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Partially specified beliefs and imprecisely specified utilities in health technology assessment Malcolm Farrow and Kevin Wilson Newcastle University September 2016 Outline 1. Motivation: Expert opinion in health technology assessment. 2.


  1. Bayesian Experimental Design Example: Life testing Having seen the data X we make a terminal decision D Y about treating future components (choose d Y ). ◮ Outcomes Y — distribution depends on d Y and on unknown θ . ◮ Various pay-offs C Y — eg financial, effects of failures — depend on d Y and Y . ◮ Discount outcomes further into the future. ◮ Overall utility U = U ( C X , C Y ) depends on C X and on C Y .

  2. Bayesian Experimental Design ◮ After observing data, choose d Y = arg max [ E d Y { U ( C X , C Y ) } ] = arg max [ U ( d Y ; C X , C Y )]. d Y ∈ D Y d Y ∈ D Y

  3. Bayesian Experimental Design ◮ After observing data, choose d Y = arg max [ E d Y { U ( C X , C Y ) } ] = arg max [ U ( d Y ; C X , C Y )]. d Y ∈ D Y d Y ∈ D Y ◮ Expected utility at this stage is max [ U ( d Y ; C X , C Y )]. d Y ∈ D Y

  4. Bayesian Experimental Design ◮ After observing data, choose d Y = arg max [ E d Y { U ( C X , C Y ) } ] = arg max [ U ( d Y ; C X , C Y )]. d Y ∈ D Y d Y ∈ D Y ◮ Expected utility at this stage is max [ U ( d Y ; C X , C Y )]. d Y ∈ D Y ◮ Before observing data, choose design d X = arg max { max [ U ( d Y ; C X , C Y )] } . d Y ∈ D Y d X ∈ D X

  5. Example: Renewals experiment ◮ We wish to choose an age replacement policy. That is we wish to choose the age at which items (machines/components/whatever) should be replaced. ◮ Experiment: life testing of items. ◮ Design choice: number to test, censoring time(s).

  6. Renewals experiment utility hierarchy Overall U � ✒ ❅ ■ � ❅ � ❅ Experiment E Future F ✻ ✻ ✕ ✁ ✻ ❑ ❆ ✁ ❆ ✁ ❆ E 1 E 2 Service S Planned P Downtime D

  7. Structure: Utility Hierarchy ◮ Utility hierarchy

  8. Structure: Utility Hierarchy ◮ Utility hierarchy ◮ At each node we have mutual utility independence over parents.

  9. Structure: Utility Hierarchy ◮ Utility hierarchy ◮ At each node we have mutual utility independence over parents. ◮ This allows a finite parameterisation of the combined utility function.

  10. Structure: Utility Hierarchy ◮ Utility hierarchy ◮ At each node we have mutual utility independence over parents. ◮ This allows a finite parameterisation of the combined utility function. ◮ All utilities are on a standard scale. ◮ Worst outcome considered: U = 0 . ◮ Best outcome considered: U = 1 . This allows us to interpret utilities and trade-offs at all nodes.

  11. Combining utilities at child nodes ◮ Additive node s � U = a i U i i =1 with � s i =1 a i ≡ 1 and a i > 0 for i = 1 , . . . , s . ◮ Binary node U = a 1 U 1 + a 2 U 2 + hU 1 U 2 where 0 < a i < 1 and − a i ≤ h ≤ 1 − a i , for i = 1 , 2 , and a 1 + a 2 + h ≡ 1 .

  12. Combining utilities at child nodes ◮ Multiplicative node � s � U = B − 1 � [1 + ka i U i ] − 1 i =1 with s � B = (1 + ka i ) − 1 i =1 a 1 ≡ 1 , k > − 1 and, for i = 1 , . . . , s , we have a i > 0 , ka i > − 1 .

  13. Imprecise Utility Tradeoffs Standard utility theory : The decision maker (DM) may state preferences between all combinations of outcomes.

  14. Imprecise Utility Tradeoffs Standard utility theory : The decision maker (DM) may state preferences between all combinations of outcomes. Imprecise utility : DM can state preferences for some, but not all, outcomes. Imprecise utility is defined by obeying all of the constraints implied by the stated preferences.

