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Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
Liver Transplantation in U.S, Scenario Evaluation
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Liver Transplantation in U.S, Scenario Evaluation

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How we balance efficieny and equity in liver transplantation

How we balance efficieny and equity in liver transplantation

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    • 1. Policy Selection for Balancing Efficiency and Equity in US Liver Transplantation - An AHP Approach Thesis Proposal Vijay M. Veerachandran [email_address] Dr.Nan Kong, Chair Committee members: Dr. José Zayas-Castro Dr. Kingsley Reeves Department of Industrial and Management Systems Engineering College of Engineering University of South Florida
    • 2. Outline
      • Introduction
      • Problem Definition
        • Motivation
        • Issues
      • Research Questions
      • Methodology
        • Multi-criteria decision methodology
        • Analytic Hierarchy Process
    • 3. Outline (contd.)
      • Literature Review
        • AHP application
        • Selection
        • AHP applications in Health-Care
      • Clinical Data Analysis
      • Simulation Model Validation
      • Research Progress
    • 4. Introduction
      • ESLD 12th leading cause of death in US
      • Liver transplantation is the only viable therapy
      • Limited by the availability of organs
      • Liver is a scarce life saving resource
      • High failure rate ~ 45%
      • More than 50,000 people in waiting list at any given time
    • 5. History
      • National Organ Transplant Act, (1984)
        • Aim: efficient and equitable distribution
      • United Network for Organ Sharing (UNOS)
        • Allocation, Procurement and Transportation of human organs
    • 6. Current Allocation Model
    • 7. Efficiency Issues
      • Selection of sickest patients
        • Is it best use of scarce resource?
      • Selection of longest waiting patient
        • Is it a good approach?
      • MELD score
        • How good is it?
      • Efficiency Approach
        • Is it fair?
      • How equitable is the current system
    • 8. Equity Issues
      • Where you Live = Whether you live
      • Geography based allocation
        • Is it Justified?
        • 31 Days – 207 Days
      • Blood Group
        • Type O - 1243 Days
        • Type AB – 210 Days
      • Hispanics, Asians and African Americans waiting time twice -> White Americans
    • 9. Efficiency & Equity
      • No consensus
      • Conflict between equity and efficiency
        • Improve efficiency while increasing health inequalities
        • Improve fairness while decreasing efficiency.
      • leads to inconsistent judgments
    • 10. Efficiency & Equity (Contd.)
      • “ In some areas of our nation patients wait five times longer or more for an organ than in other areas. Less visible but more important are the resulting inequities in who receives organs. Where waiting times are shortest, organs may go to patients who are less ill; while at the same moment, in areas where patients wait longer, organs often are not offered to patients with greater medical need”- DHHS Secretary Donna Shalala
    • 11. Research Questions
      • Choosing a best policy among alternative policies
        • Set of outcomes
      • How do we balance among the set of conflicting efficiency outcomes?
      • How to balance efficiency and equity outcomes?
    • 12. Multi-Criteria Decision Analysis
      • What is it?
        • Helps make better decisions when faced with important, complex problems
        • Involving tradeoffs
    • 13. Features of MCDA
      • Facilitate Decision Makers
        • Problems faced
        • To guide decision makers to identify a preferred course of action
        • Personal, other parties and organizational priorities, values, and objectives
    • 14. MCDA Methodologies
      • Analytic Hierarchy Process
      • Delphi Method
      • Data Envelopment Analysis
      • Goal Programming
    • 15. MCDA Methodologies
      • Analytic Hierarchy Process
      • Delphi Method
      • Data Envelopment Analysis
      • Goal Programming
    • 16. Why Analytic Hierarchy Process
      • High acceptance within field
      • Pair-wise comparison
      • Checking quality of your decision
      • Simple evaluation & representation of the solutions
      • Tangible and Intangible criteria
      • Logic & clearing emotions
    • 17. AHP is based on three principles
      • Decomposition of decision problem
      • Comparative judgment of the elements
      • Synthesis of priorities
    • 18. Step 1 - Hierarchy
      • Structure the decision problem in hierarchy
    • 19. AHP: Illustrative example
      • Which fruit after lunch
        • Apple
        • Orange
