1. Modelling and Simulation in Health Technology – from Development via Implementation to AssessmentF. Breitenecker, Vienna Univ. of Technology Niki Popper, dwh Simulation Sevices Siegfried Wassertheurer, Austrian Inst. of Technology

2. Modelling and Simulation – M & S • Modelling and Simulation – Technique since 1970 • 3rd Pillar of Science Theory Problem Simulation Solution Abstraktion der Realität Experiment

3. Theory Problem Simulation Solution Experiment Modelling and Simulation – M & S • Modelling and Simulation – Technique since 1970 • 3rd Pillar of Science • Problem Solution

4. Theory Problem Simulation Solution Experiment Modelling and Simulation – M & S • Modelling and Simulation – Technique since 1970 • 3rd Pillar of Science • Problem Solution • Aim and Goal ?

5. Theory Problem Simulation Solution Experiment Modelling and Simulation – M & S • Modelling and Simulation – Technique since 1970 • 3rd Pillar of Science • Problem Solution • Aim and Goal ? Simulation is the process of designing a model of a real system and conducting experiments with this model for the purpose either of understanding the behavior of the system and its underlying causes or of evaluating various designs of an artificial system or strategies for the operation of the system.

6. Theory Problem Simulation Solution Experiment Modelling and Simulation – M & S • Modelling and Simulation – Technique since 1970 • 3rd Pillar of Science • Problem Solution • Aim and Goal • Level of Application / Use

7. Theory Problem Simulation Solution Experiment Modelling and Simulation – M & S • Modelling and Simulation – Technique since 1970 • 3rd Pillar of Science • Problem Solution • Aim and Goal • Level of Application / Use DEVELOPMENT - IMPLEMENTATION - DIFFUSION

8. PTS PTS PTS PTS PTS PTS PTS PTS PTS PTS Modelling and Simulation – M & S DEVELOPMENT - IMPLEMENTATION - DIFFUSION of a Product / Technique / Strategy (PTS) PTS

9. PTS PTS PTS PTS PTS PTS PTS PTS PTS Modelling and Simulation – M & S DEVELOPMENT - IMPLEMENTATION - DIFFUSION of a Product / Technique / Strategy (PTS) PTS PTS M & S

10. PTS PTS PTS PTS PTS PTS PTS PTS PTS Modelling and Simulation – M & S DEVELOPMENT - IMPLEMENTATION - DIFFUSION of a Product / Technique / Strategy (PTS) PTS PTS M & S M & S

11. PTS PTS PTS PTS PTS PTS PTS PTS PTS Modelling and Simulation – M & S DEVELOPMENT - IMPLEMENTATION - DIFFUSION of a Product / Technique / Strategy (PTS) PTS PTS M & S M & S M & S

12. Modelling and Simulation – M & S DEVELOPMENT - IMPLEMENTATION - DIFFUSION of a Product / Technique / Strategy (PTS) M & S M & S

13. Modelling and Simulation – M & S DEVELOPMENT - IMPLEMENTATION - DIFFUSION of a Product / Technique / Strategy (PTS) Em-bedded M&S M & S Mechatronic M&S

14. Modelling and Simulation – M & S DEVELOPMENT - IMPLEMENTATION - DIFFUSION of a Product / Technique / Strategy (PTS) Em-bedded M&S M & S ? Mechatronic M&S

15. Modelling and Simulation – M & S DEVELOPMENT - IMPLEMENTATION - DIFFUSION DIFFUSION – Assessment at Free Market M & S

16. Modelling and Simulation – M & S DEVELOPMENT - IMPLEMENTATION - DIFFUSION DIFFUSION – Assessment at Free Market M & S

17. Modelling and Simulation – M & S DEVELOPMENT - IMPLEMENTATION - DIFFUSION DIFFUSION – Assessment at Free Market M & S

18. Modelling and Simulation – M & S DEVELOPMENT - IMPLEMENTATION - DIFFUSION DIFFUSION – Assessment at Free Market

19. Modelling and Simulation – M & S DEVELOPMENT - IMPLEMENTATION - DIFFUSION DIFFUSION – Assessment at Free Market Market M & S

