Application Case 6.7 Simulating Effects of Hepatitis B Interventions Although the United States has made significant built the new model using Microsoft Excel because investments in healthcare, some problems seem to it is user friendly. defy solution. For example, a sizable proportion of the Asian population in the United States is more prone than others to the Hepatitis B viral disease. Results/Benefits In addition to the social problems associated with The resultant model was analyzed vis--vis exist- the disease (like isolation), one out of every four ing control programs in both the United States and chronically infected individuals stands the risk of China. In the United States, four strategies were suffering from liver cancer or cirrhosis if the dis- developed and compared to the existing strategy ease is not treated effectively. Managing this disease the four strategies are could be very costly. There are a number of con- trol measures, including screening, vaccination, and 2. All individuals are vaccinated. treatment procedures. The government is reluctant b. Individuals are first screened to determine to spend money on any method of control if it is whether they have a chronic infection. If yes, not cost effective and there is no proof of increased then they are treated. health for people afflicted with the disease. Even Individuals are first screened to determine though not all the control measures are optimal whether they have a chronic infection. If they for all situations, the best method or combination have the infection, they are treated. In addi- of methods for combating the disease are not yet tion, dose associates of those infected are also known screened and vaccinated, if necessary d. Individuals are first screened to determine Methodology/Solution whether they have a chronic infection or need 4 vaccination. If they are infected, they are A multidisciplinary team consisting of those with treated if they need a vaccination, they are medical management science, and engineering vaccinated backgrounds developed a mathematical model using operations research (OR) methods that deter Results of the simulations indicated that per mined the right combination of control measures forming sood tests to determine chronie infection to be used to combat Hepatitis B in the sanddienssociates of infected people are Pacific Island populations elative + are used in the medical field Page 381 hinih model helped design a catch course of action in disease rate on picy for children and adolescents 515 not cost effective and there is no proof of increased then they are treated. health for people afflicted with the disease. Even c. Individuals are first screened to determine though not all the control measures are optimal whether they have a chronic infection. If they for all situations, the best method or combination have the infection, they are treated. In addi- of methods for combating the disease are not yet tion, close associates of those infected are also known screened and vaccinated, if necessary. d. Individuals are first screened to determine Methodology/Solution whether they have a chronic infection or need A multidisciplinary team consisting of those with a vaccination. If they are infected, they are medical, management science, and engineering treated. If they need a vaccination, they are backgrounds developed a mathematical model vaccinated using operations research (OR) methods that deter Results of the simulations indicated that per- mined the right combination of control measures forming blood tests to determine chronic infection to be used to combat Hepatitis B in the Asian and and vaccinating associates of infected people are Pacific Island populations. Normally, clinical trials cost effective are used in the medical field to determine the best in China, the model helped design a catch- course of action in disease treatment and preven- up vaccination policy for children and adolescents. tion, Complicating this situation is the unusually This catch-up policy was compared with current long period of time it takes Hepatitis B to progress coverage levels of Hepatitis B vaccination. It was Because of the high cost that would accompany concluded that when individuals under the age of clinical trials in this situation, OR models and meth 19 years are vaccinated, the health outcomes are ods were used. A combination of Markov and deci improved in the long run. In fact, this policy was sion models offered a more cost-effective way for more financially cost effective than the current determining what combination of control me Sures disease control policy in place at the time of the to use at any point in time. The decision model evaluation helps measure the economic and health benefits of the various possibilities of screening treatment, and vaccination. The Markov model was used to model QUESTIONS FOR DISCUSSION the progression of Hepatitis B. The new model was 1 Explain the advantage of OR methods such created based on past literature and expertise from as simulation over clinical trial methods in one of the researchers and drawn from actual cur determining the best control measure for rent infection and treatment data Policy makers Hepatitis B. (Context SE POL