Quantitative Health Risk Analysis Methods

by Cox, Louis Anthony, Jr.

• ISBN13: 9780387259093
• ISBN10: 0387259090
• Format: Hardcover
• Copyright: 2006-01-01
• Publisher: Springer Verlag

Summary

Worldwide health care problems are a hot, growing application in Operations Research. Along with a quickly growing field is an active community of Medical OR and Risk Analysis researchers. Tony Cox is one of the leading research scholars in the field of Risk Heath Risk. His work on health risk modeling will be synthesized along with the work of others on modeling human health risks. The monograph will cover a range of modeling and methodological issues including environmental, experimental, simulation, and mathematical modeling approaches.

Table of Contents

Preface	xiii
Acknowledgments	xvii
Qualitative and Quantitative Risk Analysis
Introduction: A Need for New Methods	1	(4)
Challenges and Goals	2	(2)
Overview of Contents	4	(1)
Background and Motivation	5	(6)
Difficult Tradeoffs	5	(2)
Recent History	7	(4)
The Role of Risk Analysis	11	(1)
Qualitative Risk Analysis	11	(12)
Some Examples of Qualitative Risk Rating Frameworks	11	(3)
The Brenner Scheme for Order-Of-Magnitude Risk Rating	14	(1)
US-FDA-CVM's Guidance Document# 152 and its limitations	15	(3)
Lessons from Previous Approaches	18	(5)
A Mathematical Theory of Qualitative Risk Rating	23	(8)
What Should Be Done Instead?	31	(1)
Discussion and Conclusions	32	(5)
Appendix Proof of Theorem 1	32	(5)
Risk Analysis: Goals and Methods
Introduction to Health Risk Analysis	37	(6)
Risk Assessment	37	(2)
Quantitative Definition of Risk	39	(3)
Risk Management	42	(1)
Risk Communication	42	(1)
Purposes and Outputs of Risk Analysis	43	(4)
Risk Analysis with Uncertain Data	47	(7)
Desired Outputs of Risk Analysis	54	(2)
Introduction to Risk Assessment	56	(8)
A Rapid Risk Rating Technique (RRRT)	56	(8)
Risk Management	64	(3)
Definition of Risk Management	64	(1)
Purposes and Outputs of Risk Management	65	(1)
Methods for Risk Management Decision-Making	65	(1)
Methods of Risk Management to Avoid	66	(1)
Validating Risk Management Results	67	(1)
Communicating Risk Analysis Results	67	(7)
Steps in Risk Communication	68	(1)
Purposes of Risk Communication	68	(1)
Desired Outputs of Risk Communication	69	(2)
Methods for Risk Communication	71	(1)
Participatory Risk-Management Decision Processes	72	(2)
Summary and Conclusions	74	(3)
Hazard Identification
Definition of Risk Assessment	77	(1)
A Bayesian Network Framework	78	(5)
Introduction to Hazard Identification	83	(4)
Definition of Hazard Identification	83	(2)
Purposes and Goals of Hazard Identification	85	(2)
Methods of Hazard Identification	87	(22)
Causal Inference From Epidemiological Data	87	(4)
Refuting Non-Causal Explanations	91	(7)
Seeking Positive Evidence for a Causal Relation	98	(11)
Case Study: Did Ending Avoparcin Use Reduce Human Resistance?	109	(3)
A Systems Dynamics Approach to Hazard Identification	112	(6)
Model Definitions and Equations	113	(3)
Model-Based Analysis of Potential Resistance Hazards	116	(2)
Hazard Identification Methods to Avoid	118	(11)
A Case Study: Presenting Real vs. Hypothesized Hazards	124	(5)
Conclusions	129	(2)
Exposure Assessment
Introduction to Risk Quantification	131	(1)
Introduction to Exposure Assessment	132	(2)
Definition and Purposes of Exposure Assessment	132	(2)
Exposure Assessment Methods: Simulation	134	(10)
Practical Simulation-Based Exposure Modeling	136	(5)
Simulation Based on Conditioning, Not Imitation	141	(3)
Attribution-Based Exposure Modeling	144	(10)
Attribution through Multiple Stages	151	(3)
Systems Dynamics Models of Exposure	154	(6)
Model Development and Simplifying Assumptions	154	(2)
Estimating Model Parameters from Data	156	(2)
Using the Model to Make Predictions	158	(2)
Exposure Assessment Methods to Avoid	160	(3)
Prevalence-Based Exposure Metrics	160	(1)
Holistic Statistical Exposure Modeling	161	(2)
Validating and Refining Exposure Models	163	(2)
Qualitative Exposure assessment	165	(2)
Summary and Conclusions	167	(3)
