论文标题

用于乳腺癌筛查的多目标约束POMDP模型

A multi-objective constrained POMDP model for breast cancer screening

论文作者

Helmeczi, Robert K., Kavaklioglu, Can, Cevik, Mucahit, Neghab, Davood Pirayesh

论文摘要

乳腺癌是一种常见且致命的疾病,但在早期诊断时通常可以治愈。尽管大多数国家都有大规模的筛查计划,但单一全球接受的乳腺癌筛查指南尚无共识。疾病的复杂性;筛查方法的可用性有限,例如乳房X线摄影,磁共振成像(MRI)和超声波;和公共卫生政策都将筛查政策制定。资源可用性问题需要设计符合预算的政策,该问题可以作为约束的部分可观察到的马尔可夫决策过程(CPOMDP)建模。在这项研究中,我们提出了一种多目标CPOMDP模型,用于乳腺癌筛查,该模型允许伴有乳房X线摄影的补充筛查方法。该模型有两个目标:最大化质量调整后的寿命(QALYS),并最大程度地降低终身乳腺癌死亡率风险(LBCMR)。我们确定了在不同预算水平的平均和高风险患者的最佳解决方案的帕累托前沿,决策者可以将其用于实践制定政策。我们发现,使用加权目标获得的策略能够生成均衡的Qalys和LBCMR值。相比之下,单瞄准模型通常在Qalys/LBCMR方面牺牲了大量量,从而在LBCMR/Qalys中获得最小的增益。此外,我们的结果表明,由于补充筛查的基线成本值以及它们所产生的其他分类,因此很少在CPOMDP政策中推荐它们,尤其是在预算约束的环境中。灵敏度分析揭示了成本和不限制值的阈值,在该值中,补充筛选是有利于开处方的。

Breast cancer is a common and deadly disease, but it is often curable when diagnosed early. While most countries have large-scale screening programs, there is no consensus on a single globally accepted guideline for breast cancer screening. The complex nature of the disease; the limited availability of screening methods such as mammography, magnetic resonance imaging (MRI), and ultrasound; and public health policies all factor into the development of screening policies. Resource availability concerns necessitate the design of policies which conform to a budget, a problem which can be modelled as a constrained partially observable Markov decision process (CPOMDP). In this study, we propose a multi-objective CPOMDP model for breast cancer screening which allows for supplemental screening methods to accompany mammography. The model has two objectives: maximize the quality-adjusted life years (QALYs) and minimize lifetime breast cancer mortality risk (LBCMR). We identify the Pareto frontier of optimal solutions for average and high-risk patients at different budget levels, which can be used by decision-makers to set policies in practice. We find that the policies obtained by using a weighted objective are able to generate well-balanced QALYs and LBCMR values. In contrast, the single-objective models generally sacrifice a substantial amount in terms of QALYs/LBCMR for a minimal gain in LBCMR/QALYs. Additionally, our results show that, with the baseline cost values for supplemental screenings as well as the additional disutility that they incur, they are rarely recommended in CPOMDP policies, especially in a budget-constrained setting. A sensitivity analysis reveals the thresholds on cost and disutility values at which supplemental screenings become advantageous to prescribe.

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