  15. Imprecise Utility Tradeoffs Standard utility theory : The decision maker (DM) may state preferences between all combinations of outcomes. Imprecise utility : DM can state preferences for some, but not all, outcomes. Imprecise utility is defined by obeying all of the constraints implied by the stated preferences. Imprecise utility tradeoffs : We suppose that DM can make preference statements over all outcomes of each individual attribute, and so may specify precise marginal utilities, but can only make preference statements for some, but not all, combinations of the various attributes. Each such preference statement imposes constraints on the tradeoff parameters which are used to combine the individual attributes into an imprecise multi-attribute utility.

  16. Elicitation and feasible set: Binary node 1.0 0.8 ( 2 ) φ n 0.6 a n2 ( 1 ) 0.4 φ n R n 0.2 ( 3 ) φ n 0.0 0.0 0.2 0.4 0.6 0.8 1.0 a n1

  17. Reducing the number of choices ◮ Pareto optimality

  18. Reducing the number of choices ◮ Pareto optimality ◮ Almost-preference leading to Almost-Pareto sets .

  19. Reducing the number of choices ◮ Pareto optimality ◮ Almost-preference leading to Almost-Pareto sets . ◮ Reduce the number of choices to be considered.

  20. Reducing the number of choices ◮ Pareto optimality ◮ Almost-preference leading to Almost-Pareto sets . ◮ Reduce the number of choices to be considered. ◮ Select a proposed choice d ∗ .

  21. Imprecision in risk aversion ◮ Scalar attribute Z .

  22. Imprecision in risk aversion ◮ Scalar attribute Z . ◮ Rescale Z so that z = 0 is “worst value”, z = 1 is “best value”.

  23. Imprecision in risk aversion ◮ Scalar attribute Z . ◮ Rescale Z so that z = 0 is “worst value”, z = 1 is “best value”. ◮ Simple family of functions: quadratics. U ( z ) = a 0 + a 1 z + a 2 z 2

  24. Imprecision in risk aversion ◮ Scalar attribute Z . ◮ Rescale Z so that z = 0 is “worst value”, z = 1 is “best value”. ◮ Simple family of functions: quadratics. U ( z ) = a 0 + a 1 z + a 2 z 2 ◮ U (0) = 0 and U (1) = 1 imply U ( x ) = az + (1 − a ) z 2

  25. Imprecision in risk aversion U ( x ) = az + (1 − a ) z 2 d dz U ( z ) = U ′ ( x ) = a + 2(1 − a ) z

  26. Imprecision in risk aversion U ( x ) = az + (1 − a ) z 2 d dz U ( z ) = U ′ ( x ) = a + 2(1 − a ) z ◮ U ′ (0) ≥ 0 and U ′ (1) ≥ 0 imply 0 ≤ a ≤ 2.

  27. Imprecision in risk aversion U ( x ) = az + (1 − a ) z 2 d dz U ( z ) = U ′ ( x ) = a + 2(1 − a ) z ◮ U ′ (0) ≥ 0 and U ′ (1) ≥ 0 imply 0 ≤ a ≤ 2. ◮ z 2 a = 0 : U 1 ( z ) = 2 z − z 2 a = 2 : U 2 ( z ) =

  28. Imprecision in risk aversion U 1 ( z ) = z 2 U 2 ( z ) = 2 z − z 2

  29. Imprecision in risk aversion U 1 ( z ) = z 2 U 2 ( z ) = 2 z − z 2 ◮ Reparameterise: U ( z ) = (1 − b ) U 1 ( z ) + bU 2 ( z ) 0 ≤ b ≤ 1 b = a / 2

  30. Imprecision in risk aversion U ( z ) = (1 − b ) U 1 ( z ) + bU 2 ( z ) b > 1 / 2 Risk averse b = 1 / 2 Risk neutral b < 1 / 2 Risk seeking

  31. Imprecision in risk aversion U ( z ) = (1 − b ) U 1 ( z ) + bU 2 ( z ) b > 1 / 2 Risk averse b = 1 / 2 Risk neutral b < 1 / 2 Risk seeking ◮ Just an additive node .

