Assessing the performance of a computer-based policy model of HIV and AIDS.

<h4>Background</h4>Model-based analyses, conducted within a decision analytic framework, provide a systematic way to combine information about the natural history of disease and effectiveness of clinical management strategies with demographic and epidemiological characteristics of the po...

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Autores principales:	Chara E Rydzak, Kara L Cotich, Paul E Sax, Heather E Hsu, Bingxia Wang, Elena Losina, Kenneth A Freedberg, Milton C Weinstein, Sue J Goldie, CEPAC Investigators
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2010
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/5d3bf393b7eb47c999cc6c4dde351269
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spelling	oai:doaj.org-article:5d3bf393b7eb47c999cc6c4dde3512692021-11-18T06:35:18ZAssessing the performance of a computer-based policy model of HIV and AIDS.1932-620310.1371/journal.pone.0012647https://doaj.org/article/5d3bf393b7eb47c999cc6c4dde3512692010-09-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/20844741/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Model-based analyses, conducted within a decision analytic framework, provide a systematic way to combine information about the natural history of disease and effectiveness of clinical management strategies with demographic and epidemiological characteristics of the population. Among the challenges with disease-specific modeling include the need to identify influential assumptions and to assess the face validity and internal consistency of the model.<h4>Methods and findings</h4>We describe a series of exercises involved in adapting a computer-based simulation model of HIV disease to the Women's Interagency HIV Study (WIHS) cohort and assess model performance as we re-parameterized the model to address policy questions in the U.S. relevant to HIV-infected women using data from the WIHS. Empiric calibration targets included 24-month survival curves stratified by treatment status and CD4 cell count. The most influential assumptions in untreated women included chronic HIV-associated mortality following an opportunistic infection, and in treated women, the 'clinical effectiveness' of HAART and the ability of HAART to prevent HIV complications independent of virologic suppression. Good-fitting parameter sets required reductions in the clinical effectiveness of 1st and 2nd line HAART and improvements in 3rd and 4th line regimens. Projected rates of treatment regimen switching using the calibrated cohort-specific model closely approximated independent analyses published using data from the WIHS.<h4>Conclusions</h4>The model demonstrated good internal consistency and face validity, and supported cohort heterogeneities that have been reported in the literature. Iterative assessment of model performance can provide information about the relative influence of uncertain assumptions and provide insight into heterogeneities within and between cohorts. Description of calibration exercises can enhance the transparency of disease-specific models.Chara E RydzakKara L CotichPaul E SaxHeather E HsuBingxia WangElena LosinaKenneth A FreedbergMilton C WeinsteinSue J GoldieCEPAC InvestigatorsPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 5, Iss 9 (2010)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Chara E Rydzak Kara L Cotich Paul E Sax Heather E Hsu Bingxia Wang Elena Losina Kenneth A Freedberg Milton C Weinstein Sue J Goldie CEPAC Investigators Assessing the performance of a computer-based policy model of HIV and AIDS.
description	<h4>Background</h4>Model-based analyses, conducted within a decision analytic framework, provide a systematic way to combine information about the natural history of disease and effectiveness of clinical management strategies with demographic and epidemiological characteristics of the population. Among the challenges with disease-specific modeling include the need to identify influential assumptions and to assess the face validity and internal consistency of the model.<h4>Methods and findings</h4>We describe a series of exercises involved in adapting a computer-based simulation model of HIV disease to the Women's Interagency HIV Study (WIHS) cohort and assess model performance as we re-parameterized the model to address policy questions in the U.S. relevant to HIV-infected women using data from the WIHS. Empiric calibration targets included 24-month survival curves stratified by treatment status and CD4 cell count. The most influential assumptions in untreated women included chronic HIV-associated mortality following an opportunistic infection, and in treated women, the 'clinical effectiveness' of HAART and the ability of HAART to prevent HIV complications independent of virologic suppression. Good-fitting parameter sets required reductions in the clinical effectiveness of 1st and 2nd line HAART and improvements in 3rd and 4th line regimens. Projected rates of treatment regimen switching using the calibrated cohort-specific model closely approximated independent analyses published using data from the WIHS.<h4>Conclusions</h4>The model demonstrated good internal consistency and face validity, and supported cohort heterogeneities that have been reported in the literature. Iterative assessment of model performance can provide information about the relative influence of uncertain assumptions and provide insight into heterogeneities within and between cohorts. Description of calibration exercises can enhance the transparency of disease-specific models.
format	article
author	Chara E Rydzak Kara L Cotich Paul E Sax Heather E Hsu Bingxia Wang Elena Losina Kenneth A Freedberg Milton C Weinstein Sue J Goldie CEPAC Investigators
author_facet	Chara E Rydzak Kara L Cotich Paul E Sax Heather E Hsu Bingxia Wang Elena Losina Kenneth A Freedberg Milton C Weinstein Sue J Goldie CEPAC Investigators
author_sort	Chara E Rydzak
title	Assessing the performance of a computer-based policy model of HIV and AIDS.
title_short	Assessing the performance of a computer-based policy model of HIV and AIDS.
title_full	Assessing the performance of a computer-based policy model of HIV and AIDS.
title_fullStr	Assessing the performance of a computer-based policy model of HIV and AIDS.
title_full_unstemmed	Assessing the performance of a computer-based policy model of HIV and AIDS.
title_sort	assessing the performance of a computer-based policy model of hiv and aids.
publisher	Public Library of Science (PLoS)
publishDate	2010
url	https://doaj.org/article/5d3bf393b7eb47c999cc6c4dde351269
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Assessing the performance of a computer-based policy model of HIV and AIDS.

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