Bernard Cora L, Brandeau Margaret L
Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
Infect Dis Model. 2017 Nov;2(4):399-411. doi: 10.1016/j.idm.2017.08.002. Epub 2017 Nov 11.
Structural assumptions in infectious disease models, such as the choice of network or compartmental model type or the inclusion of different types of heterogeneity across individuals, might affect model predictions as much as or more than the choice of input parameters. We explore the potential implications of structural assumptions on HIV model predictions and policy conclusions. We illustrate the value of inference robustness assessment through a case study of the effects of a hypothetical HIV vaccine in multiple population subgroups over eight related transmission models, which we sequentially modify to vary over two dimensions: parameter complexity (e.g., the inclusion of age and HCV comorbidity) and contact/simulation complexity (e.g., aggregated compartmental vs. individual/disaggregated compartmental vs. network models). We find that estimates of HIV incidence reductions from network models and individual compartmental models vary, but those differences are overwhelmed by the differences in HIV incidence between such models and the aggregated compartmental models (which aggregate groups of individuals into compartments). Complexities such as age structure appear to buffer the effects of aggregation and increase the threshold of net vaccine effectiveness at which aggregated models begin to overestimate reductions. The differences introduced by parameter complexity in estimated incidence reduction also translate into substantial differences in cost-effectiveness estimates. Parameter complexity does not appear to play a consistent role in differentiating the projections of network models.
传染病模型中的结构假设,例如网络模型或 compartments 模型类型的选择,或者个体间不同类型异质性的纳入,可能对模型预测产生的影响与输入参数的选择相当,甚至更大。我们探讨了结构假设对 HIV 模型预测和政策结论的潜在影响。我们通过一个案例研究来说明推断稳健性评估的价值,该案例研究了一种假设的 HIV 疫苗在八个相关传播模型中的多人群亚组中的效果,我们依次对这些模型进行修改,使其在两个维度上变化:参数复杂性(例如年龄和 HCV 合并症的纳入)和接触/模拟复杂性(例如汇总 compartments 模型与个体/非汇总 compartments 模型与网络模型)。我们发现,网络模型和个体 compartments 模型对 HIV 发病率降低的估计有所不同,但这些差异与此类模型和汇总 compartments 模型(将个体分组汇总到 compartments 中)之间的 HIV 发病率差异相比微不足道。年龄结构等复杂性似乎缓冲了汇总的影响,并提高了汇总模型开始高估降低效果的净疫苗效力阈值。估计发病率降低中参数复杂性所引入的差异也转化为成本效益估计中的实质性差异。参数复杂性在区分网络模型的预测方面似乎并没有发挥一致的作用。
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