Skip to main content

Decision Analytic Techniques

  • Chapter
  • First Online:
Difficult Decisions in Thoracic Surgery
  • 975 Accesses

Abstract

Over the last decades, growth in biomedical and associated social sciences research has resulted in the accumulation of a large body of new and more reliable information on human health.1 This research has certainly played a key role in the unprecedented improvement of health throughout the world. It has also complicated decision making, both at the individual and at the policy level, by presenting clinicians and policy makers with an increasing number of choices of medical technologies and strategies for the management of a given medical situation. A fundamental concern in medical decision making is how to synthesize information about the effect of a medical intervention on patients with specific characteristics. An additional challenge, relevant mostly to clinical decision making, involves integrating population level evidence about outcomes with patient-level values for these outcomes in order to produce individualized care. Such individualized decisions for patients demand a systematic approach to sort through the evidence and to incorporate patients’ and their family members’ values and preferences into the decision making processes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Meltzer D. Can medical cost-effectiveness analysis identify the value of research? In: Murphy KM, Topel RH, eds. Measuring the Gains from Medical Research: An Economic Approach. Chicago, IL: University of Chicago Press. 2003:206–247.

    Chapter  Google Scholar 

  2. Pauker SG, Kassirer JP. Decision analysis. N Engl J Med. 1987; 316:250–257.

    Article  PubMed  CAS  Google Scholar 

  3. Weinstein MC, Fineberg HV. Clinical Decision Making. Philadelphia, PA: WB Saunders Company. 1980.

    Google Scholar 

  4. Petitti DB. Meta-analysis, Decision Analysis and Cost-Effectiveness Analysis. New York, NY: Oxford University Press; 1994.

    Google Scholar 

  5. Sackett DL, Rosenberg WM, Gray JA. Evidence based medicine: what it is, what it isn’t. BMJ. 1996;312:71–72.

    Article  PubMed  CAS  Google Scholar 

  6. Coutler A. Partnerships with patients: the pros and cons of shared clinical decision-making. J Health Serv Res. 1997;2:112–121.

    Google Scholar 

  7. Detsky AS, Naglie G, Krahn MD et al. Primer on medical decision analysis: getting started. Med Dec Making. 1997; 17:123–125.

    Article  CAS  Google Scholar 

  8. Eddy D. Clinical Decision Making: From Theory to Practice. Boston, MA: Jones & Bartlett Publishers, 1996.

    Google Scholar 

  9. von Neumann J, Morgenstern O. Theory of Games and Economic Behavior. 1953 ed. Princeton, NJ: Princeton University Press; 1944.

    Google Scholar 

  10. Ost D, Fein A. Management strategies for the solitary pulmonary nodule. Curr Opin Pulm Med. 2004; 10:272–278.

    Article  PubMed  Google Scholar 

  11. Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-Effectiveness in Health and Medicine. New York, NY: Oxford University Press; 1996.

    Google Scholar 

  12. Drummond M, Stoddard G, Torrence G. Methods of Economic Evaluation of Health Care Programmes. Oxford: Oxford University Press; 1987:6–26.

    Google Scholar 

  13. Torrence GW. Utility approach to measuring health-related quality of life. J Chron Dis. 1987;40:593–600.

    Article  Google Scholar 

  14. Torrence GW. Measurement of health state utilities for economic appraisal: a review. J Health Econ. 1986; 5:1–30.

    Article  Google Scholar 

  15. Lowson KV, Drummond MF, Bishop JM. Costing new services: long-term domiciliary oxygen therapy. Lancet. 1981;ii:1146–1149.

    Article  Google Scholar 

  16. Weinstein MC, Stason WB. Foundation of cost-effectiveness analysis for health and medical practices. N Eng J Med. 1977;296:716–721.

    Article  CAS  Google Scholar 

  17. Garber A, Phelps C. Economic Foundations of cost-effectiveness analysis. J Health Econ. 1997;16:1–32.

    Article  PubMed  CAS  Google Scholar 

  18. Weinstein M, Zeckhauser R. Critical ratios and efficient allocation. J Pub Econ. 1973;2:147–158.

    Article  Google Scholar 

  19. Basu A, Meltzer D. Implications of spillover effects within the family for medical cost-efectiveness analysis. J Health Econ. 2005;24:751–773.

