INTEGRACION DE LOS MODELOS DE SIMULACION EN EL DISEÑO DE LOS ENSAYOS CLINICOS

Autor: ABBAS ISMAIL
Año: 2003
Universidad: POLITECNICA DE CATALUÑA
Centro de realización: ESTADÍSTICA I INVESTIGACIÓ OPERATIVA
Centro de lectura: UPC
Director: CASANOVAS GARCIA JOSEP
Tribunal: BARCELO BUGEDA JAIME , ANTOÑANZAS VILLAR FERNANDO , CANELA SOLER JAUME , OCAÑA REBULL JORDI , COBO VALERI ERIK
Resumen de la tesis

Clinical trials are frequently very expensive and can last quite long. An error in the design of a clinical trial can imply the impossibility of confirming the hypothesis because of the fact results are lacking in statistical significance. This will mean to incur losses in resources and a delay in the introduction of the new pharmaceutical product into the market. In this thesis the clinical trial design is conceived as an economic optimisation problem. The concrete optimisation criterion might depend on the approach and the decision context. From the market point of view that seeks maximising benefits, clinical trials can be seen as an investment with relatively predictable costs but a much more uncertain future benefits. Objectives and hypothesis of this thesis The main objective of this work is analysing and developing simulation models for the optimisation of clinical trial design. We have thus developed different computer-assisted stochastic models structures which allow conveniently to represent the clinical trial and simulate the results with alternative designs and hypothesis before carrying it out. The ultimate goal is determining which design optimises cost and clinical trial duration, by analysing hypothetical results before they are actually put into practice. The hypothesis wanted to be proved is that the development and application of the proposed simulation models allow more efficiently achieve the objectives formulated in a clinical trial, i.e. to obtain the sought results with a given success probability –what, as far as new pharmaceutical products is concerned, is a necessary condition before their commercialisation– with optimal cost and time span. Method The general conceptual model to optimise a clinical trial we proposes in this thesis consists in two sub-models: a recruitment of patients and treatment assignment sub-model and a follow-up sub-model, which describes the evolution of the clinical trial process and end-point variable or variables. The validation of the conceptual model is interdisciplinary and it is necessary to verify that the objectives and the hypothesis to correspond closely to those established in the protocol. Research results The results of this thesis have been applied to a clinical trial of lipodystrophy in the antrretroviral treatment (ARV). It has been build up, validated and selected a statistic model which results adjust as good as possible to the results of clinical trial of lipodystrophy. Afterwards, this same model is applied for the design optimisation of a future clinical trial. Discussion and future research The review of literature has allowed us to realise that most of the approaches applied nowadays to the design of clinical trials, including those that use simulation models, do not take into account the relevant aspects for the optimisation of the design altogether. What this thesis suggests precisely as main contribution is integrating all these aspects in a general simulation model for the design optimisation of a clinical trial according to explicit criteria and assumptions. This approach allows developing a general model of optimisation where the optimal design is seen in terms of maximisation of the expected net benefit. According to the sponsor, the benefits would be: the economic benefit, or the benefits to health, which could, eventually, be expressed in monetary units based on the willingness to pay method or other usual economic evaluation methods.
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