Bayesian Methods for Calibrating Health Policy Models: A Tutorial

Mathematical simulation models are commonly used to inform health policy decisions. These health policy models represent the social and biological mechanisms that determine health and economic outcomes, combine multiple sources of evidence about how policy alternatives will impact those outcomes, and synthesize outcomes into summary measures salient for the policy decision. Calibrating these health policy models to fit empirical data can provide face validity and improve the quality of model predictions. Bayesian methods provide powerful tools for model calibration. These methods summarize information relevant to a particular policy decision into (1) prior distributions for model parameters, (2) structural assumptions of the model, and (3) a likelihood function created from the calibration data, combining these different sources of evidence via Bayes’ theorem. This article provides a tutorial on Bayesian approaches for model calibration, describing the theoretical basis for Bayesian calibration approaches as well as pragmatic considerations that arise in the tasks of creating calibration targets, estimating the posterior distribution, and obtaining results to inform the policy decision. These considerations, as well as the specific steps for implementing the calibration, are described in the context of an extended worked example about the policy choice to provide (or not provide) treatment for a hypothetical infectious disease. Given the many simplifications and subjective decisions required to create prior distributions, model structure, and likelihood, calibration should be considered an exercise in creating a reasonable model that produces valid evidence for policy, rather than as a technique for identifying a unique theoretically optimal summary of the evidence.

[1]  N. Grassly,et al.  Improving projections at the country level: the UNAIDS Estimation and Projection Package 2005 , 2006, Sexually Transmitted Infections.

[2]  B. Carlin,et al.  Markov Chain Monte Carlo conver-gence diagnostics: a comparative review , 1996 .

[3]  Andrew Thomas,et al.  WinBUGS - A Bayesian modelling framework: Concepts, structure, and extensibility , 2000, Stat. Comput..

[4]  B. D. Finetti La prévision : ses lois logiques, ses sources subjectives , 1937 .

[5]  Cosma Rohilla Shalizi,et al.  Philosophy and the practice of Bayesian statistics. , 2010, The British journal of mathematical and statistical psychology.

[6]  Eva A Enns,et al.  Identifying Best-Fitting Inputs in Health-Economic Model Calibration , 2015, Medical decision making : an international journal of the Society for Medical Decision Making.

[7]  Nicky J Welton,et al.  Multiparameter evidence synthesis in epidemiology and medical decision-making , 2008, Journal of health services research & policy.

[8]  Jon C. Helton,et al.  An Approach to Sensitivity Analysis of Computer Models: Part II - Ranking of Input Variables, Response Surface Validation, Distribution Effect and Technique Synopsis , 1981 .

[9]  Oguzhan Alagoz,et al.  Using Active Learning for Speeding up Calibration in Simulation Models , 2016, Medical decision making : an international journal of the Society for Medical Decision Making.

[10]  Jonathan Karnon,et al.  Model Parameter Estimation and Uncertainty Analysis , 2012, Medical decision making : an international journal of the Society for Medical Decision Making.

[11]  Adrian E Raftery,et al.  Estimating and Projecting Trends in HIV/AIDS Generalized Epidemics Using Incremental Mixture Importance Sampling , 2010, Biometrics.

[12]  Leslie A. Real,et al.  Monte Carlo assessments of goodness-of-fit for ecological simulation models , 2003 .

[13]  M. Sculpher,et al.  Bayesian methods for evidence synthesis in cost-effectiveness analysis , 2012, PharmacoEconomics.

[14]  H. Raiffa,et al.  Applied Statistical Decision Theory. , 1961 .

[15]  M. Weinstein,et al.  Recommendations of the Panel on Cost-effectiveness in Health and Medicine , 1997 .

[16]  Cathal Walsh,et al.  Bayesian Calibration of a Natural History Model with Application to a Population Model for Colorectal Cancer , 2011, Medical decision making : an international journal of the Society for Medical Decision Making.

[17]  G Scott Gazelle,et al.  Calibration of disease simulation model using an engineering approach. , 2009, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[18]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[19]  Jiqiang Guo,et al.  Stan: A Probabilistic Programming Language. , 2017, Journal of statistical software.

[20]  Curtis B. Storlie,et al.  A frequentist approach to computer model calibration , 2014, 1411.4723.

[21]  Natasha K. Stout,et al.  Calibration Methods Used in Cancer Simulation Models and Suggested Reporting Guidelines , 2012, PharmacoEconomics.

[22]  D. Balding,et al.  Approximate Bayesian computation in population genetics. , 2002, Genetics.

[23]  A H Briggs,et al.  A Bayesian approach to stochastic cost-effectiveness analysis. , 1999, Health economics.

[24]  Howard Raiffa,et al.  Applied Statistical Decision Theory. , 1961 .

[25]  K R Abrams,et al.  Bayesian methods in meta-analysis and evidence synthesis. , 2001, Statistical methods in medical research.

[26]  D. Rubin Using the SIR algorithm to simulate posterior distributions , 1988 .

[27]  Andrew Gelman,et al.  General methods for monitoring convergence of iterative simulations , 1998 .

[28]  Carolyn M Rutter,et al.  An Evidence-Based Microsimulation Model for Colorectal Cancer: Validation and Application , 2010, Cancer Epidemiology, Biomarkers & Prevention.

[29]  Andrew Briggs,et al.  Cost-effectiveness acceptability curves--facts, fallacies and frequently asked questions. , 2004, Health economics.

[30]  Harry J de Koning,et al.  Calibrating Parameters for Microsimulation Disease Models , 2016, Medical decision making : an international journal of the Society for Medical Decision Making.

[31]  Jakub Szymanik,et al.  Methods Results & Discussion , 2007 .

[32]  Mark Jit,et al.  Calibration of Complex Models through Bayesian Evidence Synthesis , 2015, Medical decision making : an international journal of the Society for Medical Decision Making.

[33]  Richard G. White,et al.  Calibrating Models in Economic Evaluation , 2012, PharmacoEconomics.

[34]  Jukka Corander,et al.  Approximate Bayesian Computation , 2013, PLoS Comput. Biol..

[35]  T. Trikalinos,et al.  Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine. , 2016, JAMA.

[36]  L. Meyers,et al.  Probabilistic uncertainty analysis of epidemiological modeling to guide public health intervention policy. , 2014, Epidemics.

[37]  F. Ramsey Truth and Probability , 2016 .

[38]  Xiao-Li Meng,et al.  POSTERIOR PREDICTIVE ASSESSMENT OF MODEL FITNESS VIA REALIZED DISCREPANCIES , 1996 .

[39]  N. Welton,et al.  Estimation of Markov Chain Transition Probabilities and Rates from Fully and Partially Observed Data: Uncertainty Propagation, Evidence Synthesis, and Model Calibration , 2005, Medical decision making : an international journal of the Society for Medical Decision Making.

[40]  Andrew Gelman,et al.  Exploratory Data Analysis for Complex Models , 2004 .

[41]  James E. Campbell,et al.  An Approach to Sensitivity Analysis of Computer Models: Part I—Introduction, Input Variable Selection and Preliminary Variable Assessment , 1981 .

[42]  J. Savarino,et al.  Bayesian Calibration of Microsimulation Models , 2009, Journal of the American Statistical Association.

[43]  S. Zeger,et al.  Latent Class Model Diagnosis , 2000, Biometrics.