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A comparison of decision-maker perspectives for optimal cholesterol treatment

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2 Author(s)
J. E. Mason ; Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, USA ; B. T. Denton

Medical decisions often involve tradeoff among competing criteria. For example, patients with third-party health insurance are primarily concerned about maximizing their quality-adjusted lifespan, since the majority of the cost burden typically falls on the third-party payer. On the other hand, third-party payers are incented to minimize total healthcare-related costs. Therefore, third-party payers must weigh the short-term cost of treatment against the long-term benefits of avoiding more costly health outcomes associated with disease progression and adverse events. The goal of the societal perspective is to achieve a reasonable balance among these competing criteria of quality-adjusted lifespan and costs. Treatment of diabetes provides a good example of the need to apply multicriteria decision-making models to treatment decisions. Chronic diseases such as diabetes are associated with high medical costs and a large number of available treatment options. In this paper, we use a Markov decision process (MDP) to show how decision-maker perspectives can influence medical treatment decisions related to cardiovascular risk management in patients with type 2 diabetes. We compare optimal treatment decisions from three different perspectives: societal, patient, and third-party payer. We further formulate an inverse MDP model to estimate the implied monetary value of a year of life, from the societal perspective, according to current U.S. treatment guidelines.

Note: The Institute of Electrical and Electronics Engineers, Incorporated is distributing this Article with permission of the International Business Machines Corporation (IBM) who is the exclusive owner. The recipient of this Article may not assign, sublicense, lease, rent or otherwise transfer, reproduce, prepare derivative works, publicly display or perform, or distribute the Article.  

Published in:

IBM Journal of Research and Development  (Volume:56 ,  Issue: 5 )