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Developing and Validating Metamodels of a Microsimulation Model of Infant HIV Testing and Screening Strategies Used in a Decision Support Tool for Health Policy Makers

Background. Metamodels can simplify complex health policy models and yield instantaneous results to inform policy decisions. We investigated the predictive validity of linear regression metamodels used to support a real-time decision-making tool that compares infant HIV testing/screening strategies....

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Autores principales: Soeteman, Djøra I., Resch, Stephen C., Jalal, Hawre, Dugdale, Caitlin M., Penazzato, Martina, Weinstein, Milton C., Phillips, Andrew, Hou, Taige, Abrams, Elaine J., Dunning, Lorna, Newell, Marie-Louise, Pei, Pamela P., Freedberg, Kenneth A., Walensky, Rochelle P., Ciaranello, Andrea L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294506/
https://www.ncbi.nlm.nih.gov/pubmed/32587893
http://dx.doi.org/10.1177/2381468320932894
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author Soeteman, Djøra I.
Resch, Stephen C.
Jalal, Hawre
Dugdale, Caitlin M.
Penazzato, Martina
Weinstein, Milton C.
Phillips, Andrew
Hou, Taige
Abrams, Elaine J.
Dunning, Lorna
Newell, Marie-Louise
Pei, Pamela P.
Freedberg, Kenneth A.
Walensky, Rochelle P.
Ciaranello, Andrea L.
author_facet Soeteman, Djøra I.
Resch, Stephen C.
Jalal, Hawre
Dugdale, Caitlin M.
Penazzato, Martina
Weinstein, Milton C.
Phillips, Andrew
Hou, Taige
Abrams, Elaine J.
Dunning, Lorna
Newell, Marie-Louise
Pei, Pamela P.
Freedberg, Kenneth A.
Walensky, Rochelle P.
Ciaranello, Andrea L.
author_sort Soeteman, Djøra I.
collection PubMed
description Background. Metamodels can simplify complex health policy models and yield instantaneous results to inform policy decisions. We investigated the predictive validity of linear regression metamodels used to support a real-time decision-making tool that compares infant HIV testing/screening strategies. Methods. We developed linear regression metamodels of the Cost-Effectiveness of Preventing AIDS Complications Pediatric (CEPAC-P) microsimulation model used to predict life expectancy and lifetime HIV-related costs/person of two infant HIV testing/screening programs in South Africa. Metamodel performance was assessed with cross-validation and Bland-Altman plots, showing between-method differences in predicted outcomes against their means. Predictive validity was determined by the percentage of simulations in which the metamodels accurately predicted the strategy with the greatest net health benefit (NHB) as projected by the CEPAC-P model. We introduced a zone of indifference and investigated the width needed to produce between-method agreement in 95% of the simulations. We also calculated NHB losses from “wrong” decisions by the metamodel. Results. In cross-validation, linear regression metamodels accurately approximated CEPAC-P-projected outcomes. For life expectancy, Bland-Altman plots showed good agreement between CEPAC-P and the metamodel (within 1.1 life-months difference). For costs, 95% of between-method differences were within $65/person. The metamodels predicted the same optimal strategy as the CEPAC-P model in 87.7% of simulations, increasing to 95% with a zone of indifference of 0.24 life-months ( ∼ 7 days). The losses in health benefits due to “wrong” choices by the metamodel were modest (range: 0.0002–1.1 life-months). Conclusions. For this policy question, linear regression metamodels offered sufficient predictive validity for the optimal testing strategy as compared with the CEPAC-P model. Metamodels can simulate different scenarios in real time, based on sets of input parameters that can be depicted in a widely accessible decision-support tool.
