Assessing the performance of a computer-based policy model of HIV and AIDS

Chara Rydzak, Kara L. Cotich, Paul E. Sax, Heather E. Hsu, Bingxia Wang, Elena Losina, Kenneth A. Freedberg, Milton C. Weinstein, Sue J. Goldie

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Model-based analyses, conducted within a decision analytic framework, provide a systematic way to combine information about the natural history of disease and effectiveness of clinical management strategies with demographic and epidemiological characteristics of the population. Among the challenges with disease-specific modeling include the need to identify influential assumptions and to assess the face validity and internal consistency of the model. Methods and Findings: We describe a series of exercises involved in adapting a computer-based simulation model of HIV disease to the Women's Interagency HIV Study (WIHS) cohort and assess model performance as we re-parameterized the model to address olicy questions in the U.S. relevant to HIV-infected women using data from the WIHS. Empiric calibration targets included 4-month survival curves stratified by treatment status and CD4 cell count. The most influential assumptions in untreated women included chronic HIV-associated mortality following an opportunistic infection, and in treated women, the 'clinical effectiveness' of HAART and the ability of HAART to prevent HIV complications independent of virologic suppression. Good-fitting parameter sets required reductions in the clinical effectiveness of 1st and 2nd line HAART and improvements in 3rd and 4th line regimens. Projected rates of treatment regimen switching using the calibrated cohortspecific model closely approximated independent analyses published using data from the WIHS. Conclusions: The model demonstrated good internal consistency and face validity, and supported cohort heterogeneities that have been reported in the literature. Iterative assessment of model performance can provide information about the relative influence of uncertain assumptions and provide insight into heterogeneities within and between cohorts. Description of calibration exercises can enhance the transparency of disease-specific models.

Original languageEnglish (US)
Article numbere12647
Pages (from-to)1-13
Number of pages13
JournalPloS one
Volume5
Issue number9
DOIs
StatePublished - Nov 1 2010
Externally publishedYes

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Acquired Immunodeficiency Syndrome
HIV
Highly Active Antiretroviral Therapy
Reproducibility of Results
Calibration
Exercise
information transparency
exercise
calibration
Opportunistic Infections
Population Characteristics
CD4 Lymphocyte Count
Computer Simulation
population characteristics
Cohort Studies
cohort studies
Demography
Transparency
simulation models
demographic statistics

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Rydzak, C., Cotich, K. L., Sax, P. E., Hsu, H. E., Wang, B., Losina, E., ... Goldie, S. J. (2010). Assessing the performance of a computer-based policy model of HIV and AIDS. PloS one, 5(9), 1-13. [e12647]. https://doi.org/10.1371/journal.pone.0012647

Assessing the performance of a computer-based policy model of HIV and AIDS. / Rydzak, Chara; Cotich, Kara L.; Sax, Paul E.; Hsu, Heather E.; Wang, Bingxia; Losina, Elena; Freedberg, Kenneth A.; Weinstein, Milton C.; Goldie, Sue J.

In: PloS one, Vol. 5, No. 9, e12647, 01.11.2010, p. 1-13.

Research output: Contribution to journalArticle

Rydzak, C, Cotich, KL, Sax, PE, Hsu, HE, Wang, B, Losina, E, Freedberg, KA, Weinstein, MC & Goldie, SJ 2010, 'Assessing the performance of a computer-based policy model of HIV and AIDS', PloS one, vol. 5, no. 9, e12647, pp. 1-13. https://doi.org/10.1371/journal.pone.0012647
Rydzak, Chara ; Cotich, Kara L. ; Sax, Paul E. ; Hsu, Heather E. ; Wang, Bingxia ; Losina, Elena ; Freedberg, Kenneth A. ; Weinstein, Milton C. ; Goldie, Sue J. / Assessing the performance of a computer-based policy model of HIV and AIDS. In: PloS one. 2010 ; Vol. 5, No. 9. pp. 1-13.
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