Dose-Response Modeling and Risk Characterization
Introduction to Dose-Response Modeling	170	(3)
Definitions and Purposes of Dose-Response Modeling	171	(2)
Microbial Dose-Response Modeling	173	(15)
Empirical Statistical Dose-Response Models	173	(3)
Biologically Motivated Statistical Dose-Response Models	176	(6)
Multi-Component Dose-Response Models	182	(1)
Epidemiological Exposure-Response Models	182	(1)
Practical Dose Response Models: Summary	183	(2)
Validating Dose-Response Models	185	(2)
Showing Uncertainty In Dose-Response Models	187	(1)
Health Consequence Modeling	188	(4)
Risk Characterization	192	(18)
Definition and Purposes of Risk Characterization	192	(1)
Desired Outputs of Risk Characterization	193	(2)
Methods for Risk Characterization	195	(8)
Methods of Simplified Risk Characterization to Avoid	203	(1)
Rapid Risk Rating Technique (RRRT) Approach	203	(6)
Validation of Risk Characterization Results	209	(1)
Uncertainty and Sensitivity Analyses	210	(10)
Uncertainty Analysis	210	(4)
Sensitivity Analysis	214	(6)
Discussion and Summary	220	(5)
Human Health Risks from Virginiamycin: A Case Study
Introduction	225	(3)
Background on OD. VRE. VREF. and VREFΛ	226	(2)
Risk Assessment Data and Methods	228	(14)
Estimating Total Number of VREF Cases Per Quarter	230	(1)
Estimating VREF Cases per Quarter in Australia	230	(3)
Estimating VREF Cases per Quarter in the United States	233	(1)
Estimated Fraction of VRE Cases that are VREFΛ	233	(1)
Estimating the Australian VREFΛ Fraction of VRE by Upper Bounding	234	(1)
Estimating the U.S. VREFΛ Fraction	235	(1)
Fraction of Exogenous (Non-Nosocomial) VREF Cases	236	(1)
Fraction of VREFΛ Cases Attributable to Chickens	237	(1)
Fraction of VREFΛ Cases with QD Resistance	238	(1)
QD Resistance Fraction Among VREFΛ Cases in Australia	238	(1)
QD Resistance Fraction Among VREFΛ Cases in the United States	239	(1)
QD Effectiveness Fraction	239	(1)
Fraction of VREFΛ Cases Prescribed QD Over Time	240	(1)
Time-Varying QD Resistance Fraction	240	(2)
Health Consequences of Treatment Failures	242	(1)
Summary	243
Results	242	(6)
Results for Australia	242	(4)
Results for USA	246	(2)
Discussion of Results and Key Drivers	248	(1)
Summary and Conclusions	249	(6)
Appendix: Estimating Human Health Consequences of QD Resistance	251	(4)
Dynamic Modeling and Uncertainty Analysis
Introduction	255	(5)
Motivation: How Does History Constrain Future Risks?	256	(1)
A Growing Concern: Managing Potential Future Risks	257	(2)
From Qualitative Hazard Identification to Quantitative Risk Assessment	259	(1)
Deterministic Modeling and Results	260	(3)
VRE Colonization Dynamics Model	260	(3)
Bayesian Monte Carlo (BMC) Uncertainty Analysis	263	(4)
Selecting Priors for Probabilistic Sensitivity Analysis	264	(1)
Data on Historical QD Resistance Rates	265	(1)
Bayesian Monte Carlo (BMC) Estimation of Posterior Distributions	266	(1)
Stochastic Discrete-Event Simulation (DES) of Time-to-Outbreak	266	(1)
Results of Uncertain Dynamic Model	267	(5)
Initial Bayesian Analysis and Estimation of Parameters	267	(1)
Revised Prescription Rate of QD	268	(1)
Human Health Risks vs. Key Parameter Values	269	(2)
Estimated Individual and Population Risks	271	(1)
Discussion	272	(2)
Summary and Conclusions	274	(3)
Potential Human Health Benefits of Animal Antibiotics
Introduction	277	(3)
A Risk Management Dilemma for Virginiamycin	278	(2)
Framework for Assessing Impacts	280	(3)
Data for RRRT Risk-Benefit Calculations	283	(5)
Calculation of ΔF	283	(3)
Calculation of P-	286	(2)
Results for Virginiamycin impacts	288	(1)
Uncertainty and Sensitivity Analyses	289	(2)
Extensions to Cattle and Swine	291	(1)
Comparison to risks in Australia	291	(1)
RRRT for Macrolides and Enrofloxacin	292	(7)
Discussion	299	(5)
Comparison to Other Risk Assessment Approaches	299	(1)
Comparison of Model Predictions to Experience	300	(1)
Other Considerations and Extensions	301	(3)
Summary and Conclusions	304	(5)
Appendix: The Log-Exponential Risk Model	306	(3)
References	309	(34)
Index	343