A novel hybrid modeling approach for the evaluation of integrated care and economic outcome in heart failure treatment

Abstract

BackgroundDemographic changes, increased life expectancy and the associated rise in chronic diseases pose challenges to public health care systems. Optimized treatment methods and integrated concepts of care are potential solutions to overcome increasing financial burdens and improve quality of care. In this context modeling is a powerful tool to evaluate potential benefits of different treatment procedures on health outcomes as well as health care budgets. This work presents a novel modeling approach for simulating different treatment procedures of heart failure patients based on extensive data sets from outpatient and inpatient care.MethodsOur hybrid heart failure model is based on discrete event and agent based methodologies and facilitates the incorporation of different therapeutic procedures for outpatient and inpatient care on patient individual level. The state of health is modeled with the functional classification of the New York Heart Association (NYHA), strongly affecting discrete state transition probabilities alongside age and gender. Cooperation with Austrian health care and health insurance providers allowed the realization of a detailed model structure based on clinical data of more than 25,000 patients.ResultsSimulation results of conventional care and a telemonitoring program underline the unfavorable prognosis for heart failure and reveal the correlation of NYHA classes with health and economic outcomes. Average expenses for the treatment of NYHA class IV patients of €10,077 ± €165 were more than doubled compared to other classes. The selected use case of a telemonitoring program demonstrated potential cost savings within two years of application. NYHA classes II and III revealed most potential for additional treatment measures.ConclusionThe presented model allows performing extensive simulations of established treatment procedures for heart failure patients and evaluating new holistic methods of care and innovative study designs. This approach offers health care providers a unique, adaptable and comprehensive tool for decision making in the complex and socioeconomically challenging field of cardiovascular diseases.

Evolution of Hemodynamic Parameters Simulated by Means of Diffusion Models

“…Highly illustrative investigations were proposed by Lassnig at al. [8]. Other clinical prediction models (CPMs), also known as clinical prediction scores or rules, are used to estimate the risk of an existing disease (diagnostic prediction model) or future outcomes (prognostic prediction model) for a given individual and consist of analyzing the values of numerous predictors (prognostic or risk factors), such as age, sex, and biomarkers [9][10][11][12].…”

Digital twins and hybrid modelling for simulation of physiological variables and stroke risk

“…Furthermore, it is also important to be able to simulate on a both long and short timescale, since it is only via short-term simulations (days-months) that one can compare predictions with observed changes and thus gain more faith in the models, and since it is only via long-term simulations (years-decades) that risks are substantially altered. Finally, as mentioned in the introduction, there are some, but not many, hybrid models in biomedicine already available (20)(21)(22)(23)(24)(25)(26)(27), but no other model exists for multi-scale simulations of stroke risk.…”

“…drugs) (26). Within the field of cardiovascular diseases specifically, a hybrid model that combines a discrete model with an agent-based model has been used to simulate treatment procedures of heart failure and comparing both health outcomes and financial aspects (27). However, despite these many suggestions and first examples, and despite the importance of developing digital twins for stroke, no hybrid model underlying digital twins for stroke has yet been developed.…”

Assessing Patient Engagement in Health Care: Proposal for a Modeling and Simulation Framework for Behavioral Analysis

“…In the case of stroke care and within the context of precision medicine for stroke, a hybrid modeling approach has been shown to be the most beneficial [ 7 ]. The application of hybrid modeling has also been observed in the field of cardiovascular diseases; hybrid modeling approaches have been used to assess integrated care for challenging and complex diseases to offer comprehensive tools for decision-making [ 8 ].…”