Therapy Simulation Models in
Ankit Dhaundiyal ,
M.S.(Pharm.) 3rd Semester,
Dept. of Pharmacoinformatics,
NIPER, S.A.S. Nagar, Punjab (160062)
• Brief Introduction of Pharmacy Informatics
• Use of Computers in simulating different pathological
states of human body
• Diabetes Treatment Simulation Model
• Virtual Reality Therapy
What is Pharmacy Informatics/Health Informatics ?
• Pharmacy informatics is the scientific field that
focuses on medication-related data and knowledge
within the continuum of healthcare systems -
including its acquisition, storage, analysis, use and
dissemination - in the delivery of optimal medication-
related patient care and health outcomes
(HIMSS October 2006)
• What is Health Informatics?
– A discipline at the intersection of information
science, computer science, and health care
– Is the interdisciplinary study of the design,
development, adoption and application of IT-based
innovations in healthcare services delivery,
management and planning.
– Deals with the resources, devices, and methods
required to optimize the acquisition, storage,
retrieval, and use of information in health and
• Applications of Health Informatics
– Translational Bioinformatics
– Clinical Research Informatics
– Clinical Informatics
– Consumer Health Informatics
– Public Health Informatics
• Health Informatics is, in part, a mathematics and
statistics-based approach to understanding health
What is a Model ?
• A model is a logical mathematical framework that
permits the integration of facts and values and that links
these data to outcomes that are of interest to health-care
• End result of a model is often an estimate of cost per
quality-adjusted life year (QALY) gained or other
measure of value for money.
Conditions for a Good Model
• Ability to reveal the logical connection between inputs
(i.e., data and assumptions) and outputs in the form of
valued consequences and costs
• should be transparent to the end user
Components of a Model
Model definition and evaluation
Between model validation
External and predictive validation
• Various Therapeutic Simulation Models
1. Diabetes mellitus
3. Radiation therapy simulation
4. Post traumatic disorder
Diabetes Treatment Simulation Model
• Assess alternative treatment intensification strategies on survival
and diabetes-related complications
• The objective of this analysis is to project the long-term impacts on
life expectancy and occurrence over 5, 10, and 40 years of
microvascular and macrovascular complications of diabetes.
• Different haemoglobin A1c (HbA1c) thresholds used for
intensifying treatment of type 2 diabetes.
• In the present analysis, the model is used to investigate the impact of
alternative HbA1c thresholds for treatment intensification ranging
from 7.0 to 9.0% .
• Model is run using 80 simulated patients for each of 1224 patient
profiles from the Real-Life effectiveness and Care Patterns of
Diabetes Management study (for a total of 97 920 simulated
patients) to project the number of patients who will experience
diabetes-related complications over time
• Enables health-care researchers, providers and decision makers to
project the long-term consequences of provider behaviours on
various diabetes related complications as well as patients’ quality of
life (QOL; quality-adjusted life years)
• Januvia Diabetes Economic (JADE) Model, to evaluate the effects of
using different HbA1c thresholds for intensifying pharmacotherapy
on long-term health outcomes in patients with type 2 diabetes.
• Model Structure of JADE :
The model builds on the landmark United Kingdom Prospective
Diabetes Study (UKPDS) Outcomes Model, incorporating its
integrated system of event risk equations and simulation
algorithm to predict the occurrence and timing of seven diabetes-
related complications and death.
Permits the calculation of cost-effectiveness interventions to help
determine cost-effective treatment strategies for patients with type
The JADE Model has been written using Microsoft Visual Basic
6.3 [Visual Basics for Applicants (VBA)] with Microsoft Office
JADE Model comprises five related modules :
Risk factor/adverse events
Diabetes-related events and
Initial Conditions :
• Purpose of the Initial Conditions module is to establish the
baseline profile for each patient whose life course with
diabetes will be simulated.
• Each profile contains information on the patient’s current
risk factor status, history of pre-existing diabetes-related
complications and current treatment regimen.
Treatment Module :
• Used to simulate the sequence of up to six treatment
regimens prescribed over a patient’s lifetime.
• Specific sequence or path a patient takes through the
treatment algorithm depends on the patient’s simulated
HbA1c response to, and toleration of, specific regimens and
the development of potential contraindications over time
Fig 1. Treatment pathways evaluated in the treatment-intensification example. Basal,
basal insulin; MDI, multiple-dose insulin; MF, metformin; Rosi, rosiglitazone; SU,
Fig 2. Structure of the Januvia Diabetes Economic Model. QOL, quality of life.
Risk Factor/Adverse Events Module
• When a patient initiates a new oral AHA or insulin
regimen, changes in HbA1c are assumed to follow
three stages over time:
a drop in HbA1c during the first cycle,
followed by a stable HbA1c period
then increases in HbA1c at a fixed rate over time.
• Other time-varying factors :
1. Total cholesterol (TC) to high-density lipoprotein
cholesterol (HDL) ratio,
2. Systolic blood pressure (SBP)
3. Body mass index
• Accumulates the costs, survival time and quality-
adjusted survival time for a patient.
• The user can specify whether diabetes-related
complications have either a short-term (single-cycle)
or long-term (lifetime) impact on the patient’s QOL.
• Method of psychotherapy that uses virtual
reality technology to treat patients with anxiety
disorders and phobias
Various Universities offering study
courses in Health informatics
• Principles of Good Practice for Decision Analytic Modeling in Health-Care Evaluation:
Report of the ISPOR Task Force on Good Research Practices—Modeling Studies Milton
C.Weinstein, PhD, Bernie O’Brien, PhD, John Hornberger, MD, MS, Joseph Jackson, PhD,
Volume 6 • Number 1 • 2003 VA L U E I N H E A LT H.
• THE USE OF COMPUTER SIMULATION IN HEALTH CARE FACILITY DESIGN O.
George Kennedy, Ph.D. Manager, Management Systems - Midwestern Region MEDICUS
• Development of a diabetes treatment simulation model: with application to assessing
alternative treatment intensification strategies on survival and diabetes-related complications
J. Chen,1 E. Alemao,2 D. Yin2 and J. Cook Diabetes, Obesity and Metabolism, 10 (Suppl. 1),