A Cost-Effective Agent for Clinical Trial Assignment

1. A Cost-Effective Agent for Clinical Trial Assignment Princeton K. Kokku Lawrence O. Hall Dmitry B. Goldgof Eugene Fink Jeffrey P. Krischer

2. Clinical Trials • A clinical trial is an evaluation of a new treatment procedure • Researchers recruit patients with appropriate health problems and medical histories

3. Selection of Subjects The selection of subjects for clinical trials is a manual procedure, and researchers may miss some of the eligible patients. Gotay [1991] showed that only 39% of the eligible patients are selected for clinical trials Fallowfield et al. [1997] showed that less than 50% of the eligible patients are selected

4. Medical Tests • The total cost of related medical tests may depend on their ordering • Finding the right ordering is usually a complex optimization problem

5. Expert System • Automatic selection of subjects for clinical trials • Cost-effective ordering of related tests • Explanation of the reasons for acceptance or rejection

6. System Design • Interface • Knowledge base • Inference rules • Ordering of tests

7. Interface • Entry of patients’ data • Emulation of a doctor-patient interview • Explanation of the eligibility decisions

8. Knowledge Base • Tests and questions • Eligibility criteria

9. Inference Rules The system includes inference rules suggested by physicians. Example: If the cancer stage is III or IV, then the cancer is invasive.

10. Ordering of Tests • The system chooses the ordering of tests that reduces their expected total cost • After getting the results of the first test, it revises the ordering of the remaining tests • The ordering of tests is based on the test costs, number of trials that require each test, and structure of eligibility criteria

11. Entering Patients’ Data Adding patients Selecting clinical trials Entering initial data Revising medical data Entering medical data

12. Adding Patients Adding patients Selecting clinical trials Entering initial data Revising medical data Entering medical data Add a new patient Find an old patient

13. Selecting Clinical Trials Adding patients Selecting clinical trials Entering initial data Revising medical data Entering medical data Choose candidate trials View all available trials

14. Entering Initial Data Adding patients Selecting clinical trials Entering initial data Revising medical data Entering medical data Answer initial questions Change previous answers

15. Entering Medical Data Adding patients Selecting clinical trials Entering initial data Revising medical data Entering medical data Enter medical-test results View eligibility decisions

16. Experiments • Twelve breast-cancer trials at theH. Lee Moffitt Cancer Center • Retrospective data from 187 patients • Current data from 74 patients

17. ClinicalTrial MissingData SameMatches NewMatches 10822108401107211378119921210012101 1004845820 519261962030 031930130 Finding Eligible PatientsRetrospective data from 187 patients

18. ClinicalTrial MissingData SameMatches NewMatches 11132119311197112100121011260112775 4130604 112032615 1000121 Finding Eligible PatientsCurrent data from 74 patients

19. Conclusions • The system can help to identify eligible patients and increase the number of trial participants • It can potentially reduce the cost of medical tests related to eligibility decisions

20. Future Work • Conduct more experiments • Add clinical trials for lung cancer • Combine the implemented heuristics with probabilistic reasoning