heor-agent-mcp 1.4.0 → 1.4.1

This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
@@ -1 +1 @@
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- {"version":3,"file":"countryRegistry.d.ts","sourceRoot":"","sources":["../../src/jca/countryRegistry.ts"],"names":[],"mappings":"AAAA;;;;;;;;;GASG;AACH,OAAO,KAAK,EAEV,cAAc,EAEd,kBAAkB,EAClB,YAAY,EAEZ,eAAe,EAChB,MAAM,YAAY,CAAC;AAEpB,eAAO,MAAM,YAAY,EAAG,SAAkB,CAAC;AAkL/C,eAAO,MAAM,gBAAgB,EAAE,MAAM,CAAC,YAAY,EAAE,cAAc,CAoBjE,CAAC;AAEF;;;GAGG;AACH,wBAAgB,kBAAkB,CAAC,UAAU,EAAE,MAAM,GAAG,kBAAkB,CAgEzE;AAED,wBAAgB,UAAU,CAAC,YAAY,EAAE,YAAY,GAAG,cAAc,CAErE;AAED,wBAAgB,0BAA0B,CACxC,QAAQ,EAAE,kBAAkB,GAC3B,eAAe,EAAE,CAEnB"}
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+ {"version":3,"file":"countryRegistry.d.ts","sourceRoot":"","sources":["../../src/jca/countryRegistry.ts"],"names":[],"mappings":"AAAA;;;;;;;;;GASG;AACH,OAAO,KAAK,EAEV,cAAc,EAEd,kBAAkB,EAClB,YAAY,EAEZ,eAAe,EAChB,MAAM,YAAY,CAAC;AAEpB,eAAO,MAAM,YAAY,EAAG,SAAkB,CAAC;AAyT/C,eAAO,MAAM,gBAAgB,EAAE,MAAM,CAAC,YAAY,EAAE,cAAc,CAoBjE,CAAC;AAEF;;;GAGG;AACH,wBAAgB,kBAAkB,CAAC,UAAU,EAAE,MAAM,GAAG,kBAAkB,CA6EzE;AAED,wBAAgB,UAAU,CAAC,YAAY,EAAE,YAAY,GAAG,cAAc,CAErE;AAED,wBAAgB,0BAA0B,CACxC,QAAQ,EAAE,kBAAkB,GAC3B,eAAe,EAAE,CAEnB"}
@@ -20,6 +20,20 @@ function ibdOutcomePriority() {
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  function chronicOutcomePriority() {
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  return ["HRQoL", "remission", "AE", "other"];
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  }
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+ function hfrefOutcomePriority() {
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+ // EuroQol Annex II preference + DAPA-HF / EMPEROR-Reduced primary
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+ // composite. CV death and HF hospitalization sit at the top of the
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+ // patient-relevant outcomes hierarchy for HFrEF; HRQoL via KCCQ/EQ-5D
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+ // is a key secondary.
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+ return [
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+ "CV_death",
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+ "HF_hospitalization",
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+ "all_cause_mortality",
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+ "HRQoL",
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+ "NYHA_progression",
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+ "AE",
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+ ];
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+ }
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  function outcomePriorityFor(category) {
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  if (category === "oncology_nsclc" || category === "oncology_other") {
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  return oncologyOutcomePriority();
@@ -27,6 +41,9 @@ function outcomePriorityFor(category) {
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  if (category === "ibd_uc" || category === "ibd_cd") {
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  return ibdOutcomePriority();
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  }
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+ if (category === "cardiovascular_hfref") {
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+ return hfrefOutcomePriority();
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+ }
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  return chronicOutcomePriority();
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  }
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  function nsclcSecondLineComparators(country) {
@@ -105,6 +122,112 @@ function genericComparators(country, category) {
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  },
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  ];
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  }
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+ /**
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+ * Per-country comparator universe for HFrEF. Curated against the dapagliflozin
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+ * + empagliflozin + sacubitril-valsartan reimbursement landscape (post-TA679,
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+ * post-TA773, post-TA388). Closes the per-country-depth gap design log #15
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+ * exposed when Claude.ai's HFrEF dossier had country-specific zVT detail
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+ * (DE 3 zVT scenarios, FR ASMR vs SMR, NL ARNI-eligible vs ineligible) but
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+ * HEORAgent's `jca_pico_scope` returned the generic "country-specific SoC"
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+ * placeholder. See design log #18.
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+ *
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+ * Each country has multiple distinct comparator entries reflecting either
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+ * the zVT structure that body uses (Germany's G-BA defines several zVT
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+ * scenarios per indication and rates each separately) or the value
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+ * framework's distinct comparator universes (HAS evaluates SMR against
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+ * placebo-on-GDMT and ASMR against the in-class active comparator).
