础耻迟丑辞谤蝉:听Manaf Zargoush, Mehmet Gumus, Vedat Verter,听Stella S. Daskalopoulou
Publication: Production and Operations Management, Forthcoming
Abstract:
Limited guidance is available for providing patient鈥恠pecific care to hypertensive patients, although this chronic condition is the leading risk factor for cardiovascular diseases. To address this issue, we develop an analytical model that takes into account the most relevant risk factors including age, sex, blood pressure, diabetes status, smoking habits, and blood cholesterol. Using the Markov Decision Process framework, we develop a model to maximize expected quality鈥恆djusted life years, as well as characterize the optimal sequence and combination of antihypertensive medications. Assuming the physician uses the standard medication dose for each drug, and the patient fully adheres to the prescribed treatment regimen, we prove that optimal treatment policies exhibit a threshold structure. Our findings indicate that our recommended thresholds vary by age and other patient characteristics, for example (1) the optimal thresholds for all medication prescription are nonincreasing in age, and (2) the medications need to be prescribed at lower thresholds for males who smoke than for males who have diabetes. The improvements in quality鈥恆djusted life years associated with our model compare favorably with those obtained by following the British Hypertension Society's guideline, and the gains increase with the severity of risk factors. For instance, in both genders (although at different rates), diabetic patients gain more than non鈥恉iabetic patients. Our sensitivity analysis results indicate that the optimal thresholds decrease if the medications have lower side鈥恊ffects and vice versa.