20. Modelling and Simulation – M & S ASSESSMENT DIFFUSION DEVELOPMENT - IMPLEMENTATION - of a Product / Technique / Strategy (PTS) Em-bedded M&S Market M & S MECHATRONICS Mechatronic M&S

21. Modelling and Simulation – M & S ASSESSMENT DIFFUSION DEVELOPMENT - IMPLEMENTATION - Em-bedded M&S Market M & S MECHATRONICS Mechatronic M&S

22. Modelling and Simulation – M & S ASSESSMENT DIFFUSION DEVELOPMENT - IMPLEMENTATION - Embedded M&S Embedded M&S HEALTH TECHNOLOGY M & S M&S

23. Modelling and Simulation – M & S HEALTH TECHNOLOGY DEVELOPMENT - IMPLEMENTATION - DIFFUSION - ASSESSMENT Limited Market Controlled Market (Laws) Health Care Systems Use depends on Assessment ASSESSMENT - > DIFFUSION M & S

24. Modelling and Simulation – M & S ASSESSMENT DIFFUSION DEVELOPMENT - IMPLEMENTATION - HEALTH TECHNOLOGY Embedded M&S Embedded M&S M&S with Markov – ODE – PDE - CA - AB - NN

25. Modelling and Simulation – M & S Cardiovascular RiskStratificationandTherapy Optimization in Epidemiology using Simulation

26. The arterialsystem in (technical) terms • Single source (heart) • Branched elasitc tubes for blood transport (arteries) • Various sinks (organs) • Unsteady pressure gradients drive the system • Arterial pressures (systolic/diastolic) are actually the most important inidactors in prevention/treatment

27. Pathology (Hypertension)

28. Costs Source: Austrian Social Insurance (1999-2004)

29. Outcome • Only 10-15 % of treated patients reach their therapy goals within OECD countries! (Source: WHO, AHA) • Vienna Study • 7100 Probands • 50 % Hypertensives • 1110 in treatment • 185 (16%) well treated!

30. 1 Paradox – 2 Answers Only 50 % CHD are related to Hypertension?!

31. Circadian Blood Pressure • 24 h Blood pressure profile • White coat hypertension • Masked hypertension Blood Pressure is time dependent!

33. Explanation Blood pressure depends on the arterial site!

34. Howto handle? Dynamics! Womersley Solution for Navier-Stokes Eq.

35. Generalized Transfer Function (GTF) This approach allows for the first time widespread epidemiological use!

36. Ambulatory Pulse Wave Analysis

37. Validation

38. Example 1: Physiological Case

39. Example 2:Non-Dipper

40. Example 3:Raiser

41. Modelling and Simulation – M & S META – LEVEL: „SIMULATION ON THE MARKET“ – Health Technology ZEBRAS

42. Modelling and Simulation – M & S META – LEVEL: „SIMULATION ON THE MARKET“ HEALTH TECHNOLOGY ASSESSMENT – Using Simulation - Competitor NN DT MC CA SD DE PM AB DEVs

43. Modelling and Simulation – M & S META – LEVEL: „SIMULATION ON THE MARKET“ DIFFERENT (EASIER) APPLICATION

44. DEMANDS: EASY TO USE

45. Σ

46. Modelling and Simulation – M & S META – LEVEL: „SIMULATION ON THE MARKET“ HEALTH TECHNOLOGY ASSESSMENT – Using Simulation - Competitors DT MC CA SD DE PM AB DEVs NN

47. Modelling and Simulation – M & S META – LEVEL: „SIMULATION ON THE MARKET“ HEALTH TECHNOLOGY ASSESSMENT – Using Simulation - Competitors DT MC CA SD DE PM AB DEVs NN

48. Modelling and Simulation – M & S HEALTH TECHNOLOGY ASSESSMENT Evaluation = Evidence Based Decision Making For Effective and Efficient Use of Ressources YES: Do not things without Benefit – “Make it Rational” NO: Deprive things with Benefit – “Rationalise”

49. Dissociation of Prooved Benefit of Costs for Medical Care

50. Modelling and Simulation – M & S M&S IN HEALTH TECHNOLOGY ASSESSMENT Problem 1: Goal Function - LYG, QLYG, ...