LLM-based Agent Simulation for Maternal Health Interventions: Uncertainty Estimation and Decision-focused Evaluation

Abstract

Agent-based simulation is crucial for modeling complex human behavior, yet traditional approaches require extensive domain knowledge and large datasets. In data-scarce healthcare settings where historic and counterfactual data are limited, large language models (LLMs) offer a promising alternative by leveraging broad world knowledge. This study examines an LLM-driven simulation of a maternal mobile health program, predicting beneficiaries' listening behavior when they receive health information via automated messages (control) or live representatives (intervention). Since uncertainty quantification is critical for decision-making in health interventions, we propose an LLM epistemic uncertainty estimation method based on binary entropy across multiple samples. We enhance model robustness through ensemble approaches, improving F1 score and model calibration compared to individual models. Beyond direct evaluation, we take a decision-focused approach, demonstrating how LLM predictions inform intervention feasibility and trial implementation in data-limited settings. The proposed method extends to public health, disaster response, and other domains requiring rapid intervention assessment under severe data constraints. All code and prompts used for this work can be found at https://github.com/sarahmart/LLM-ABS-ARMMAN-prediction.