Irreversible treatment decisions under consideration of the research and development pipeline for new therapies

Steven M. Shechter, Oguzhan Alagoz, Mark S. Roberts

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


This article addresses a topic not considered in previous models of patient treatment: the possible downstream availability of improved treatment options coming out of the medical research and development (RD) pipeline. We provide clinical examples in which a patient may prefer to wait and take the chance that an improved therapy comes to market rather than choose an irreversible treatment option that has serious quality of life ramifications and would render future treatment discoveries meaningless for that patient. We then develop a Markov decision process model of the optimal time to initiate treatment, which incorporates uncertainty around the development of new therapies and their effects. After deriving structural properties for the model, we provide a numerical example that demonstrates how models that do not have any foresight of the RD pipeline may result in optimal policies that differ from models that have such foresight, implying erroneous decisions in the former models. Our example quantifies the effects of such errors.

Original languageEnglish (US)
Pages (from-to)632-642
Number of pages11
JournalIIE Transactions (Institute of Industrial Engineers)
Issue number9
StatePublished - Sep 1 2010
Externally publishedYes


  • Markov decision processes
  • Medical decision making
  • Research and development

ASJC Scopus subject areas

  • Industrial and Manufacturing Engineering

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