    Article  PubMed  Google Scholar 

  20. Alexander GC; Casalino LP; Meltzer DO. Patient-physician communication about out-of-pocket costs. JAMA. 2003;290:953–958.

    Article  PubMed  Google Scholar 

  21. Alexander GC; Casalino LP; Meltzer DO. Physician strategies to reduce patients’ out-of –pocket prescription costs. Arch Intern Med. 2005;165:633–636.

    Article  PubMed  Google Scholar 

  22. Detsky AS, Naglie G, Krahn MD et al. Primer on medical decision analysis: Building a tree. Med Dec Making. 1997;17:126–135.

    Article  CAS  Google Scholar 

  23. Bayes T. An Essay towards solving a problem in the doctrine of chances. Philos Transact Roy Soc. 1763;330–418. Reprinted, with biographical note by GA Barnard in Biometrika. 1958;45:293–315.

    Google Scholar 

  24. Pratt JW. Bayesian interpretation of standard inference statements (with discussions). J R Stat Soc B. 1965;27:169–203.

    Google Scholar 

  25. Ferguson MK, Lehman AG. Sleeve lobectomy or pneumonectomy: optimal management strategy using decision analysis techniques. Ann Thorac Surg. 2003;76:1782–1788.

    Article  PubMed  Google Scholar 

  26. Morimoto T, Tsuguya F, Koyama H et al. Optimal strategy for the first episode of primary spontaneous pneumothorax in young men. J Gen Intern Med. 2002;17:193–202.

    Article  PubMed  Google Scholar 

  27. Falcoz PE, Binquet C, Clement F et al. Management of the second episode of spontaneous pneumothorax: a decision analysis. Ann Thorac Surg. 2003;76:1843–1848.

    Article  PubMed  Google Scholar 

  28. Porter G, Cantor S, Walsh G et al. Cost-effectiveness of pulmonary resection and systemic chemotherapy in the management of metastatic soft tissue sarcoma: A combined analysis from the University of Texas M.D. Anderson and Memorial Sloan-Kettering Cancer Centers. J Thorac Cardiovasc Surg. 2004;127:1366–1372.

    Article  PubMed  Google Scholar 

  29. Martini N, Rusch V, Bains, MS et al. Factors influencing ten-year survival in resected stages I to IIIa non-small cell lung cancer. J Thorac Cardiovasc Surg. 1999;117:32–36.

    Article  PubMed  CAS  Google Scholar 

  30. Olak J, Detsky A. Surgical decision analysis: esophagectomy/esophagogastrectomy with or without drainage? Ann Thorac Surg. 1992;53:493–497.

    Article  PubMed  CAS  Google Scholar 

  31. Cheung HC, Siu KF, Wong J. Is pyloroplasty necessary in esophageal replacement by stomach? A prospective, randomized controlled trial. Surgery. 1987;102:19–24.

    PubMed  CAS  Google Scholar 

  32. Goldie SJ, Kuntz KM, Weinstein MC et al. Cost-effectiveness of screening for anal squamous intraepithelial lesions and anal cancer in human immunodeficiency virus-negative homosexual and bisexual men. Am J Med. 2000;108:634–641.

    Article  PubMed  CAS  Google Scholar 

  33. Goldie SJ, Weinstein MC, Kuntz KM et al. The costs, clinical benefits, and cost-effectiveness of screening for cervical cancer in HIV-infected women. Ann Intern Med. 1999;130:97–107.

    Article  PubMed  CAS  Google Scholar 

  34. Goldie SJ, Kuhn L, Denny L et al. Policy analysis of cervical cancer screening strategies in low-resource settings: clinical benefits and cost-effectiveness. JAMA. 2001;285:3107–3115.

    Article  PubMed  CAS  Google Scholar 

  35. Zeliadt SB, Etzioni RD, Penson DF et al. Lifetime implications and cost-effectiveness of using finasteride to prevent prostate cancer. Am J Med. 2005;118:850–857.

    Article  PubMed  CAS  Google Scholar 

  36. Manser R, Dalton A, Carter R et al. Cost-effectiveness analysis of screening for lung cancer with low dose spiral CT (computed tomography) in the Australian setting. Lung Cancer. 2005;48:171–185.

    Article  PubMed  Google Scholar 

  37. Briggs AH, Goeree R, Blackhouse G et al. Probabilistic analysis of cost-effectiveness models: choosing between treatment strategies for gastroesophageal reflux disease. Med Dec Making. 2002;22:290–308.