        • Grape
    • 20. Hierarchy CRITERIA ALTERNATIVES GOAL
    • 21. Step 2 - Comparison scale 9 Extremely Preferable,Important or Likely 8 7 Very strongly Preferable,Important or Likely 6 5 Strongly Preferable,Important or Likely 4 3 Moderately Preferable,Important or Likely 2 1 Equally Preferable,Important or Likely
    • 22. Pairwise Comparison among Evaluation Criteria 0.2129 1 0.166667 7 0.3333 Seediness 0.4371 6 1 8 1 Appearance 0.1851 0.142857 0.125 1 7 Quality 0.1647 3 1 0.1428 1 Color Weights Seediness Appearance Quality Color CRITERION 
    • 23. Pairwise Comparison of Color among Alternatives 0.692308 1 9.00001 3 Grapes 0.076923 0.111111 1 0.333333 Orange 0.230769 0.333333 3 1 Apple Weights Grapes Orange Apple ALTERNATIVE
    • 24. Step 3 - Synthesis Priority
      • Synthesis Comparison
        • Prioritize alternatives with respect to criterions
        • Weights Criterions with respect to goals
      • Priorities × Weights of Criteria
      • Sum up results to get overall priority
    • 25. Global Evaluation 0.178178 0.737498 0.142857 0.692308 Grapes 0.751405 0.0852256 0.714286 0.076923 Orange 0.0704176 0.177276 0.142857 0.230769 Apple 0.212907 0.437111 0.185184 0.164798 Weights Seediness Appearance Quality Color Evaluation
    • 26. Results 0.50084 0.037935 0.3223684 0.0264 0.114090 Grapes 0.34218 0.159979 0.037253 0.1322 0.012676 Orange 0.15696 0.014992 0.0774892 0.0264 0.038030 Apple Results Seediness Appearance Quality Color SUM PRODUCT
    • 27. Fruit Selection
    • 28. Literature Review - AHP Themes
    • 29. Literature Review – AHP Application Areas
    • 30. Previous Studies
      • Decision Counseling for men considering prostate cancer (Liberatore et al. 2003)
      • Normative and prescriptive criteria: The efficacy of organ transplantation allocation protocols (Koch 1996)
      • Geographic Favoritism in Liver Transplantation - Unfortunate or Unfair? (Ubel 1996)
      • Equitable allocation of livers for orthotopic transplantation: an application of the Analytic Hierarchy Process. (Cook et al. 1990)
    • 31. Model: Transplantation Outcomes     ALLOCATION TYPE- LOCAL/REGIONAL/NATIONAL/FOREIGN 12 RECIPIENT DAYS BETWEEN PREVIOUS AND CURRENT TRANSPLANT 11 RECIPIENT LENGTH OF STAY FROM TRANSPLANT TO DISCHARGE 10 AGE IN YEARS AT TIME OF LISTING 9 MELD SCORE 8 DAYS ON LIVER WAITING LIST 7 COLD ISCHEMIC TIME (HOURS) 6 RECIPIENT DIED (1=DEAD,0=ALIVE) 5 STATE OF RESIDENCY @ REGISTRATION RECIPIENT LENGTH OF STAY POST TX 4 GENDER AGE IN YEARS AT TIME OF LISTING 3 ETHNICITY CATEGORY THE NUMBER OF PREVIOUS TRANSPLANTS 2 RACE AVERAGE COLD ISCHEMIC TIME (HOURS) 1 Equity Efficiency No
    • 32. Hierarchy Selection of best Policy Efficiency Equity Average MELD score No: Patients waiting list Average Waiting time Race Geography Asian Hispanic Afro-American Difference in Meld Score Difference in waiting time Gender Policy A Policy B Policy x
    • 33. Clinical Data Analysis
      • Source: United Network for Organ Sharing (UNOS)
      • Waiting list / transplant and follow-up UNOS Standard Transplant Analysis and Research (STAR)
      • Latest data - January 2006
      • 417 Fields for 142,873 transplants
    • 34. Clinical Data (Contd.)
      • Pre / Post transplant clinical information
      • Candidate information
      • Donor information
      • Waiting list data
        • Number of people
        • Number of days in waiting list
      • Organ Matching Information
    • 35. Simulation Model
      • Why Simulation Model?
        • Test the impact of different allocation policies
      • Patient and Organ Generator
      • Matching Module
      • Disease progression module
      • Output
        • Patient survival
        • Number of wasted organs
    • 36. Simulated allocation Modeling
    • 37. Research Progress
      • Identify and classify outcomes (Done)
      • Expert opinion about the outcomes (Done)
        • Efficiency
        • Equity
      • Identify a policy or set of policies from the outcomes based on expert suggestions (Nearly Done)
      • Simulation validation for set of outputs
      • Pair-wise comparison to prioritize the attributes based on the outcomes
      • Suggest recommendations leading to policy selection
      • Experts are Medical Doctors, Surgeons, Transplant Decision Makers, UNOS Members
    • 38. Thanks !!!
    • 39. Questions ?
    • 40. Additional Slides
      • Why AHP?
      • Liver Transplantation
        • Schematic Diagram
      • Literature Review
    • 41. Why Analytic Hierarchy Process
      • Comprehensive Logical and structured framework
      • Numerical scale for qualitative performances
      • Hierarchical structure
      • Pair-wise comparison
      • Incorporates knowledge and expertise
    • 42. Current Liver Allocation Policy
    • 43. Literature Review - AHP Themes

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