  32. Imprecision in risk aversion U ( z ) = (1 − b ) U 1 ( z ) + bU 2 ( z ) b > 1 / 2 Risk averse b = 1 / 2 Risk neutral b < 1 / 2 Risk seeking ◮ Just an additive node . ◮ Simply add an extra level to the hierarchy.

  33. Imprecision in risk aversion U ( z ) = (1 − b ) U 1 ( z ) + bU 2 ( z ) b > 1 / 2 Risk averse b = 1 / 2 Risk neutral b < 1 / 2 Risk seeking ◮ Just an additive node . ◮ Simply add an extra level to the hierarchy. ◮ All earlier theory applies.

  34. Imprecision in risk aversion 1.0 0.8 0.6 U 0.4 0.2 0.0 0.0 0.2 0.4 0.6 0.8 1.0 z

  35. Imprecision in risk aversion ◮ Can we improve on this? ◮ Other families of functions? ◮ More than two basis functions to give greater flexibility of shape?

  36. Imprecision in risk aversion Quadratic utility: U ( z ) = (1 − b ) U 1 ( z ) + bU 2 ( z ) = z − ( z − z 2 ) z 2 U 1 ( z ) = 2 z − z 2 = z + ( z − z 2 ) U 2 ( z ) = General form: z − h ( z ) U 1 ( z ) = U 2 ( z ) = z + h ( z )

  37. Imprecision in risk aversion General form: U 1 ( z ) = z − h ( z ) U 2 ( z ) = z + h ( z ) Subject to U 1 ( z ) and U 2 ( z ) both increasing functions, widest difference with this form when � (0 ≤ z ≤ 0 . 5) z h ( z ) = 1 − z (0 . 5 ≤ z ≤ 1)

  38. Imprecision in risk aversion 1.0 0.8 0.6 U 0.4 0.2 0.0 0.0 0.2 0.4 0.6 0.8 1.0 z

  39. Imprecision in risk aversion ◮ Limited range and shape with this method. ◮ More direct method: ◮ Determine a range for U ( z ∗ ) where 0 < z ∗ < 1 . ◮ Probability equivalent method. ◮ Offer the decision maker a choice between ◮ d A : the attribute value corresponding to z = z ∗ , with certainty, and ◮ d B : with probability α, the attribute value corresponding to z = 1 and, with probability 1 − α, the attribute value corresponding to z = 0 . ◮ The lower utility for z ∗ , U 1 ( z ∗ ) is the largest value of α at which the decision maker would choose d A . ◮ The upper utility for z ∗ , U 2 ( z ∗ ) is the smallest value of α at which the decision maker would choose d B .

  40. Imprecision in risk aversion ◮ Determine a range for U ( z ∗ ) where 0 < z ∗ < 1 . ◮ Probability equivalent method. ◮ Offer the decision maker a choice between ◮ d A : the attribute value corresponding to z = z ∗ , with certainty, and ◮ d B : with probability α, the attribute value corresponding to z = 1 and, with probability 1 − α, the attribute value corresponding to z = 0 . ◮ The lower utility for z ∗ , U 1 ( z ∗ ) is the smallest value of α at which the decision maker would choose d B . ◮ The upper utility for z ∗ , U 2 ( z ∗ ) is the largest value of α at which the decision maker would choose d A . ◮ Repeat this process at a range of values z ∗ . ◮ Interpolate (linear?). Obtain lower and upper utility functions, U 1 ( z ) and U 2 ( z ) . ◮ These can then be our two basis functions.

  41. Imprecision in risk aversion ◮ Possibility of additional basis functions to give more flexibility in shape. ◮ Eg one which is closer to U 1 ( z ) for some of the range of z and otherwise closer to U 2 ( z ) .

  42. Imprecision in risk aversion: Effect on trade-offs U ′ 1 ( z ) � = U ′ 2 ( z ) ◮ Suppose U n = a n U z + (1 − a n ) U x . ◮ If U z = (1 − b ) U 1 ( z ) + bU 2 ( z ) , the effect on U n of a fixed change in z may depend on the choice of b . ◮ This may be acceptable. ◮ Otherwise consider joint feasible region for a and b so that the range of a can depend on the choice of b .

