Emulators for complex decision models in healthcare: feasibility of calibration, explication of analyses, and development of intitution with an application in prostate cancer

 描述(由申请人提供)：患者、医生和政策制定者面临着关于健康的复杂决定。这些决定是复杂的，因为存在许多替代方案，利益和损害的集合，不同的患者偏好，以及证据基础的不确定性。正式的方法，如决策分析模型，在存在这些复杂性的情况下促进了决策过程。然而，这些模型在实践中并没有得到广泛的应用，因为它们很难开发，计算成本很高，而且不透明。仿真器或元模型是模型的统计近似值，已在一系列学科中用于解决复杂问题。尽管它还没有被广泛应用于健康领域，但它可能是促进有关健康的复杂决策的有用工具。整个项目的目标是开发一个框架，通过仿真器促进计算昂贵的决策模型的开发、分析和传播，并将该框架应用于前列腺癌筛查实例。具体地说，该项目的目的是：(1)开发一个使用仿真器的框架，以促进详细模型的开发和分析；(2)使用前列腺癌筛查的综合模型，为框架的概念应用提供证据；(3)探索仿真器的使用是否有助于根据新的背景定制模型，并建立对其行为的直觉。拟议的工作具有重要意义，因为它可能有助于缓解挑战(特别是与计算 负担)在实践中实施和传播决策模型。我们将以易于使用和易于量身定做的方式实施经过充分开发和验证的前列腺癌筛查模型。我们预计，这项工作的结果可能会鼓励和促进未来在这一领域的研究和应用。

 DESCRIPTION (provided by applicant): Patients, physicians, and policy makers face complex decisions about health. These decisions are complex because of the existence of numerous alternatives, aggregation of benefits and harms, differing patient preference, and uncertainty in the evidence base. Formal approaches, such as decision analytic models, facilitate the decision-making process in the presence of these complexities. However, these models are not widely used in practice as they are difficult to develop, computationally expensive, and opaque. An emulator, or metamodel, is a statistical approximation of a model and has been used in a range of disciplines to address complex problems. Although it has not been widely used in health, it may be a useful tool to facilitate complex decisions about health. The overall project objective is to develop a framework for facilitating the development, analysis and dissemination of computationally expensive decision models by means of emulators, and to apply the framework in a prostate cancer screening example. Specifically, the project aims to: (1) develop a framework for using emulators to facilitate the development and analysis of detailed models; (2) provide a proof of concept application of the framework using a comprehensive model for prostate cancer screening; (3) explore whether the use of emulators can facilitate tailoring models to new contexts, and building intuition about their behavior. The proposed work is significant because it may help mitigate the challenges (particularly relating to the computational burden) of implementing and disseminating decision models in practice. We will make an easy- to-use and easy-to-tailor implementation of a well-developed and validated prostate cancer screening model. We anticipate the results of this work may encourage and enable future research and applications in this field.