Zhang Wenqian, Wang Haiyan
School of Economics and Management, Southeast University, Nanjing 211189, China.
Healthcare (Basel). 2022 Feb 1;10(2):283. doi: 10.3390/healthcare10020283.
During the process of disease diagnosis, overdiagnosis can lead to potential health loss and unnecessary anxiety for patients as well as increased medical costs, while underdiagnosis can result in patients not being treated on time. To deal with these problems, we construct a partially observable Markov decision process (POMDP) model of chronic diseases to study optimal diagnostic policies, which takes into account individual characteristics of patients. The objective of our model is to maximize a patient's total expected quality-adjusted life years (QALYs). We also derive some structural properties, including the existence of the diagnostic threshold and the optimal diagnosis age for chronic diseases. The resulting optimization is applied to the management of coronary heart disease (CHD). Based on clinical data, we validate our model, demonstrate how the quantitative tool can provide actionable insights for physicians and decision makers in health-related fields, and compare optimal policies with actual clinical decisions. The results indicate that the diagnostic threshold first decreases and then increases as the patient's age increases, which contradicts the intuitive non-decreasing thresholds. Moreover, diagnostic thresholds were higher for women than for men, especially at younger ages.
在疾病诊断过程中，过度诊断会导致潜在的健康损失、给患者带来不必要的焦虑以及增加医疗成本，而诊断不足则会导致患者无法及时得到治疗。为了解决这些问题，我们构建了一个慢性病的部分可观测马尔可夫决策过程（POMDP）模型来研究最优诊断策略，该模型考虑了患者的个体特征。我们模型的目标是使患者的总预期质量调整生命年（QALY）最大化。我们还推导了一些结构性质，包括慢性病诊断阈值的存在性和最优诊断年龄。所得的优化方法应用于冠心病（CHD）的管理。基于临床数据，我们验证了我们的模型，展示了这种定量工具如何能为健康相关领域的医生和决策者提供可操作的见解，并将最优策略与实际临床决策进行比较。结果表明，诊断阈值随着患者年龄的增加先降低后升高，这与直观的非递减阈值相矛盾。此外，女性的诊断阈值高于男性，尤其是在较年轻的年龄段。
