new

Get trending papers in your email inbox!

Subscribe

Daily Papers

byAK and the research community

Mar 11

Cost-effectiveness analysis for therapy sequence in advanced cancer: A microsimulation approach with application to metastatic prostate cancer

Purpose. Patients with advanced cancer may undergo multiple lines of treatment, switching therapies as their disease progresses. Motivated by a study of metastatic prostate cancer, we develop a microsimulation framework to study therapy sequence. Methods. We propose a discrete-time state transition model to study two lines of anti-cancer therapy. Based on digitized published progression-free survival (PFS) and overall survival (OS) curves, we infer event types (progression or death), and estimate transition probabilities using cumulative incidence functions with competing risks. Our model incorporates within-patient dependence over time, such that response to first-line therapy informs subsequent event probabilities. Parameters governing the degree of within-patient dependence can be used to calibrate the model-based results to those of a target trial. We demonstrate these methods in a study of two therapy sequences for metastatic prostate cancer, where Docetaxel (DCT) and Abiraterone Acetate (AA) are both appropriate for use in either first or second line treatment. We assess costs, Quality-Adjusted Life Years (QALYs) and Incremental Cost Effectiveness Ratio (ICER) for two treatment strategies: DCT then AA vs AA then DCT. Results. Using digitized survival curves from relevant clinical trials, we identified 8.6-13.9% of PFS times that should be categorized as deaths, allowing for estimation of cumulative incidence functions. Models assuming within-patient independence overestimated OS time, corrected with our calibration approach. Correction resulted in meaningful changes in the difference in QALYs between treatment strategies (0.07 vs 0.15) and the ICER (-\76,836/QALY vs -21,030/QALY). Conclusions. Microsimulation models can be successfully used to study cost-effectiveness of therapy sequences, taking care to account correctly for within-patient dependence.

  • 5 authors
·
Oct 10, 2022

Cost-of-Pass: An Economic Framework for Evaluating Language Models

The widespread adoption of AI systems in the economy hinges on their ability to generate economic value that outweighs their inference costs. Evaluating this tradeoff requires metrics that account for both performance and costs. We propose a framework grounded in production theory for evaluating language models by combining accuracy and inference cost. We introduce "cost-of-pass", the expected monetary cost of generating a correct solution. We then define the "frontier cost-of-pass" as the minimum cost-of-pass achievable across available models or the "human-expert, using the approximate cost of hiring an expert. Our analysis reveals distinct economic insights. First, lightweight models are most cost-effective for basic quantitative tasks, large models for knowledge-intensive ones, and reasoning models for complex quantitative problems, despite higher per-token costs. Second, tracking this frontier cost-of-pass over the past year reveals significant progress, particularly for complex quantitative tasks where the cost has roughly halved every few months. Third, to trace key innovations driving this progress, we examine counterfactual frontiers: estimates of cost-efficiency without specific model classes. We find that innovations in lightweight, large, and reasoning models have been essential for pushing the frontier in basic quantitative, knowledge-intensive, and complex quantitative tasks, respectively. Finally, we assess the cost-reductions afforded by common inference-time techniques like majority voting and self-refinement, finding that their marginal accuracy gains rarely justify their costs. Our findings underscore that complementary model-level innovations are the primary drivers of cost-efficiency, and our economic framework provides a principled tool for measuring this progress and guiding deployment.

  • 5 authors
·
Apr 17, 2025 2

What Benefits Drive Membership in Medicare Advantage Plans?

We seek to identify the most relevant benefits offered by Medicare Advantage Health Plans that drive membership and market share. As an example, we explore plans operating in a single county in New Jersey between 2018 and 2023. A dataset of benefits from publicly available data sources was created and the variance inflation factor was applied to identify the correlation between the extracted features, to avoid multicollinearity and overparameterization problems. We categorized the variable Market Share and used it as a multinomial response variable with three categories: less than 0.3\%, 0.3\% to 1.5\%, and over 1.5\%. Categories were chosen to achieve approximately uniform distribution of plans (47, 60, and 65 respectively). We built a multinomial Lasso model using 5-fold cross-validation to tune the penalty parameter. Lasso forced some features to be dropped from the model, which reduces the risk of overfitting and increases the interpretability of the results. For each category, important variables are different. Certain brands drive market share, as do PPO plans and prescription drug coverage. Benefits, particularly ancillary benefits that are not part of CMS's required benefits, appear to have little influence, while financial terms such as deductibles, copays, and out-of-pocket limits are associated with higher market share. Finally, we evaluated the predictive accuracy of the Lasso model with the test set. The accuracy is 0.76.

  • 2 authors
·
Nov 3, 2025