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Nos visita Natalia Yankovic, IESE Business School

Natalia Yankovic  es Profesora de Dirección de Producción, Tecnología y Operaciones , IESE Business School  (Ingeniero Civil Industrial, generación 2000),  y dictó  la charla, ” Age Dependent Optimal Policies for Hepatitis C Virus Treatment” (*) .  Estoen el marco del ciclo de Seminarios “Management Science”, organizados por Ingeniería Industrial y el  Instituto de Sistemas Complejos de Ingeniería (ISCI).

Estos seminarios  convocan charlas de distinguidos académicos nacionales y extranjeros en temas de investigación en áreas afines a gestión, incluyendo Gestión de Operaciones, Investigación Operativa, Marketing, Tecnología de Información, Economía Conductual, entre otros y están dirigidos a academices, post-docs, alumnos de post-grado y alumnos de pre-grado que trabajen en investigación.

Para participar debe inscribirse con anticipación en:  https://docs.google.com/spreadsheets/d/173FimniFWIuRXGwDvLVD9EMMrQehrWvBp8DncJd5k4c/edit?usp=sharin


* Abstract:

In recent years, new and highly effective treatments for the hepatitis C virus (HCV) have become available. However, the high price of new treatments calls for a careful evaluation, especially considering the economic constraints that most health care systems are facing.

The available methodologies for performing cost-effectiveness analyses are based on Markov models and fail to incorporate the dynamic nature of these decisions: physicians can (and actually do) revisit the drug administration considering the evolution of the disease for each patient. We use a dynamic programming model to include age-dependent transitions (age-dependent probability of natural death and a threshold limit for accessing liver transplant) and the possibility of delaying the decision to administer the new drug explicitly.

We show that, in a simplified version of the model, new drugs should be administered to patients at a given level of fibrosis if they are within pre-specified age limits. Otherwise, a conservative approach of closely monitoring the evolution of the patient should be followed. We construct an age-dependent cohort of patients to check the results in terms of expected outcomes and costs of the optimal and heuristic policies against the policy followed by the Spanish government. With the proposed policies, we achieve similar performance in terms of number of transplants, HCV-related deaths and QALYs with less overall expenditure. Additionally, the use of these resources are spreader out over time, when compared to those required in policies that do not consider revisiting the decision.

The contribution of this work is the novel application of a well-established methodology that provides an age- and health-dependent policy. The proposed policy is in line with the current medical practice of closely monitoring HCV patients, and it makes the introduction of disruptive drugs easier to finance.