{"title":"知情和不知情的经验治疗政策。","authors":"Nicolas Houy, Julien Flaig","doi":"10.1093/imammb/dqz015","DOIUrl":null,"url":null,"abstract":"<p><p>We argue that a proper distinction must be made between informed and uninformed decision making when setting empirical therapy policies, as this allows one to estimate the value of gathering more information about the pathogens and their transmission and thus to set research priorities. We rely on the stochastic version of a compartmental model to describe the spread of an infecting organism in a health care facility and the emergence and spread of resistance to two drugs. We focus on information and uncertainty regarding the parameters of this model. We consider a family of adaptive empirical therapy policies. In the uninformed setting, the best adaptive policy allowsone to reduce the average cumulative infected patient days over 2 years by 39.3% (95% confidence interval (CI), 30.3-48.1%) compared to the combination therapy. Choosing empirical therapy policies while knowing the exact parameter values allows one to further decrease the cumulative infected patient days by 3.9% (95% CI, 2.1-5.8%) on average. In our setting, the benefit of perfect information might be offset by increased drug consumption.</p>","PeriodicalId":49863,"journal":{"name":"Mathematical Medicine and Biology-A Journal of the Ima","volume":"37 2","pages":"334-350"},"PeriodicalIF":0.8000,"publicationDate":"2020-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/imammb/dqz015","citationCount":"1","resultStr":"{\"title\":\"Informed and uninformed empirical therapy policies.\",\"authors\":\"Nicolas Houy, Julien Flaig\",\"doi\":\"10.1093/imammb/dqz015\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>We argue that a proper distinction must be made between informed and uninformed decision making when setting empirical therapy policies, as this allows one to estimate the value of gathering more information about the pathogens and their transmission and thus to set research priorities. We rely on the stochastic version of a compartmental model to describe the spread of an infecting organism in a health care facility and the emergence and spread of resistance to two drugs. We focus on information and uncertainty regarding the parameters of this model. We consider a family of adaptive empirical therapy policies. In the uninformed setting, the best adaptive policy allowsone to reduce the average cumulative infected patient days over 2 years by 39.3% (95% confidence interval (CI), 30.3-48.1%) compared to the combination therapy. Choosing empirical therapy policies while knowing the exact parameter values allows one to further decrease the cumulative infected patient days by 3.9% (95% CI, 2.1-5.8%) on average. In our setting, the benefit of perfect information might be offset by increased drug consumption.</p>\",\"PeriodicalId\":49863,\"journal\":{\"name\":\"Mathematical Medicine and Biology-A Journal of the Ima\",\"volume\":\"37 2\",\"pages\":\"334-350\"},\"PeriodicalIF\":0.8000,\"publicationDate\":\"2020-09-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1093/imammb/dqz015\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Mathematical Medicine and Biology-A Journal of the Ima\",\"FirstCategoryId\":\"99\",\"ListUrlMain\":\"https://doi.org/10.1093/imammb/dqz015\",\"RegionNum\":4,\"RegionCategory\":\"数学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"BIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Mathematical Medicine and Biology-A Journal of the Ima","FirstCategoryId":"99","ListUrlMain":"https://doi.org/10.1093/imammb/dqz015","RegionNum":4,"RegionCategory":"数学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"BIOLOGY","Score":null,"Total":0}
Informed and uninformed empirical therapy policies.
We argue that a proper distinction must be made between informed and uninformed decision making when setting empirical therapy policies, as this allows one to estimate the value of gathering more information about the pathogens and their transmission and thus to set research priorities. We rely on the stochastic version of a compartmental model to describe the spread of an infecting organism in a health care facility and the emergence and spread of resistance to two drugs. We focus on information and uncertainty regarding the parameters of this model. We consider a family of adaptive empirical therapy policies. In the uninformed setting, the best adaptive policy allowsone to reduce the average cumulative infected patient days over 2 years by 39.3% (95% confidence interval (CI), 30.3-48.1%) compared to the combination therapy. Choosing empirical therapy policies while knowing the exact parameter values allows one to further decrease the cumulative infected patient days by 3.9% (95% CI, 2.1-5.8%) on average. In our setting, the benefit of perfect information might be offset by increased drug consumption.
期刊介绍:
Formerly the IMA Journal of Mathematics Applied in Medicine and Biology.
Mathematical Medicine and Biology publishes original articles with a significant mathematical content addressing topics in medicine and biology. Papers exploiting modern developments in applied mathematics are particularly welcome. The biomedical relevance of mathematical models should be demonstrated clearly and validation by comparison against experiment is strongly encouraged.
The journal welcomes contributions relevant to any area of the life sciences including:
-biomechanics-
biophysics-
cell biology-
developmental biology-
ecology and the environment-
epidemiology-
immunology-
infectious diseases-
neuroscience-
pharmacology-
physiology-
population biology