中文摘要
药物经济学评价中将随机临床试验或短期随访结果外推到慢性疾病自然史的全过程，需要借助数学模型，传统的Markov模型是结果外推的常用方法。但传统Markov链是一种无后效性的离散性随机过程，模型中状态转移概率不能随时间的变化而变化，其模型假设会导致决策模型缺乏"表面效度"。此外，传统Markov模型用来校准模型的信息来自统计模型，这种"平均化"可能削弱实际病例中某些特定疾病的随机的或不确定的疾病特征，从而漏掉临床过程中的重要变化。基于传统Markov模型的以上两个问题，提出引入时间依存变量和个体模拟信息的Markov模型，以提高药物经济学评价结果指导临床实践的客观性。并将此改进的Markov模型运用到脑卒中二级预防的药物经济学评价中进行实证，采用自行设计的问卷调查随访新发卒中患者400例，采用改进的Markov决策模型比较不同二级预防方案的成本效果，目前尚未查到类似基于中国人群数据卒中二级预防决策研究，本研究可为今后疾病预防长期决策研究提供方法学参考。
英文摘要
When extrapolating beyond the evidence from randomized clinical trail or short-term data to the natural histories of chronic diseases, mathmatical models are essential and Markov models are often used for this extrapolation. Traditional Markov chain is a kind of discrete stochastic process, and Markov transition probabilities cannot be conditional of the time spent in a given state, the simple Markov assumption could lead to a loss in the model's "face validity". In addition, in traditional Markov model, the information used to calibrate these models comes from statistical models and this averaging tends to smooth the stochastic, sometimes erratic behavior of specific disease seen in actual patients. Thus important variation in clinical course might be missed. Based on the above-mentioned two reasons, this study would develop the Markov model incorporating time dependent variable and indivadual simulation information and it could enhance the reliability and validity of Pharmacoeconomic evaluations.In order to demonstrating its application on chronic diseases, the advance Markov model was designed to apply on pharmacoeconomic evaluation on secondary prevention of stroke.400 cases of first ever stroke were recruited and followed up two years. Self-designed questionnair was used to collect informations. Combined th
结题摘要
药物经济学评价中将随机临床试验或短期随访结果外推到慢性疾病自然史的全过程，需要借助数学模型，传统的Markov模型是结果外推的常用方法。但传统Markov链是一种无后效性的离散性随机过程，模型中状态转移概率不能随时间的变化而变化，其模型假设会导致决策模型缺乏"表面效度"。此外，传统Markov模型用来校准模型的信息来自统计模型，这种"平均化"可能削弱实际病例中某些特定疾病的随机的或不确定的疾病特征，从而漏掉临床过程中的重要变化。基于传统Markov模型的以上两个问题，提出引入时间依存变量和个体模拟信息的Markov模型，以提高药物经济学评价结果指导临床实践的客观性。并将此改进的Markov模型运用到脑卒中二级预防的药物经济学评价中进行实证，采用自行设计的问卷调查随访新发卒中患者400例，采用改进的Markov决策模型比较不同二级预防方案的成本效果，目前尚未查到类似基于中国人群数据卒中二级预防决策研究，本研究可为今后疾病预防长期决策研究提供方法学参考。