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Author Mondschein, S.; Yankovic, N.; Matus, O. doi  openurl
  Title The Challenges of Administering a New Treatment: The Case of Direct -Acting Antivirals for Hepatitis C Virus Type
  Year 2021 Publication Public Health Abbreviated Journal Public Health  
  Volume 190 Issue Pages 116-122  
  Keywords Hepatitis C virus; Patient prioritization; Heuristics  
  Abstract Objectives: We develop a patient prioritization scheme for treating patients infected with hepatitis C virus (HCV) and study under which scenarios it outperforms the current practices in Spain and Chile.

Study design: We use simulation to evaluate the performance of prioritization rules under two HCV patient cohorts, constructed using secondary data of public records from Chile and Spain, during 2015-2016.

Methods: We use the results of a mathematical model, which determines individual optimal HCV treatment policies as an input for constructing a patient prioritization rule, when limited resources are present. The prioritization is based on marginal analysis on cost increases and health-outcome gains. We construct the Chilean and Spanish case studies and used Monte Carlo simulation to evaluate the performance of our methodology in these two scenarios.

Results: The resulting prioritizations for the Chilean and Spanish patients are similar, despite the significant differences of both countries, in terms of epidemiological profiles and cost structures. Furthermore, when resources are scarce compared with the number of patients in need of the new drug, our prioritization significantly outperforms current practices of treating sicker patients first, both in terms of cost and healthcare indicators: for the Chilean case, we have an increase in the quality-adjusted life years (QALYs) of 0.83 with a cost reduction of 8176 euros per patient, with a budget covering 2.5% of the patients in the cohort. This difference slowly decreases when increasing the available resources, converging to the performance indicators obtained when all patients are treated immediately: for the Spanish case, we have a decrease in the QALYs of 0.17 with a cost reduction of 1134 euros per patient, with a budget covering 20% of the patients in the cohort.

Conclusion: Decision science can provide useful analytical tools for designing efficient public policies that can excel in terms of quantitative health performance indicators.
 