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+ */
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+ function cardiovascularHfrefComparators(country) {
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+ const instruments = instrumentsFor("cardiovascular_hfref");
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+ // Common in-class active comparator across most jurisdictions
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+ const empa = {
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+ molecule: "empagliflozin",
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+ rationale: `In-class SGLT2 inhibitor active comparator (NICE TA773 / EMPEROR-Reduced). ITC via DAPA-HF + EMPEROR-Reduced or Zannad 2020 IPD pooled meta-analysis (Lancet) is the standard route in ${country.toUpperCase()}.`,
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+ outcome_instrument_preferences: instruments,
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+ };
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+ // Common comparator: optimised GDMT placebo (ACEi/ARB + beta-blocker + MRA)
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+ const gdmtAceI = {
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+ molecule: "ACEi/ARB-based GDMT (no SGLT2i)",
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+ rationale: `Optimised standard care: ACE inhibitor or ARB + beta-blocker + MRA, without SGLT2 inhibitor. Represents the trial control arm of DAPA-HF (placebo + GDMT). Used as the SMR / cost-utility anchor.`,
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+ outcome_instrument_preferences: instruments,
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+ };
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+ // ARNI-based GDMT (sacubitril-valsartan replacing ACEi/ARB per ESC 2021)
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+ const gdmtArni = {
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+ molecule: "ARNI-based GDMT (sacubitril-valsartan + beta-blocker + MRA, no SGLT2i)",
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+ rationale: `ESC 2021 / NICE TA388-aligned optimised GDMT with ARNI replacing ACEi/ARB. Distinct ${country.toUpperCase()} sub-population: ARNI-eligible patients on optimised therapy without SGLT2i.`,
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+ outcome_instrument_preferences: instruments,
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+ };
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+ if (country === "de") {
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+ // G-BA / IQWiG: zVT typically defines 2-3 patient-relevant scenarios.
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+ // For HFrEF + SGLT2i, the canonical zVT split is by background therapy
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+ // (ACEi/ARB-based vs ARNI-based) and by in-class comparator (empa).
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+ return [gdmtAceI, gdmtArni, empa];
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+ }
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+ if (country === "fr") {
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+ // HAS: distinguishes SMR (medical service rendered, vs placebo+GDMT)
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+ // and ASMR (added benefit, vs in-class active comparator).
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+ return [
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+ {
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+ molecule: "ARNI-based GDMT (no SGLT2i) — for SMR",
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+ rationale: `HAS SMR anchor: optimised standard care including sacubitril-valsartan where appropriate. Reflects DAPA-HF placebo arm + ESC-aligned GDMT.`,
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+ outcome_instrument_preferences: instruments,
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+ },
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+ {
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+ molecule: "empagliflozin — for ASMR",
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+ rationale: `HAS ASMR anchor: in-class active comparator. The added benefit (vs Jardiance) drives ASMR rating. ITC via DAPA-HF + EMPEROR-Reduced.`,
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+ outcome_instrument_preferences: instruments,
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+ },
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+ ];
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+ }
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+ if (country === "it") {
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+ // AIFA: innovativeness criteria consider unmet need + clinical benefit
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+ // + quality of evidence. In-class active comparator features prominently
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+ // for the "added therapeutic value" assessment.
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+ return [gdmtAceI, empa];
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+ }
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+ if (country === "es") {
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+ // AEMPS / RedETS IPT: stepwise positioning. Spanish IPT typically describes
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+ // 1L ACEi/ARB + beta-blocker, 2L MRA, then SGLT2i add-on. Regional
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+ // (autonomous community) decisions can add restrictions post-IPT.
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+ return [
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+ {
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+ molecule: "ACEi/ARB + beta-blocker + MRA (no SGLT2i, no ARNI)",
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+ rationale: `Spanish IPT 1L/2L positioning: standard triple therapy without SGLT2i. Reflects the population for which dapagliflozin add-on is being considered.`,
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+ outcome_instrument_preferences: instruments,
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+ },
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+ empa,
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+ {
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+ molecule: "sacubitril-valsartan + beta-blocker + MRA",
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+ rationale: `Sometimes raised by autonomous communities as an alternative anchor given sacubitril-valsartan's established place in Spanish HFrEF therapy.`,
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+ outcome_instrument_preferences: instruments,
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+ },
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+ ];
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+ }
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+ if (country === "nl") {
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+ // ZIN: ARNI-eligible vs ARNI-ineligible/intolerant is a typical
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+ // sub-population split because the cost-utility differs materially.
