Antimicrobial Treatment of Mild Mycobacterium Avium Complex-pulmonary Disease Predicted to Increase Survival and Quality Adjusted Life Years: A Microsimulation Decision Analysis Model
Bibliographic record
Abstract
Abstract RATIONALE: Treatment for Mycobacterium avium complex-pulmonary disease (MAC-PD) requires many months of multiple antibiotics, which carry with them the risk for drug toxicity. For patients with mild MAC-PD, it is challenging to decide whether to pursue treatment or active observation. We conducted a patient-centered microsimulation to compare the quality adjusted life years (QALY) and life expectancy associated with treatment or observation. METHODS: We simulated 10,000 individuals using monthly cycles, with the base case of a 65-year-old Canadian individual with macrolide-susceptible nodular-bronchiectatic MAC-PD with preserved lung function, following individuals for 40 years. Individuals started in either the observation or treatment state and followed attached diagram. Treatment followed the ATS/IDSA/ERS/ESCMID guidelines and was continued between 13-24 months depending on when culture conversion occurred. Treatment toxicity was simulated as a transient decrease in utility based on common toxicities associated with each medication. Model outcomes were QALY and life-expectancy. Probabilities and utilities were obtained from the literature. The hazard ratio of early culture conversion (≤3 months’ treatment) arose from Samsung Medical Center data. Deterministic sensitivity analyses were performed on each variable by varying across likely ranges, and five two-way sensitivity analyses were carried out based on clinical relevance. A probabilistic sensitivity analysis was done by simulating 1000 parameter values from each parent distribution and measuring mean and 95% credible interval (CrI). RESULTS: In the base case, utility was greater in the treatment than with observation, with 16.2 QALYs in treatment as compared to 14.5 with observation. Similarly, life-expectancy was 22.4 years in treatment and 19.9 with observation. Treatment was superior to observation in all deterministic one-way or two-way analyses when measuring utilities. Life-expectancy was greater with treatment than observation in all scenarios except for when the hazard ratio of early culture conversion was 1, in which case observation was superior. In the probabilistic sensitivity analysis, treatment led to greater utility with mean 15.3 QALYs (95% CrI 8.33-18.9) compared to 13.9 QALYs with observation (95% CrI 8.66-17.2). Life expectancy was also greater with treatment (21.1 years, 95% CrI 18.1-24.4) compared to observation (19.3 years, 95% CrI 17.2-21.8). CONCLUSION: In microsimulation, treatment for MAC-PD leads to prolonged survival with greater expected utility. Findings were robust across multiple sensitivity analyses. Our findings can help guide patients and clinicians in deciding on potential treatment options.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".