  43. Sample size example ◮ Two groups, binary outcomes, eg ◮ Success: still working after t hours. ◮ Failure: failed before t hours. ◮ Group g : give treatment g to n g items. Observe X g successes. ◮ Choose treatment for future items. ◮ Unknown success rate with treatment g is θ g .

  44. Sample size example: Terminal decision ◮ Terminal prior: ◮ θ g ∼ Beta ( a t , g , b t , g ) ◮ θ 1 , θ 2 independent. ◮ a t , 1 = a t , 2 = b t , 1 = b t , 2 = 1 . 5 . ◮ Terminal utility: ◮ Such that choose according to which posterior mean for θ g is greater. (See Appendix).

  45. Sample size example: Design prior ◮ θ 1 , θ 2 NOT independent. ◮ Copula? ◮ Probit/logit — bivariate normal? ◮ Mixture?

  46. Sample size example: Design prior ◮ θ 1 , θ 2 NOT independent. ◮ Copula? ◮ Probit/logit — bivariate normal? ◮ Mixture? ◮ Use mixture. Details in appendix.

  47. Sample size example: Design prior 1.0 0.8 1 2 0.6 3 θ 2 0.4 3.5 0.2 2 . 5 1.5 0.5 0.0 0.0 0.2 0.4 0.6 0.8 1.0 θ 1

  48. Sample size example: Design utility – Benefit ◮ Attribute: θ . See Appendix. ◮ Elicit a lower and an upper utility function U B , L ( θ ) and U B , U ( θ ). ◮ Evaluations at a range of values of θ and linear interpolation. θ 0 0.25 0.5 0.75 1 U B , L ( θ ) 0 0.25 0.5 0.75 1 – risk neutral ◮ U B , U ( θ ) 0.00 0.45 0.85 0.95 1.00 – risk averse

  49. Sample size example: Design utility – Benefit 1.0 ● ● ● ● 0.8 ● 0.6 Utility ● ● 0.4 ● 0.2 0.0 ● ● 0.0 0.2 0.4 0.6 0.8 1.0 θ

  50. Sample size example: Design utility – Cost ◮ For simplicity in this example we use a simple (precise) form. ◮ Let n max , 1 and n max , 2 be the largest sample sizes which we would consider. ◮ Let � 1 ( n g = 0) Z C , g = ( n g > 0) . h 0 , g + h 1 , g n g 1 − h 0 , g + h 1 , g n max , g ◮ Marginal cost utility is U C = a c , 1 Z C , 1 + a c , 2 Z C , 2 . ◮ We use a c , 1 = a c , 2 = 0 . 5 , h 0 , 1 = h 0 , 2 = 10 , h 1 , 1 = h 1 , 2 = 1 , n max , 1 = 100 , n max , 2 = 60 .

  51. Sample size example: Design utility – Overall ◮ The overall design utility is U = b C U C + b B U B

  52. Sample size example: Design utility – Overall ◮ The overall design utility is U = b C U C + b B U B ◮ We use 0 . 03 ≤ b C ≤ 0 . 07 , b B = 1 − b C .

  53. Sample size example: Design utility – Overall ◮ The overall design utility is U = b C U C + b B U B ◮ We use 0 . 03 ≤ b C ≤ 0 . 07 , b B = 1 − b C . ◮ Evaluation of expected utilities: see Appendix.

  54. Sample size example: Choosing a design ◮ With 0 ≤ n 1 ≤ 100 and 0 ≤ n 2 ≤ 60, there are 6161 potential designs. ◮ Of these, 38 are Pareto-optimal. ◮ With the exception of (0 , 0), ◮ all of the Pareto-optimal designs have 12 ≤ n 1 ≤ 25 ◮ all have 0 . 6 n 1 < n 2 ≤ n 1 ◮ and all but three have 0 . 7 n 1 < n 2 ≤ n 1 .

