OPTIMAL TIMING OF LIVER TRANSPLANTATION

终末期肝病(ESLD)是 在美国，肝移植是一种有效的 这种疾病的治疗费用昂贵。最近的宣传环境 器官分配和等待时间带来了一个问题 条件下移植的最佳人选和时机选择 严格的公众监督。因此，这个项目的具体目标是 是构建一个复杂的、逼真的数学模拟模型 ESLD，足够详细，以确定最佳时机 自然病程中的移植。因为这些 方法能够跨多个 同时，该模型将整合自然历史， 将生存、成本和生活质量整合为单一决策分析 框架。尽管这些模型有大量的数据 需求、最新发展和可获得性的几个大型 NIDDK肝脏等一系列肝移植候选者 移植注册)对这些数据进行详细的校准 可能的模型。这个项目是健康服务的一个例子。 旨在利用现有注册表和数据库进行的研究 尽最大可能。这项工作分为三个独立的任务：1)通过 使用技术和在PERVER下开发的基本模型结构 在PI的帮助下，我们将创建特定于疾病的模拟模型 ESLD。这一努力将通过使用更好的 支持建模软件，可广泛移植 匹兹堡大学和女执事医院的专业知识。 2)模型将用随时间变化的估计值进行校准 预期生存、资源使用和生活质量 移植后。这些估计的不同部分的数据 将来自几个现有的大型数据集(匹兹堡和 NIDDK)增加了明智的主要数据收集以填充 现有数据中的某些差距。3)一旦建造和校准， 将使用仿真模型来研究以下几个问题 选择标准对儿童生存、生活质量和费用的影响 移植在ESLD中的应用及不同标准的效果 器官浪费和移植等待时间。这项工作将 第一次创建一个完整的模型，该模型将允许 不同时机和分配方式的成本效益评价 战略。

End stage liver disease (ESLD) is a problem of major proportions in the United States, and liver transplantation is an effective but expensive therapy for this disease. Recent publicity surrounding organ allocation and waiting times has brought the question of the optimal selection of candidates and timing of transplantation under significant public scrutiny. Therefore, the specific aim of this project is to construct a complex, realistic mathematical simulation model of ESLD that is sufficiently detailed to determine the optimal timing of transplantation during the natural course of disease. Because these methods have the ability to evaluate models across several dimensions simultaneously, the model will integrate natural history, survival, costs, and quality of life into a single decision analytic framework. Although such models have substantial data requirements, the recent development and availability of several large series of liver transplantation candidates such as the NIDDK Liver Transplantation Registry) make the detailed calibration of such models possible. This project is an example of health services research designed to utilize existing registries and databases to the extent possible. The work is divided into three separate tasks: 1) By using techniques and the basic model structure developed under prior work by the PI, we will create disease specific simulation models of ESLD. The effort will be enhanced through the use of better supported modeling software, and the extensive transplantation expertise of the University of Pittsburgh and the Deaconess Hospital. 2) The model will be calibrated with time-varying estimates of expected survival, resource use, and quality of life both before and after transplantation. Data for various portions of these estimates will come from several large existing datasets (Pittsburgh and NIDDK) augmented with judicious primary data collection to fill certain gaps in existing data. 3) Once built and calibrated, the simulation model will be used to investigate several questions about the effect of selection criteria on survival, quality of life and costs in the use of transplantation in ESLD, and the effect of various criteria on organ wasting and transplant waiting times. This work will create, for the first time, a complete model that will allow for the evaluation of the cost-effectiveness of different timing and allocation strategies.