Designing Risk‐Adjusted Therapy for Patients with Hypertension. Issue 12 (23rd April 2018)

• Record Type: Journal Article
• Authors: Zargoush, Manaf; Gümüş, Mehmet; Verter, Vedat; Daskalopoulou, Stella S.
• Other Names: Bretthauer Kurt M. guestEditor.; Savin Sergei guestEditor.
• Is Part Of: Production and operations management. Volume 27:Issue 12(2018)
• Page Start: 2291
• Page End: 2312
• Publication Date: 2018-04-23
• Subjects: hypertension treatment -- personalized healthcare -- medical decision making -- Markov Decision Processes -- threshold policy; Production management -- Periodicals; 658.505
• DOI: 10.1111/poms.12872
• Languages: English
• ISSNs: 1059-1478

Abstract

Abstract : Limited guidance is available for providing patient‐specific care to hypertensive patients, although this chronic condition is the leading risk factor for cardiovascular diseases. To address this issue, we develop an analytical model that takes into account the most relevant risk factors including age, sex, blood pressure, diabetes status, smoking habits, and blood cholesterol. Using the Markov Decision Process framework, we develop a model to maximize expected quality‐adjusted life years, as well as characterize the optimal sequence and combination of antihypertensive medications. Assuming the physician uses the standard medication dose for each drug, and the patient fully adheres to the prescribed treatment regimen, we prove that optimal treatment policies exhibit a threshold structure. Our findings indicate that our recommended thresholds vary by age and other patient characteristics, for example (1) the optimal thresholds for all medication prescription are nonincreasing in age, and (2) the medications need to be prescribed at lower thresholds for males who smoke than for males who have diabetes. The improvements in quality‐adjusted life years associated with our model compare favorably with those obtained by following the British Hypertension Society's guideline, and the gains increase with the severity of risk factors. For instance, in both genders (although at different rates), diabetic patients gain more than non‐diabetic patients. Our sensitivity analysis results indicate that the optimal thresholds decrease if the medications have lower side‐effects and vice versa.