EurekaMag
+ Translate
+ Most Popular
Identification of compounds with anti-West Nile Virus activity
Geological age of the Ptilophyllum flora; a critical reassessment
Nira (Co 86032) - a new variety of sugarcane for Maharashtra
Occurrence of Eutrichophilus mexicanus (Rudow, 1866) and Eutrichophilus lobatus (Ewing, 1936) (Phthiraptera: Trichodectidae) on Sphiggurus villosus (Cuvier, 1825) (Rodentia: Erethizontidae) in Rio de
An assessment of water quality of river ganga at garhmukteshwar ghaziabad uttar pradesh india
The identity of the lipstick mold of cultivated mushrooms agaricus bisporus
Comparison of rice bran and maize bran as feeds for growing and fattening pigs
The composition of pampas-grass (Cortaderia argentea.)
Studies on feeding of tapioca thippi (tapioca or cassava starch waste) to swine
Effects of drum rolling on yield of summer groundnut
Integrated farming system for gardenland conditions of Coimbatore district - an over view
Influence of a decision analysis model on selection of drug therapy
Comparative performance of West Coast Tall and Lakshadweep Ordinary cultivars of coconut
Evaluation of WCT coconut and Komadan coconut
Cellars as hibernation sites for bats
Donkioporia expansa - A lesser known wood destroyer in buildings
The Bangla adaptation of Mini-Mental State Examination (BAMSE): An instrument to assess cognitive function in illiterate and literate individuals
Enterobacter amnigenus. An unusual human pathogen
'Rajeshwari' - a high-yielding white seeded variety of sesame for Andhra Pradesh
Gymnosperms of Sikkim, India
The great Coalinga cricket invasion
Psoriasis: correlation between severity index (PASI) and quality of life index (DLQI) in patients assessed before and after systemic treatment
Real-time PCR assays for the specific detection of monkeypox virus West African and Congo Basin strain DNA
Classification of fermented foods: worldwide review of household fermentation techniques
The biology of human starvation: some new insights

Dynamic treatment selection and modification for personalised blood pressure therapy using a Markov decision process model: a cost-effectiveness analysis


Dynamic treatment selection and modification for personalised blood pressure therapy using a Markov decision process model: a cost-effectiveness analysis



Bmj Open 7(11): E018374



ISSN/ISBN: 2044-6055

PMID: 29146652

DOI: 10.1136/bmjopen-2017-018374

Personalised medicine seeks to select and modify treatments based on individual patient characteristics and preferences. We sought to develop an automated strategy to select and modify blood pressure treatments, incorporating the likelihood that patients with different characteristics would benefit from different types of medications and dosages and the potential severity and impact of different side effects among patients with different characteristics. We developed a Markov decision process (MDP) model to incorporate meta-analytic data and estimate the optimal treatment for maximising discounted lifetime quality-adjusted life-years (QALYs) based on individual patient characteristics, incorporating medication adjustment choices when a patient incurs side effects. We compared the MDP to current US blood pressure treatment guidelines (the Eighth Joint National Committee, JNC8) and a variant of current guidelines that incorporates results of a major recent trial of intensive treatment (Intensive JNC8). We used a microsimulation model of patient demographics, cardiovascular disease risk factors and side effect probabilities, sampling from the National Health and Nutrition Examination Survey (2003-2014), to compare the expected population outcomes from adopting the MDP versus guideline-based strategies. Costs and QALYs for the MDP-based treatment (MDPT), JNC8 and Intensive JNC8 strategies. Compared with the JNC8 guideline, the MDPT strategy would be cost-saving from a societal perspective with discounted savings of US$1187 per capita (95% CI 1178 to 1209) and an estimated discounted gain of 0.06 QALYs per capita (95% CI 0.04 to 0.08) among the US adult population. QALY gains would largely accrue from reductions in severe side effects associated with higher treatment doses later in life. The Intensive JNC8 strategy was dominated by the MDPT strategy. An MDP-based approach can aid decision-making by incorporating meta-analytic evidence to personalise blood pressure treatment and improve overall population health compared with current blood pressure treatment guidelines.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 059636625

Download citation: RISBibTeXText

Related references

Adding noise to Markov cohort state-transition model in decision modeling and cost-effectiveness analysis. References 39(10): 1529-1540, 2020

A Markov process analysis comparing the cost effectiveness of maintenance therapy with citalopram versus standard therapy in major depression. Pharmacoeconomics 8(2): 159-168, 1995

Cost-effectiveness and cost-utility of population-based glaucoma screening in China: a decision-analytic Markov model. Lancet. Global Health 7(7): E968-E978, 2019

The effectiveness and cost effectiveness of dark chocolate consumption as prevention therapy in people at high risk of cardiovascular disease: best case scenario analysis using a Markov model. Bmj 344: E3657, 2012

Cost-effectiveness of two models of management for patients on chronic warfarin therapy--a Markov model analysis. Thrombosis and Haemostasis 90(6): 1106-1111, 2003

Cost effectiveness of treatment for amblyopia: an analysis based on a probabilistic Markov model. British Journal of Ophthalmology 88(5): 606-612, 2004

Cost effectiveness of neoadjuvant chemotherapy in locally advanced operable head and neck cancer followed by surgery and postoperative radiotherapy: a Markov model-based decision analysis. Oncology 84(6): 336-341, 2013

Cost-effectiveness of cemented versus cementless total hip arthroplasty. A Markov decision analysis based on implant cost. Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology 9(1): 23-28, 2008

Cost-effectiveness of milk powder fortified with potassium to decrease blood pressure and prevent cardiovascular events among the adult population in China: a Markov model. Bmj Open 7(9): E017136, 2017

Cost-effectiveness of seven IVF strategies: results of a Markov decision-analytic model. Human Reproduction 24(7): 1648-1655, 2009

The cost-effectiveness analysis of drug therapy versus surgery for symptomatic adenoid hypertrophy by a Markov model. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment Care and Rehabilitation 29(3): 629-638, 2020

Cost-Effectiveness Analysis of Helicobacter pylori Eradication Therapy for Prevention of Gastric Cancer: A Markov Model. Digestive Diseases and Sciences 65(6): 1679-1688, 2020

Cost-effectiveness analysis of rabies immunization strategy based on dynamic-decision tree model. Zhonghua Yu Fang Yi Xue Za Zhi 53(8): 804-810, 2019

Cost effectiveness of varenicline in Belgium, compared with bupropion, nicotine replacement therapy, brief counselling and unaided smoking cessation: a BENESCO Markov cost-effectiveness analysis. Clinical drug investigation 29(10): 655-665, 2009

The cost-effectiveness of treatment with erythropoietin compared to red blood cell transfusions for patients with chemotherapy induced anaemia: a Markov model. Acta Oncologica 47(6): 1009-1017, 2008