Quantitative Modeling Software with Applications to Medical Decision Making - Project Summary/Abstract
In recent years, health care systems and physicians have made concerted efforts to practice evidence-based
medicine and provide patients with the best available information when making choices about their medical
care. However, medical decisions are often complex with many uncertainties and potential outcomes to
consider, some beneficial and some adverse. A popular analytic method used to help identify best treatment
strategies while accounting for uncertainty is decision analysis, which typically involves computer modeling of a
treatment choice outlined in the form of a decision tree, which shows options and health outcomes that may
occur as a result of the choice made. Complex decision trees are evaluated via Monte Carlo microsimulation to
allow for variability in individual patient characteristics and trace a patient’s path through the tree; when the
microsimulation is repeated many times to simulate many individuals, it provides the probability of each
potential outcome resulting from the initial decision. From this probability distribution, quantitative measures
associated with each decision can be calculated such as life years, quality-adjusted life years (a generic
measure of disease burden), and others; furthermore, when costs are also incorporated, cost-effectiveness
analysis (CEA) can be performed to compute the incremental cost-effectiveness of each option. In this
proposal, we describe plans to add functionality to the mathematical modeling software Berkeley Madonna to
allow users to build decision trees and carry out Monte Carlo microsimulations and Markov cohort analysis.
Berkeley Madonna’s interface was designed to make mathematical modeling quick and easy for non-technical
users by using a simple syntax and graphical images to construct sophisticated differential equations. We will
leverage this easy-to-use interface to enable medical researchers to perform microsimulation with software that
is more user-friendly, transparent, powerful, and affordable than currently available options. In Aim 1, we
propose further development of our decision analysis user interface that allows users to graphically construct
decision trees and perform microsimulations. In this aim, in addition to optimizing tools and features for the
GUI, we will add CEA output reports and graphics, sensitivity analysis capabilities, and Markov cohort analysis
capabilities. We will create tutorials and a user guide as well as ready-made templates that provide users a
jumping off point for quickly making their own models. In Aim 2, we propose to optimize code for performance
on single CPUs, multiple CPUs, and GPUs. Analysis speed is important because large, complex models can
take weeks to months to run with currently available software, none of which harness the power of GPU
technology; successful completion of this aim would make Berkeley Madonna the fastest available software by
far for performing decision analysis microsimulations. Finally, we will carry out extensive beta testing.
Achievement of these goals will provide an easy-to-use, transparent, powerful, and affordable tool to
biomedical researchers, educators, and professionals, and positively impact scientific discovery.
