGRATION; IF LOOKING AT LONG TERM IMPACTS OF INFECTION) + (MAY NEED TO CONSIDER DIFFERENT STRAINS OR CHANGES TO THE POPULATION’S IMMUNITY TO THE DIFF STRAINS)
  • RESEARCH QUESTION (THE MODEL STRUCTURE IS A FUNCTION OF THE RESEARCH QUESTION, SHOULD BE CLEARLY DEFINED)
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14
Q

WHAT DOES THE ‘SEIR’ MODEL OF INFECTIOUS DISEASE MODELLING STAND FOR?

A

SUSCEPTIBLE—>PREINFECTIOUS (EXPOSED)—>INFECTIOUS—> RECOVERED

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15
Q

WHAT ARE DETERMINISTIC MODELS?

A

MODELS THAT DESCRIBE WHAT HAPPENS ON AVERAGE IN A POPULATION (SAME RESULTS EACH TIME THEY ARE RAN)

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16
Q

WHAT ARE STOCHASTIC MODELS?

A

THEY ALLOW THE NUMBER OF INDIVIDUALS WHO MOVE THROUGH COMPARTMENTS TO VARY THROUGH CHANCE

  • USEFUL FOR ASSUMPTIONS AND WHEN THERE IS A LOT OF UNCERTAINTY IN THE MODEL
  • INCLUDE RANGS OF VALUES, AND DIFFER EACH TIME THEY RUN
17
Q

TYPES OF MODELS?

A
  • COMPARTMENTAL (PEOPLE CLASSIFIED INTO WELL KNOWN CLEARLY DEFINED CATEGORIES)
  • INDIVIDUAL BASED OR MICROSIMULATION
  • TRANSMISSION DYNAMIC OR DYNAMIC TRANSMISSION (ALLOWS CONTACT BETWEEN PEOPLE IN THE MODELS, MOSTLY FOR INFECTIOUS DISEASE)
  • STATIC (NO MIXING BETWEEN THE INDIVIDUALS)
  • NETWORK (OFTEN USED FOR STIs, VERY COMPLEX)
18
Q

EAMPLES OF INFECTIOUS DISEASE MODEL INPUT PARAMETERS?

A
  • RISK THAT SUSCEPTIBLE PEOPLE BECOME INFECTED BETWEEN A SPECIFIED TIME POINT
  • PROPORTION OF INFECTED PEOPLE WHO BECOME INFECTIOUS
  • PROPORTION OF INFECTIOUS INDIVIDUALS WHO RECOVER (I.E. BECOME IMMUNE, BUT THENMIGHT HAVE TO CONSIDER HOW LONG THE IMMUNITY LASTS)
  • RELIABLE DATA
  • UNCERTAINTY IN THE DATA
19
Q

WHAT IS FORCE OF INFECTION (λ)?

A

THE RATE AT WHICH SUSCEPTIBLE INDIIDUALS BECOME INFECTED PER UNIT OF TIME/ THE PROBABILITY PER UNIT TIME THAT A SUSCEPTIBLE PERSON ACQUIRES AN INFECTION

20
Q

BY MULTIPLYING THE FORCE OF INFECTION BY THE NUMBER OF SUSCEPTIBLE PEOPLE, WE GET?

A

RATE OF INFECTION

21
Q

BASIC REPRODUCTION NUMBER (R0; R NAUGHT) INTERPRETATION?

A
  • THE HIGHER THE NUMBER, THE MORE INFECTIOUS A CONDITION IS
    R0=1, THE INCIDENCE OF THE DISEASEIN THE POPULATION REMAINS THE SAME, AND THERE IS NO CHANGE
    R0<1, THE INCIDENCE OF THE DISEASE WILL DECREASE, AND THE DISEASE WILL EVENTUALLY BE ELIMINATED
    R>1, THE INCIDENCE OF THE DISEASE WILL EXPONENTIALLY INCREASE
22
Q

BASIC REPRODUCTION NUMBER IS…

A

AVERAGE NUMBER OF SECONDARY INFECTIOUS PERONS RESULTING FROM ONE INFECTIOUS PERSON FOLLOWING INTRODUCTION INTO A TOTALLY SUSCEPTIBLE POPULATION

23
Q

NET REPRODUCTION NUMBER IS… (Rn)

A

AVERAGE NUMBER OF SECONDARY INFECTIOUS PERSONS RESULTING FROM ONE INFECTIOUS PERSON IN A GIVEN POPULATION (WHERE SUSCEPTIBILITY VARIES, NOT THE WHOLE POPULATION IS SUSCEPTIBLE/ NOT TOTALLY SUSCEPTIBLE)

24
Q

EXAMPLES OF PROGRAMS/SOFTWARES THAT CAN BE USED FOR SETTING UP MODELS?

