Mind the gap! A multilevel analysis of factors related to variation in published cost-effectiveness estimates within and between countries

Background. Published cost-effectiveness estimates can vary considerably, both within and between countries. Despite extensive discussion, little is known empirically about factors relating to these variations. Objectives. To use multilevel statistical modeling to integrate cost-effectiveness estimates from published economic evaluations to investigate potential causes of variation. Methods. Cost-effectiveness studies of statins for cardiovascular disease prevention were identified by systematic review. Estimates of incremental costs and effects were extracted from reported base case, sensitivity, and subgroup analyses, with estimates grouped in studies and in countries. Three bivariate models were developed: a cross-classified model to accommodate data from multinational studies, a hierarchical model with multinational data allocated to a single category at country level, and a hierarchical model excluding multinational data. Covariates at different levels were drawn from a long list of factors suggested in the literature. Results. We found 67 studies reporting 2094 cost-effectiveness estimates relating to 23 countries (6 studies reporting for more than 1 country). Data and study-level covariates included patient characteristics, intervention and comparator cost, and some study methods (e.g., discount rates and time horizon). After adjusting for these factors, the proportion of variation attributable to countries was negligible in the cross-classified model but moderate in the hierarchical models (14%−19% of total variance). Country-level variables that improved the fit of the hierarchical models included measures of income and health care finance, health care resources, and population risks. Conclusions. Our analysis suggested that variability in published cost-effectiveness estimates is related more to differences in study methods than to differences in national context. Multinational studies were associated with much lower country-level variation than single-country studies. These findings are for a single clinical question and may be atypical

Formal Model Engineering for Embedded Systems Using Real-Time Maude

This paper motivates why Real-Time Maude should be well suited to provide a formal semantics and formal analysis capabilities to modeling languages for embedded systems. One can then use the code generation facilities of the tools for the modeling languages to automatically synthesize Real-Time Maude verification models from design models, enabling a formal model engineering process that combines the convenience of modeling using an informal but intuitive modeling language with formal verification. We give a brief overview six fairly different modeling formalisms for which Real-Time Maude has provided the formal semantics and (possibly) formal analysis. These models include behavioral subsets of the avionics modeling standard AADL, Ptolemy II discrete-event models, two EMF-based timed model transformation systems, and a modeling language for handset software.Comment: In Proceedings AMMSE 2011, arXiv:1106.596

Modeling the Intra-class Variability for Liver Lesion Detection using a Multi-class Patch-based CNN

Automatic detection of liver lesions in CT images poses a great challenge for researchers. In this work we present a deep learning approach that models explicitly the variability within the non-lesion class, based on prior knowledge of the data, to support an automated lesion detection system. A multi-class convolutional neural network (CNN) is proposed to categorize input image patches into sub-categories of boundary and interior patches, the decisions of which are fused to reach a binary lesion vs non-lesion decision. For validation of our system, we use CT images of 132 livers and 498 lesions. Our approach shows highly improved detection results that outperform the state-of-the-art fully convolutional network. Automated computerized tools, as shown in this work, have the potential in the future to support the radiologists towards improved detection.Comment: To be presented at PatchMI: 3rd International Workshop on Patch-based Techniques in Medical Imaging, MICCAI 201

Privacy-preserving model learning on a blockchain network-of-networks.

ObjectiveTo facilitate clinical/genomic/biomedical research, constructing generalizable predictive models using cross-institutional methods while protecting privacy is imperative. However, state-of-the-art methods assume a "flattened" topology, while real-world research networks may consist of "network-of-networks" which can imply practical issues including training on small data for rare diseases/conditions, prioritizing locally trained models, and maintaining models for each level of the hierarchy. In this study, we focus on developing a hierarchical approach to inherit the benefits of the privacy-preserving methods, retain the advantages of adopting blockchain, and address practical concerns on a research network-of-networks.Materials and methodsWe propose a framework to combine level-wise model learning, blockchain-based model dissemination, and a novel hierarchical consensus algorithm for model ensemble. We developed an example implementation HierarchicalChain (hierarchical privacy-preserving modeling on blockchain), evaluated it on 3 healthcare/genomic datasets, as well as compared its predictive correctness, learning iteration, and execution time with a state-of-the-art method designed for flattened network topology.ResultsHierarchicalChain improves the predictive correctness for small training datasets and provides comparable correctness results with the competing method with higher learning iteration and similar per-iteration execution time, inherits the benefits of the privacy-preserving learning and advantages of blockchain technology, and immutable records models for each level.DiscussionHierarchicalChain is independent of the core privacy-preserving learning method, as well as of the underlying blockchain platform. Further studies are warranted for various types of network topology, complex data, and privacy concerns.ConclusionWe demonstrated the potential of utilizing the information from the hierarchical network-of-networks topology to improve prediction

Taxonomic classification of planning decisions in health care: a review of the state of the art in OR/MS

We provide a structured overview of the typical decisions to be made in resource capacity planning and control in health care, and a review of relevant OR/MS articles for each planning decision. The contribution of this paper is twofold. First, to position the planning decisions, a taxonomy is presented. This taxonomy provides health care managers and OR/MS researchers with a method to identify, break down and classify planning and control decisions. Second, following the taxonomy, for six health care services, we provide an exhaustive specification of planning and control decisions in resource capacity planning and control. For each planning and control decision, we structurally review the key OR/MS articles and the OR/MS methods and techniques that are applied in the literature to support decision making