Reference no: EM132835467
1. Read the application case 6.7 "Simulating Effects of Hepatitis B Interventions" on page 353 of your textbook.
2. Describe one advantage and disadvantage of OR methods like the one described. Provide a thorough description.
Simulating Effects of Hepatitis B Interventions
Although the United States has made significant investments in healthcare, some problems seem to defy solution. For example, a sizable proportion of the Asian population in the United States is more prone than others to the Hepatitis B viral disease. In addition to the social problems associated with the disease (like isolation), one out of every four chronically infected individuals stands the risk of suffering from liver cancer or cirrhosis if the disease is not treated effectively. Managing this disease could be very costly. There are a number of control measures, including screening, vaccination, and treatment procedures. The government is reluctant to spend money on any method of control if it is not cost effective and there is no proof of increased health for people afflicted with the disease. Even though not all the control measures are optimal for all situations, the best method or combination of methods for combating the disease are not yet known.
Methodology/Solution
A multidisciplinary team consisting of those with medical, management science, and engineering backgrounds developed a mathematical model using operations research (OR) methods that determined the right combination of control measures to be used to combat Hepatitis B in the Asian and Pacific Island populations. Normally, clinical trials are used in the medical field to determine the best course of action in disease treatment and prevention. Complicating this situation is the unusually long period of time it takes Hepatitis B to progress. Because of the high cost that would accompany clinical trials in this situation, OR models and methods were used. A combination of Markov and decision models offered a more cost-effective way for determining what combination of control measures to use at any point in time. The decision model helps measure the economic and health benefits of the various possibilities of screening, treatment, and vaccination. The Markov model was used to model the progression of Hepatitis B. The new model was created based on past literature and expertise from one of the researchers and draws from actual current infection and treatment data. Policy makers built the new model using Microsoft Excel because it is user friendly.
Results/Benefits
The resultant model was analyzed vis-à-vis existing control programs in both the United States and China. In the United States, four strategies were developed and compared to the existing strategy. The four strategies are
a. All individuals are vaccinated.
b. Individuals are first screened to determine whether they have a chronic infection. If yes, then they are treated.
c. Individuals are first screened to determine whether they have a chronic infection. If they have the infection, they are treated. In addition, close associates of those infected are also screened and vaccinated, if necessary.
d. Individuals are first screened to determine whether they have a chronic infection or need a vaccination. If they are infected, they are treated. If they need a vaccination, they are vaccinated.
Results of the simulations indicated that performing blood tests to determine chronic infection and vaccinating associates of infected people are cost effective. In China, the model helped design a catchup vaccination policy for children and adolescents. This catch-up policy was compared with current coverage levels of Hepatitis B vaccination. It was concluded that when individuals under the age of 19 years are vaccinated, the health outcomes are improved in the long run. In fact, this policy was more financially cost effective than the current disease control policy in place at the time of the evaluation.