  Address  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0033-3506 ISBN Medium  
  Area Expedition Conference  
  Notes WOS:000613322000036 Approved  
  Call Number UAI @ eduardo.moreno @ Serial 1114  
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Author Mondschein, S.; Yankovic, N.; Matus, O. doi  openurl
  Title Age-dependent optimal policies for hepatitis C virus treatment Type
  Year 2021 Publication International Transactions In Operational Research Abbreviated Journal Int. Trans. Oper. Res.  
  Volume 28 Issue 6 Pages 3303-3329  
  Keywords dynamic programming; public health; hepatitis C virus  
  Abstract In recent years, highly effective treatments for hepatitis C virus (HCV) have become available. However, high prices of new treatments call for a careful policy evaluation when considering economic constraints. Although the current medical advice is to administer the new therapies to all patients, economic and capacity constraints require an efficient allocation of these scarce resources. We use stochastic dynamic programming to determine the optimal policy for prescribing the new treatment based on the age and disease progression of the patient. We show that, in a simplified version of the model, new drugs should be administered to patients at a given level of fibrosis if they are within prespecified age limits; otherwise, a conservative approach of closely monitoring the evolution of the patient should be followed. We use a cohort of Spanish patients to study the optimal policy regarding costs and health indicators. For this purpose, we compare the performance of the optimal policy against a liberal policy of treating all sick patients. In this analysis, we achieve similar results in terms of the number of transplants, HCV-related deaths, and quality of adjusted life years, with a significant reduction in overall expenditure. Furthermore, the budget required during the first year of implementation when using the proposed methodology is only 12% of that when administering the treatment to all patients at once. Finally, we propose a method to prioritize patients when there is a shortage (surplus) in the annual budget constraint and, therefore, some recommended treatments must be postponed (added).  
  Address [Mondschein, Susana; Matus, Omar] Univ Adolfo Ibanez, Fac Ingn, Diagonal Las Torres 2640, Santiago 755000, Chile, Email: susana.mondschein@uai.cl;  
  Corporate Author Thesis  
  Publisher Wiley Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0969-6016 ISBN Medium  
  Area Expedition Conference  
  Notes WOS:000481229600001 Approved  
  Call Number UAI @ eduardo.moreno @ Serial 1041  
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Author Matus, O.; Barrera, J.; Moreno, E.; Rubino, G. pdf  doi
openurl 
  Title On the Marshall-Olkin Copula Model for Network Reliability Under Dependent Failures Type
  Year 2019 Publication IEEE Transactions On Reliability Abbreviated Journal IEEE Trans. Reliab.  
  Volume 68 Issue 2 Pages 451-461  
  Keywords Copula theory; failure analysis; network design; optimization methods; reliability  
  Abstract The Marshall-Olkin (MO) copulamodel has emerged as the standard tool for capturing dependence between components in failure analysis in reliability. In this model, shocks arise at exponential random times, that affect one or several components inducing a natural correlation in the failure process. However, because the number of parameter of the model grows exponentially with the number of components, MO suffers of the “curse of dimensionality.” MO models are usually intended to be applied to design a network before its construction; therefore, it is natural to assume that only partial information about failure behavior can be gathered, mostly from similar existing networks. To construct such an MO model, we propose an optimization approach to define the shock's parameters in the MO copula, in order to match marginal failures probabilities and correlations between these failures. To deal with the exponential number of parameters of this problem, we use a column-generation technique. We also discuss additional criteria that can be incorporated to obtain a suitable model. Our computational experiments show that the resulting MO model produces a close estimation of the network reliability, especially when the correlation between component failures is significant.  
  Address [Matus, Omar; Barrera, Javiera; Moreno, Eduardo] Univ Adolfo Ibanez, Fac Engn & Sci, Santiago 7941169, Chile, Email: omar.matus@edu.uai.cl;  
  Corporate Author Thesis  
  Publisher Ieee-Inst Electrical Electronics Engineers Inc Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0018-9529 ISBN Medium  
  Area Expedition Conference  
  Notes WOS:000470826100005 Approved  
  Call Number UAI @ eduardo.moreno @ Serial 1027  
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Author Garmendia, M.L.; Matus, O.; Mondschein, S.; Kusanovic, J.P. pdf  doi
openurl 
  Title Gestational weight gain recommendations for Chilean women: a mathematical optimization approach Type
  Year 2018 Publication Public Health Abbreviated Journal Public Health  
  Volume 163 Issue Pages 80-86  
  Keywords Pregnancy; Weight gain; Obesity; Pregnancy high risk; Chile  
  Abstract Objectives: We examined if the guidelines for gestational weight gain (GWG) proposed by the Institute of Medicine (IOM) are the most suitable for Chilean women. Study design: Secondary analysis of records of single full-term births at the Dr. Sotero del Rio Hospital, Santiago, Chile, during 2003-2012 (n = 62,579). Methods: From clinical records, we obtained data regarding maternal age, height, prepregnancy and at delivery weights, pathologies during pregnancy such as gestational diabetes (GDM) and pre-eclampsia, gestational age at delivery, and number of infants born small for gestational age (SGA) and large for gestational age (LGA). We formulated a mathematical model (MM) to determine the GWG range that maximizes the likelihood of a healthy pregnancy (HP) if the recommendation is followed. We defined an HP as one where the mother has no complications such as pre-eclampsia, GDM, SGA, or LGA. Results: Forty-six percent of women had prepregnancy overweight or obesity. The prevalence of GDM, pre-eclampsia, SGA, and LGA were 3%, 1.2%, 9%, and 12%, respectively. An HP was present in 76% of pregnancies, 79% in the underweight group, 79% in normal weight group, 74% in the overweight group, and 67% in obese women. The GWG recommendations given by the MM (14-20 kg for underweight, 6-20 kg for normal weight, 9 -11 kg for overweight, and 6-7 kg for obese) led to higher probabilities of achieving an HP than the ones obtained with the IOM recommendations. Conclusion: The adoption of GWG recommendations based on characteristics of the Chilean population might lead to better short- and long-term health results for pregnant women. (C) 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.  
  Address [Garmendia, M. L.] Univ Chile, Inst Nutr & Food Technol, Avda Libano 5524, Santiago, Chile, Email: susana.mondschein@uai.cl  
  Corporate Author Thesis  
  Publisher W B Saunders Co Ltd Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0033-3506 ISBN Medium  
  Area Expedition Conference  
  Notes WOS:000446680400014 Approved  
  Call Number UAI @ eduardo.moreno @ Serial 918  
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Author Garmendia, M.L.; Mondschein, S.; Matus, O.; Murrugarra, R.; Uauy, R. pdf  doi
openurl 
  Title Predictors of gestational weight gain among Chilean pregnant women: The Chilean Maternal and Infant Nutrition Cohort study Type
  Year 2017 Publication Health Care For Women International Abbreviated Journal Health Care Women Int.  
  Volume 38 Issue 8 Pages 892-904  
  Keywords  
  Abstract We identified factors associated with gestational weight gain (GWG) in 1,654 Chilean pregnant women with full-term pregnancies. At baseline, we collected information about sociodemographic, gyneco-obstetric, anthropometric, and health-care-related factors. We found that prepregnancy nutritional body mass index was the most important factor related to GWG above recommendations (overweight: ratio of relative risks [RRR] = 2.31, 95% confidence interval [CI, 1.73, 3.09] and obesity: RRR = 2.90, 95% CI [2.08, 4.03]). We believe that women who are overweight/obese at the beginning of pregnancy should be identified because of their higher risk, and that adequate strategies should be designed and implemented to help them achieve a healthy GWG.  
  Address [Luisa Garmendia, Maria; Uauy, Ricardo] Univ Chile, Inst Nutr & Food Technol, Libano 5524, Santiago, Chile, Email: mgarmendia@inta.uchile.cl  
  Corporate Author Thesis  
  Publisher Taylor & Francis Inc Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0739-9332 ISBN Medium  
  Area Expedition Conference  
  Notes WOS:000407518400009 Approved  
  Call Number UAI @ eduardo.moreno @ Serial 758  
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