Designing Risk-Adjusted Therapy for Patients with Hypertension

• 成果类型: Article
• 署名作者: Zargoush, Manaf; Gumus, Mehmet; Verter, Vedat; Daskalopoulou, Stella S.
• 署名单位: McMaster University; McGill University; McGill University
• 刊物名称: PRODUCTION AND OPERATIONS MANAGEMENT
• ISSN/ISSBN: 1059-1478
• DOI: 10.1111/poms.12872
• 发表日期: 2018
• 页码: 2291-2312
• 关键词: hypertension treatment; personalized healthcare; medical decision making; Markov decision processes; threshold policy

摘要

Limited guidance is available for providing patient-specific 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-adjusted 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-adjusted 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-diabetic patients. Our sensitivity analysis results indicate that the optimal thresholds decrease if the medications have lower side-effects and vice versa.