    Google Scholar 

  38. Congdon P. Bayesian Statistical Modeling. Chichester, England/New York: Wiley; 2001.

    Google Scholar 

  39. Tweedie RL, Scott DJ, Biggerstaff BJ et al. Bayesian meta-analysis, with application to studies of ETS and lung cancer. Lung Cancer. 1996;14(suppl 1):S171–S194.

    Article  PubMed  Google Scholar 

  40. Meltzer D. Addressing uncertainty in medical cost-effectiveness analysis: Implications of expected utility maximization for methods to perform sensitivity analysis and the use of cost-effectiveness analysis to set priorities for medical research. J Health Econ. 2001;20:109–129.

    Article  PubMed  CAS  Google Scholar 

  41. Claxton K. The irrelevance of inference: a decision making approach to the stochastic evaluation of health care technologies. J Health Econ. 1999;18:341–364.

    Article  PubMed  CAS  Google Scholar 

  42. Claxon K, Neumann PJ, Araki S. et al. Bayesian value of information analysis: An application to a policy model of Alzheimer’s disease. Int J Tech Ass Health Care. 2001;17:38–55.

    Article  Google Scholar 

  43. Kennedy AD, Sculpher MJ, Coulter A et al. Effects of decision aids for menorrhagia on treatment choices, health outcomes, and costs: a randomized controlled trial. JAMA. 2002;288:2701–2708.

    Article  PubMed  Google Scholar 

  44. Basu A. Value of information on preference heterogeneity and individualized care. Med Dec Making. 2007;27:112–127.

    Article  Google Scholar 

  45. Dominioni L, Imperatore A, Rovera F et al. Stage I non small cell lung carcinoma, analysis of survival and implications for screening. Suppl Cancer. 2000;89:2334–2344.

    Article  CAS  Google Scholar 

  46. Swensen SJ, Silverstein MD, Ilstrup DM et al. The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules. Arch Intern Med. 1997;157:849–855.

    Article  PubMed  CAS  Google Scholar 

  47. Wisnivesky JP, Yankelevitz D, Henschke CI. Stage of lung cancer in relation to its size. Chest. 2005;127:1136–1139.

    Article  PubMed  Google Scholar 

  48. Ginsberg RJ, Hill LD, Eagan RT et al. Modern thirty-day operative mortality for surgical resections in lung cancer. J Thorac Cardiovasc Surg. 1983;86:654–658.

    PubMed  CAS  Google Scholar 

  49. Stéphan F, Boucheseiche S, Hollande J et al. Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest. 2000;118:1263–1270.

    Article  PubMed  Google Scholar 

  50. Barrera R, Shi W, Amar D et al. Smoking and timing of cessation: impact on pulmonary complications after thorocatomy. Chest. 2005;127:1977–1983.

    Article  PubMed  Google Scholar 

  51. Chadha AS, Ganti AK, Sohi JS et al. Survival in untreated early stage non-small cell lung cancer. Anticancer Res. 2005;25:3517–3520.

    PubMed  Google Scholar 

  52. McGarry RC, Song G, des Rosiers P et al. Observation-only management of early stage, medically inoperable lung cancer: poor outcome. Chest. 2002;121:1155–1158

    Article  PubMed  Google Scholar 

  53. U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.

    Google Scholar 

  54. Arias E. United States Life Tables, 2002. National Vital Statistics Reports. Hyattsville, MD: National Center for Health Statistics; 2004:53(6).

    Google Scholar 

  55. English DR, Holman CDJ, Milne E et al. The Quantification of Drug Caused Morbidity and Mortality in Australia. Canberra: Commonwealth Department of Human Services and Health; 1995

    Google Scholar 

Download references

Acknowledgements

We are grateful to Caleb G. Alexander and William Dale at the University of Chicago for helpful comments and suggestions.

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag London Limited

About this chapter

Cite this chapter

Basu, A., Lehman, A. (2011). Decision Analytic Techniques. In: Ferguson, M. (eds) Difficult Decisions in Thoracic Surgery. Springer, London. https://doi.org/10.1007/978-1-84996-492-0_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-84996-492-0_3

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84996-364-0

  • Online ISBN: 978-1-84996-492-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics