Applying multiple criteria decision analysis to comparative benefit-risk assessment: choosing among statins in primary prevention

Decision makers in different health care settings need to weigh the benefits and harms of alternative treatment strategies. Such health care decisions include marketing authorization by regulatory agencies, practice guideline formulation by clinical groups, and treatment selection by prescribers and patients in clinical practice. Multiple criteria decision analysis (MCDA) is a family of formal methods that help make explicit the tradeoffs that decision makers accept between the benefit and risk outcomes of different treatment options. Despite the recent interest in MCDA, certain methodological aspects are poorly understood. This paper presents 7 guidelines for applying MCDA in benefitrisk assessment and illustrates their use in the selection of a statin drug for the primary prevention of cardiovascular disease. We provide guidance on the key methodological issues of how to define the decision problem, how to select a set of nonoverlapping evaluation criteria, how to synthesize and summarize the evidence, how to translate relative measures to absolute ones that permit comparisons between the criteria, how to define suitable scale ranges, how to elicit partial preference information from the decision makers, and how to incorporate uncertainty in the analysis. Our example on statins indicates that fluvastatin is likely to be the most preferred drug by our decision maker and that this result is insensitive to the amount of preference information incorporated in the analysis

Stock-flow consistent macroeconomic model with nonuniform distributional constraint

We report on results concerning a partially aggregated Stock Flow Consistent (SFC) macroeconomic model in the stationary state where the sectors of banks and firms are aggregated, the sector of households is dis-aggregated, and the probability density function (pdf) of the wealth of households is exogenous, constrained by econometric data. It is shown that the equality part of the constraint can be reduced to a single constant-sum equation, which relates this problem to the study of continuous mass transport problems, and to the sum of iid random variables. Existing results can thus be applied, and provide marginal probabilities, and the location of the critical point before condensation occurs. Various numerical experiments are performed using Monte Carlo sampling of the hit-and-run type, using wealth and income data for France

Evidence-based prescribing: combining network meta-analysis with multicriteria decision analysis to choose among multiple drugs

What is the drug of choice for condition x? is among the most commonly asked questions in primary care.1 Reflecting the complexity of prescribing decisions, answering this question requires a difficult trade-off between the benefits and harms of multiple drugs for a given condition. The principles of evidence-based medicine suggest that prescribing decisions should be guided by an objective benchmark, namely scientific evidence.2 Such evidence is particularly important when choosing a first-line treatment among multiple alternatives. Unfortunately, existing clinical evidence on benefits and harms is rarely adequate to inform prescribing decisions. A randomized controlled trial comparing all relevant drugs would provide such information. However, clinical trials are often designed for regulatory purposes and, therefore, include selective patient populations and do not include all available comparator drugs.3,4 To obtain insight into the comparative benefits and harms of multiple drugs, prescribers turn to summaries of evidence to discern the most promising drugs from their less effective comparators. Recent methods used to synthesize existing evidence provide much-needed information on the comparative benefits and harms of multiple drugs. Network meta-analysis is one such method that allows for the combination of direct and indirect evidences from randomized trials, facilitating the comparison of all relevant drugs even when they are not directly compared with each other in clinical trials.5 The recent surge in the number of network meta-analyses in the general medical literature is a testament to the increasing need for comparative evidence in prescribing decisions

Volume of the steady-state space of financial flows in a monetary stock-flow-consistent model

We show that a steady-state stock-flow consistent macro-economic model can be represented as a Constraint Satisfaction Problem (CSP).The set of solutions is a polytope, which volume depends on the constraintsapplied and reveals the potential fragility of the economic circuit,with no need to study the dynamics. Several methods to compute the volume are compared, inspired by operations research methods and theanalysis of metabolic networks, both exact and approximate.We also introduce a random transaction matrix, and study the particularcase of linear flows with respect to money stocks

Π5 – Τεχνική έκθεση (βιβλιογραφική ανασκόπηση συνδυασμού μεθόδων τεχνητής νοημοσύνης και πολυκριτήριας ανάλυσης)

Η παρούσα βιβλιογραφική ανασκόπηση επικεντρώνεται στην ανάλυση της σχέσης ανάμεσα σε τεχνικές ΠΑΑ και μεθοδολογίες από το πεδίο της ΤΝ, καθώς και του τρόπου με τον οποίο η ευστάθεια αντιμετωπίζεται στα δύο πεδία. Η καταγραφή αυτή συμβάλει στον εντοπισμό συνεργειών που μπορούν να προκύψουν από την ανάπτυξη διαδικασιών που συνδυάζουν ιδέες, έννοιες και αρχές από τα πεδία της ΠΑΑ και της ΤΝ για την καλύτερη μελέτη της ευστάθειας σε προβλήματα λήψης αποφάσεων. H βιβλιογραφική ανασκόπηση πραγματοποιείται στα πλαίσια διαδικασιών ανάπτυξης μοντέλων αποφάσεων μέσω της αναλυτικής-συνθετικής προσέγγισης (preference disaggregation approach, Jacquet-Lagrèze & Siskos, 2001) της ΠΑΑ, η οποία όπως θα αναλυθεί έχει σημαντικά κοινά στοιχεία με τεχνικές από το χώρο της ΤΝ και ιδιαίτερα με μεθοδολογίες μηχανικής μάθησης (machine learning)