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spelling pubmed-72945062020-06-24 Developing and Validating Metamodels of a Microsimulation Model of Infant HIV Testing and Screening Strategies Used in a Decision Support Tool for Health Policy Makers Soeteman, Djøra I. Resch, Stephen C. Jalal, Hawre Dugdale, Caitlin M. Penazzato, Martina Weinstein, Milton C. Phillips, Andrew Hou, Taige Abrams, Elaine J. Dunning, Lorna Newell, Marie-Louise Pei, Pamela P. Freedberg, Kenneth A. Walensky, Rochelle P. Ciaranello, Andrea L. MDM Policy Pract Article Background. Metamodels can simplify complex health policy models and yield instantaneous results to inform policy decisions. We investigated the predictive validity of linear regression metamodels used to support a real-time decision-making tool that compares infant HIV testing/screening strategies. Methods. We developed linear regression metamodels of the Cost-Effectiveness of Preventing AIDS Complications Pediatric (CEPAC-P) microsimulation model used to predict life expectancy and lifetime HIV-related costs/person of two infant HIV testing/screening programs in South Africa. Metamodel performance was assessed with cross-validation and Bland-Altman plots, showing between-method differences in predicted outcomes against their means. Predictive validity was determined by the percentage of simulations in which the metamodels accurately predicted the strategy with the greatest net health benefit (NHB) as projected by the CEPAC-P model. We introduced a zone of indifference and investigated the width needed to produce between-method agreement in 95% of the simulations. We also calculated NHB losses from “wrong” decisions by the metamodel. Results. In cross-validation, linear regression metamodels accurately approximated CEPAC-P-projected outcomes. For life expectancy, Bland-Altman plots showed good agreement between CEPAC-P and the metamodel (within 1.1 life-months difference). For costs, 95% of between-method differences were within $65/person. The metamodels predicted the same optimal strategy as the CEPAC-P model in 87.7% of simulations, increasing to 95% with a zone of indifference of 0.24 life-months ( ∼ 7 days). The losses in health benefits due to “wrong” choices by the metamodel were modest (range: 0.0002–1.1 life-months). Conclusions. For this policy question, linear regression metamodels offered sufficient predictive validity for the optimal testing strategy as compared with the CEPAC-P model. Metamodels can simulate different scenarios in real time, based on sets of input parameters that can be depicted in a widely accessible decision-support tool. SAGE Publications 2020-06-12 /pmc/articles/PMC7294506/ /pubmed/32587893 http://dx.doi.org/10.1177/2381468320932894 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Soeteman, Djøra I.
Resch, Stephen C.
Jalal, Hawre
Dugdale, Caitlin M.
Penazzato, Martina
Weinstein, Milton C.
Phillips, Andrew
Hou, Taige
Abrams, Elaine J.
Dunning, Lorna
Newell, Marie-Louise
Pei, Pamela P.
Freedberg, Kenneth A.
Walensky, Rochelle P.
Ciaranello, Andrea L.
Developing and Validating Metamodels of a Microsimulation Model of Infant HIV Testing and Screening Strategies Used in a Decision Support Tool for Health Policy Makers
title Developing and Validating Metamodels of a Microsimulation Model of Infant HIV Testing and Screening Strategies Used in a Decision Support Tool for Health Policy Makers
title_full Developing and Validating Metamodels of a Microsimulation Model of Infant HIV Testing and Screening Strategies Used in a Decision Support Tool for Health Policy Makers
title_fullStr Developing and Validating Metamodels of a Microsimulation Model of Infant HIV Testing and Screening Strategies Used in a Decision Support Tool for Health Policy Makers
title_full_unstemmed Developing and Validating Metamodels of a Microsimulation Model of Infant HIV Testing and Screening Strategies Used in a Decision Support Tool for Health Policy Makers
title_short Developing and Validating Metamodels of a Microsimulation Model of Infant HIV Testing and Screening Strategies Used in a Decision Support Tool for Health Policy Makers
title_sort developing and validating metamodels of a microsimulation model of infant hiv testing and screening strategies used in a decision support tool for health policy makers
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294506/
https://www.ncbi.nlm.nih.gov/pubmed/32587893
http://dx.doi.org/10.1177/2381468320932894
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