  55. Sample size example: Results ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 15 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 10 ● ● n 2 5 0 ● 0 5 10 15 20 25 n 1

  56. Almost preference Two alternatives A , B . Set Q of parameter specifications. Choose ε ≥ 0, a value to indicate a practical indifference between utility values.

  57. Almost preference Two alternatives A , B . Set Q of parameter specifications. Choose ε ≥ 0, a value to indicate a practical indifference between utility values. ◮ A is ε - preferable to B , written A � ε B , over Q if inf Q ( U ( A ) − U ( B )) ≥ − ε .

  58. Almost preference Two alternatives A , B . Set Q of parameter specifications. Choose ε ≥ 0, a value to indicate a practical indifference between utility values. ◮ A is ε - preferable to B , written A � ε B , over Q if inf Q ( U ( A ) − U ( B )) ≥ − ε . ◮ A , B are ε - equivalent , written A ≃ ε B , if both A � ε B and B � ε A .

  59. Almost preference Two alternatives A , B . Set Q of parameter specifications. Choose ε ≥ 0, a value to indicate a practical indifference between utility values. ◮ A is ε - preferable to B , written A � ε B , over Q if inf Q ( U ( A ) − U ( B )) ≥ − ε . ◮ A , B are ε - equivalent , written A ≃ ε B , if both A � ε B and B � ε A . ◮ A is said to ε - dominate B , written A ≻ ε B , if A � ε B but B �� ε A .

  60. Almost preference Two alternatives A , B . Set Q of parameter specifications. Choose ε ≥ 0, a value to indicate a practical indifference between utility values. ◮ A is ε - preferable to B , written A � ε B , over Q if inf Q ( U ( A ) − U ( B )) ≥ − ε . ◮ A , B are ε - equivalent , written A ≃ ε B , if both A � ε B and B � ε A . ◮ A is said to ε - dominate B , written A ≻ ε B , if A � ε B but B �� ε A . ◮ Setting ε = 0, an alternative which is not 0-dominated by any other is Pareto optimal.

  61. Almost preference: collections The collection A is ε -preferable to the collection B of alternatives, written A � ε B if, for each B ∈ B , there is at least one A ∈ A for which A � ε B .

  62. Reducing the collection of alternatives ◮ We now eliminate alternatives which are almost dominated or almost equivalent to others by finding ε -Pareto decision sets for a range of values of ε .

  63. Reducing the collection of alternatives ◮ We now eliminate alternatives which are almost dominated or almost equivalent to others by finding ε -Pareto decision sets for a range of values of ε . ◮ Let our set of Pareto optimal rules be D . Then A ⊆ D is an ε - Pareto decision set if A � ε B where A ∪ B = D and A ∩ B = ∅ .

  64. Reducing the collection of alternatives ◮ We now eliminate alternatives which are almost dominated or almost equivalent to others by finding ε -Pareto decision sets for a range of values of ε . ◮ Let our set of Pareto optimal rules be D . Then A ⊆ D is an ε - Pareto decision set if A � ε B where A ∪ B = D and A ∩ B = ∅ . ◮ Increasing the value of ε eliminates progressively more alternatives

  65. Reducing the collection of alternatives ◮ We now eliminate alternatives which are almost dominated or almost equivalent to others by finding ε -Pareto decision sets for a range of values of ε . ◮ Let our set of Pareto optimal rules be D . Then A ⊆ D is an ε - Pareto decision set if A � ε B where A ∪ B = D and A ∩ B = ∅ . ◮ Increasing the value of ε eliminates progressively more alternatives ◮ We construct a list of decisions and the ε values at which they are just deleted by ε -preference.

  66. Sample size example: Results, ε = 0 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 15 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 10 ● ● n 2 5 0 ● 0 5 10 15 20 25 n 1

  67. Sample size example: Results, ε = 0 . 00000077 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 15 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 10 ● ● n 2 5 0 ● 0 5 10 15 20 25 n 1

  68. Sample size example: Results, ε = 0 . 00000080 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 15 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 10 ● ● n 2 5 0 ● 0 5 10 15 20 25 n 1

  69. Sample size example: Results, ε = 0 . 000571 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 15 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 10 ● ● n 2 5 0 ● 0 5 10 15 20 25 n 1

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