Constrained Optimization Methods in Health Services Research—An Introduction: Report 1 of the ISPOR Optimization Methods Emerging Good Practices Task Force

Abstract

Providing health services with the greatest possible value to patients and society given the constraints imposed by patient characteristics, health care system characteristics, budgets, and so forth relies heavily on the design of structures and processes. Such problems are complex and require a rigorous and systematic approach to identify the best solution. Constrained optimization is a set of methods designed to identify efficiently and systematically the best solution (the optimal solution) to a problem characterized by a number of potential solutions in the presence of identified constraints. This report identifies 1) key concepts and the main steps in building an optimization model; 2) the types of problems for which optimal solutions can be determined in real-world health applications; and 3) the appropriate optimization methods for these problems. We first present a simple graphical model based on the treatment of "regular" and "severe" patients, which maximizes the overall health benefit subject to time and budget constraints. We then relate it back to how optimization is relevant in health services research for addressing present day challenges. We also explain how these mathematical optimization methods relate to simulation methods, to standard health economic analysis techniques, and to the emergent fields of analytics and machine learning.

Constrained Optimization for the Selection of Influenza Vaccines to Maximize the Population Benefit: A Demonstration Project

“…The PMMFV, using an optimization heuristic, identifies the most cost-efficient strategy across different age groups to maximize a preselected beneficial outcome cumulative over a finite time horizon. It applies CO methods that are underutilized in health economics to inform healthcare decision making [31,32]. The approach links budget allocation to an overall health gain for the population that should be maximized by proposing the best combination of interventions.…”

How to assess for the full economic value of vaccines? From past to present, drawing lessons for the future

“…In CO, different interventions such as vaccination and screening, or vaccination and vector control, are evaluated in combination rather than against each other as in CEA [40][41][42]. Optimisation calculations link the constrained budget and the outcome to be maximised into one analysis [43,77,78]. CO can also set public health goals to be reached within a certain time frame at the lowest possible budget.…”

Application of Constrained Optimization Methods in Health Services Research: Report 2 of the ISPOR Optimization Methods Emerging Good Practices Task Force

“…Health technology assessment using tools from constrained optimization methods is also gaining popularity [26]. We also encourage the readers to refer to the initial ISPOR Optimization Emerging Good Practices Task Force Report, which presented a more comprehensive overview of the different applications for which optimization techniques can be used [1].…”

“…The ISPOR Optimization Methods Emerging Good Practices Task Force provided an introduction to constrained optimization methods to solve important health policy and clinical problems in its first report [1]. The previous report outlined the relationship of constrained optimization methods relative to traditional health economic modeling and simulation models and identified some of the major variants of constrained optimization models, such as linear programming, dynamic programming, integer programming, and stochastic programming.…”

“…Interpret the optimal solution and use it for decision making Source: Crown et al [1], Table 3, p. 315.…”