A

EXCEL, C++, R, PYTHON, BERKELEY MADONNA…

25
Q

COST EFFECTIVENESS TRESHOLD USED BY NICE?

A

20,000-30,000 POUNDS PER QALY

26
Q

WHY AND WHEN WAS NICE ESTABLISHED?

A

IN 1999 TO TOP THE POSTCODE LOTTERY IN HEALTHCARE

27
Q

OPPORTUNITY COST?

A

THE BENEFIT YOU GIVE UP DUE TO NOT BEING ABLE TO SPEND MONEY ON MORE THAN ONE THING (LOST BENEFITS OF ALTERNATIVE COURSES OF ACTION)

28
Q

COST EFFECTIVENESS PLANE?

A

X: EFFECT DIFFERENCE
Y: COST DIFFERENCE
SOUTH EAST QUADRANT: INTERVENTION LESS COSTLY BUT MORE EFFECTIVE
ALL QUANDRANT EXCEPT FOR THE NORTH WEST ONE REPRESENT ATTRACTIVE/POSSIBLE OPTIONS AND THE DECISION IS MADE BASED ON THE MAKER’S PREFERENCES; WILLINGNESS TO COMPROMISE PRICE OR EFFECTIVENESS IN TERMS OF HEALTH

29
Q

MAIN AIM OF HEALTH ECON?

A

MAXIMISE HEALTH OF POPULATION WITH SCARCE RESOURCES

30
Q

TYPES OF ECON EVALUATION?

A

COST EFFECTIVENESS ANALYSIS: EFFECTS MEASURED IN NATURAL UNITS (E.G. NUMBER OF CASES DETECTED), COST/LYG (LIFE YEARS GAINS), USED FOR E.F. DIFF TREATMENTS OF THE SAME DISEASE

COST UTILITY ANALYSIS: EFFECTS VALUED AS UTILITY IN QALYs, COST/QALY, CAN COMPARE DIFFERENT DISEASES

COST BENEFIT ANALYSIS: MONETARY VALUATION PLACED ON HEALTH OUTCOMES, COST:BENEFIT RATIO (BOTH IN POUNDS)

31
Q

POSSIBLE PERSPECTIVES/VIEWPOINTS OF ECON ANALYSIS?

A
  • INDIVIDUAL (WOULD INCLUDE E.G. TRAVEL COSTS, TIME OFF WORK)
  • ORGANISTION (E.G. HOSPITAL)
  • NHS (MOST COMMON)
  • SOCIETAL
32
Q

DATA SOURCES FOR ECON EVALUATION?

A
  • NHS REFERENCE COSTS
  • RESEARCH LITERATURE
  • BRITISH NATIONAL FORMULARY
  • EXPERT OPINION
    (IF DATA FROM LITERATURE IS OLD, MAKE SURE TO INFLATE IT TO CURRENT TIMES + ALL DATA NEEDS TO BE FROM THE SAME YEAR + BETTER TO RELY ON EXPERTS THAN PROBABILITIES)
33
Q

INCREMENTAL COST-EFFECTIVENESS RATIO?

A

The incremental cost-effectiveness ratio (ICER) is a statistic used in cost-effectiveness analysis to summarise the cost-effectiveness of a health care intervention. It is defined by the difference in cost between two possible interventions, divided by the difference in their effect

ICER=(COSTa-COSTb)/(EFFECTa-EFFECTb)

34
Q

WHAT IS SENSITIVITY ANALYSIS?

A

A SET OF TECHNIQUES USED TO ANALYSE HOW SENSITIVE RESULTS ARE TO UNCERTAINTY

INF (40 decks)

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