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+ return [
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+ {
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+ molecule: "ARNI-based GDMT (no SGLT2i) — ARNI-eligible patients",
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+ rationale: `ZIN sub-population: patients eligible for and tolerant of sacubitril-valsartan. Anchor uses ARNI in background.`,
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+ outcome_instrument_preferences: instruments,
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+ },
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+ {
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+ molecule: "ACEi/ARB-based GDMT (no SGLT2i) — ARNI-ineligible patients",
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+ rationale: `ZIN sub-population: patients ineligible for or intolerant of sacubitril-valsartan. Anchor uses ACEi/ARB in background.`,
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+ outcome_instrument_preferences: instruments,
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+ },
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+ empa,
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+ ];
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+ }
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+ if (country === "uk") {
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+ // Post-Brexit context only — NICE TA679 already established empagliflozin
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+ // as a relevant in-class comparator; SoC includes ARNI per NG106.
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+ return [gdmtArni, empa];
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+ }
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+ // eu_other or unknown — degrade gracefully
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+ return [gdmtAceI, empa];
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+ }
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  function comparatorsFor(country, category, drug_class, line) {
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  if (category === "oncology_nsclc" && line === "second_line") {
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  return nsclcSecondLineComparators(country);
@@ -112,6 +235,9 @@ function comparatorsFor(country, category, drug_class, line) {
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  if (category === "ibd_uc") {
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  return ibdUcBiologicComparators(country);
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  }
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+ if (category === "cardiovascular_hfref") {
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+ return cardiovascularHfrefComparators(country);
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+ }
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  // Drug-class-aware fallback for unknown indications
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  if (category === "oncology_other" || category === "oncology_nsclc") {
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  const instruments = instrumentsFor(category);
@@ -223,6 +349,17 @@ export function classifyIndication(indication) {
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  }
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  if (x.includes("obesity") || x.includes("overweight"))
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  return "obesity";
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+ // HFrEF-specific (sub-class of cardiovascular). Detected when any of the
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+ // common phrasings appear. Match HFrEF before generic cardiovascular so
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+ // the more-specific category wins. Word boundaries prevent "hfref" from
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+ // matching "preferred" etc. — but it's also rare enough as a token that
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+ // a substring match is fine.
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+ if (x.includes("hfref") ||
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+ x.includes("heart failure with reduced ejection") ||
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+ x.includes("reduced ejection fraction") ||
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+ x.includes("heart failure reduced ejection")) {
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+ return "cardiovascular_hfref";
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+ }
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  if (x.includes("cardiovascular") ||
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  x.includes("heart failure") ||
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  x.includes("hypertension")) {
@@ -1 +1 @@
1
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1
+ 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@@ -1,7 +1,7 @@
1
1
  export type Jurisdiction = "de" | "fr" | "it" | "es" | "nl" | "uk" | "eu_other";
2
2
  export type DrugClass = "monoclonal_antibody" | "small_molecule" | "atmp_cell" | "atmp_gene" | "atmp_tissue" | "biosimilar" | "vaccine" | "radiopharmaceutical" | "other";
3
3
  export type LineOfTherapy = "first_line" | "second_line" | "third_line_plus" | "any";
4
- export type OutcomePriority = "OS" | "PFS" | "HRQoL" | "AE" | "remission" | "other";
4
+ export type OutcomePriority = "OS" | "PFS" | "HRQoL" | "AE" | "remission" | "CV_death" | "HF_hospitalization" | "all_cause_mortality" | "NYHA_progression" | "other";
5
5
  export interface ComparatorEntry {
6
6
  molecule: string;
7
7
  rationale: string;
@@ -16,7 +16,7 @@ export interface CountryProfile {
16
16
  comparators: (indication_category: IndicationCategory, drug_class: DrugClass, line: LineOfTherapy) => ComparatorEntry[];
17
17
  population_subgroups: (indication_category: IndicationCategory) => string[];
18
18
  }
19
- export type IndicationCategory = "oncology_nsclc" | "oncology_other" | "ibd_uc" | "ibd_cd" | "diabetes_t2" | "obesity" | "cardiovascular" | "rheumatology" | "neurology" | "rare_disease" | "infectious_disease" | "other";
19
+ export type IndicationCategory = "oncology_nsclc" | "oncology_other" | "ibd_uc" | "ibd_cd" | "diabetes_t2" | "obesity" | "cardiovascular" | "cardiovascular_hfref" | "rheumatology" | "neurology" | "rare_disease" | "infectious_disease" | "other";
20
20
  export interface PicoMatrix {
21
21
  drug: string;
22
22
  indication: string;
@@ -1 +1 @@
1
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package/package.json CHANGED
@@ -1,6 +1,6 @@
1
1
  {
2
2
  "name": "heor-agent-mcp",
3
- "version": "1.4.0",
3
+ "version": "1.4.1",
4
4
  "mcpName": "io.github.neptun2000/heor-agent",
5
5
  "license": "MIT",
6
6
  "author": "mnaumov",