Quantitative Framework

BLRA (Benefit-Less-Risk Analysis)


1.Description

BLRA deals with multiple criteria decision problems using individual-level data. It organises observed adverse events into body functions for BR assessment. Benefits and risks are balanced by a defined proportionality constant f in the benefit-less-risk expression ∑"benefits"-f×∑"risks" .

2. Evaluation

2.1 Principle
  • The BLRA framework helps to increase transparency in decision-making through a seven-step process:
  • It requires estimates of the transition probabilities associated with each option.
  • MDP may be applicable to all medical decision problems due to its dynamic nature.

2.2 Feature
  • MDP allows multiple criteria and multiple options.
  • Multiple criteria may make the structure of MDP very complicated.
  • The application of MDP relies on the availability of transition probabilities between states within the model.
  • MDP allows the benefit and risk status to change with time, but it may be challenging to obtain the transition probabilities data.

2.3 Visualisation

The main visualisations for MDP are:
  • Network diagram

2.4 Assesability and accessibility
  • Stakeholders may include their value preferences at each stage in the model.
  • Understanding of the model may require extensive mathematical knowledge.
  • MDP may be suitable for post-market decision based on long-term data.
  • MDP may also be suitable to model the possible outcomes of patient's decision to undergo a certain therapy considering all the possibilities and consequences.
  • It is often very difficult to clearly define health states which are central to the application of MDP.
  • MDP is often modelled using software with programming language:
Matlab (http://www.mathworks.co.uk/products/matlab)
R (http://www.r-project.org).
  • A specialist software for modelling simpler MDP models is:
Treeage (http://www.treeage.com)

3.References

[1]Sonnenberg FA, Beck JR. Markov models in medical decision making: a practical guide. Med Decis Making 1993 Oct;13(4):322-38.
[2]Thompson JP, Noyes K, Dorsey ER, Schwid SR, Holloway RG. Quantitative risk-benefit analysis of natalizumab. Neurology 2008 Jul 29;71(5):357-64.