Decision Making in Health and Medicine: Integrating Evidence and Values
Abstract
Decision making in health care involves consideration of a complex set of diagnostic, therapeutic and prognostic uncertainties. Medical therapies have side effects, surgical interventions may lead to complications, and diagnostic tests can produce misleading results. Furthermore, patient values and service costs must be considered. Decisions in clinical and health policy require careful weighing of risks and benefits and are commonly a trade-off of competing objectives: maximizing quality of life vs maximizing life expectancy vs minimizing the resources required. This text takes a proactive, systematic and rational approach to medical decision making. It covers decision trees, Bayesian revision, receiver operating characteristic curves, and cost-effectiveness analysis, as well as advanced topics such as Markov models, microsimulation, probabilistic sensitivity analysis and value of information analysis. It provides an essential resource for trainees and researchers involved in medical decision modelling, evidence-based medicine, clinical epidemiology, comparative effectiveness, public health, health economics, and health technology assessment.
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Within-cycle correction is an approach to reducing the biases introduced by discretization in discrete-time cSTMs.
“Another approach is to use within-cycle corrections (WCC).2,22”
From An Introductory Tutorial on Cohort State-Transition Models in R Using a Cost-Effectiveness Analysis Example (2023) · cites this paper as [22]
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Ali, Z. S., Bailey, R., Daniels, L. B., Vakhshori, V., Lewis, D., Hossain, A., Sitterley, K., Lee, J., Storm, P., Heuer, G., et al. (2014) · Journal of Neurosurgery: Pediatrics · doi:10.3171/2013.11.peds1320 · Cited by 42 · see citing works
Gøthesen, Ø., Slover, J., Havelin, L., Askildsen, J., Malchau, H., & Furnes, O. (2013) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-14-202 · Cited by 42
Koerkamp, B. G., Nikken, J., Oei, E. H., Stijnen, T., Ginai, A., & Hunink, M. G. M. (2008) · Radiology · doi:10.1148/radiol.2462070093 · Cited by 41
Self-citationCost-effectiveness of primary HPV screening for cervical cancer in Germany—a decision analysis
Sroczynski, G., Schnell-Inderst, P., Mühlberger, N., Lang, K., Aidelsburger, P., Wasem, J., Mittendorf, T., Engel, J., Hillemanns, P., Petry, K. U., et al. (2011) · European Journal of Cancer · doi:10.1016/j.ejca.2011.03.006 · Cited by 40 · see citing works
Trippoli, S. (2017) · European journal of internal medicine · doi:10.1016/j.ejim.2017.05.015 · Cited by 40 · see citing works
Alarid-Escudero, F., Krijkamp, E., Enns, E. A., Yang, A., Hunink, M. G. M., Pechlivanoglou, P., & Jalal, H. (2023) · Medical Decision Making · doi:10.1177/0272989x221103163 · Cited by 39 · see citing works
“2,22 In this tutorial, we use Simpson’s 1/3rd rule by multiplying the rewards (e.g., costs and effectiveness) by 1 / 3 in the first and last cycles, by 4 / 3 for the odd cycles, and by 2 / 3 for the even cycles.”
Self-citationAdvancing the Power of Economic Evidence to Inform Investments in Children, Youth, and Families
Steuerle, E., Jackson, L., Families, & Youth Board On Children (2016) · National Academies Press eBooks · doi:10.17226/23481 · Cited by 38 · see citing works
Nordby, H., & Nøhr, Ø. N. (2012) · Prehospital and Disaster Medicine · doi:10.1017/s1049023x1200026x · Cited by 38 · see citing works
Robinson, M., Palmer, S., Sculpher, M., Philips, Z., Ginnelly, L., Bowens, A., Golder, S., Alfakih, K., Bakhai, A., Packham, C., et al. (2005) · Health Technology Assessment · doi:10.3310/hta9270 · Cited by 38
Cost-effectiveness of Antivenoms for Snakebite Envenoming in Nigeria
Habib, A., Lamorde, M., Dalhat, M., Habib, Z., & Kuznik, A. (2015) · PLoS Neglected Tropical Diseases · doi:10.1371/journal.pntd.0003381 · Cited by 37
“41 [34,35].”
Evaluation and review of pharmacoeconomic models
Hay, J. (2004) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.5.9.1867 · Cited by 37 · see citing works
“A final modelling approach, known as Monte Carlo simulation, can be applied to any of the modelling methods already described, or to arbitrary model structures or modelling hybrids [23,24].”
MethodA case against default effect sizes in sport and exercise science
Caldwell, A., & Vigotsky, A. (2020) · PeerJ · doi:10.7717/peerj.10314 · Cited by 36 · see citing works
A cost analysis of Behcet's syndrome in Turkey.
Sut, N., Seyahi, E., Yurdakul, S., Şenocak, M., & Yazici, H. (2006) · Rheumatology · doi:10.1093/rheumatology/kel382 · Cited by 36
“The cost was analysed in two parts: direct and indirect costs [9–14].”
BackgroundMethodInfluentialLu, G., Brazier, J., & Ades, A. (2013) · Value in Health · doi:10.1016/j.jval.2012.07.003 · Cited by 36 · see citing works
“them into treatment effect estimates on the generic QOL scale [3–5].”
BackgroundWattson, D. A., Hunink, M. G. M., DiPiro, P., Das, P., Hodgson, D., Mauch, P., & Ng, A. (2014) · International Journal of Radiation Oncology, Biology, Physics · doi:10.1016/j.ijrobp.2014.06.013 · Cited by 35
“We constructed a Markov state transition model to evaluate the strategies of annual LDCT screening versus no screening among HL survivors, using Data TreeAge Pro 2013 (TreeAge Software, Inc, Williamstown, MA) (18).”
MethodSelf-citationManagement of patients with acoustic neuromas: A Markov decision analysis
Morrison, D. (2010) · The Laryngoscope · doi:10.1002/lary.20819 · Cited by 35
Bärnighausen, T., & Bloom, D. E. (2009) · Social Science & Medicine (1967) · doi:10.1016/j.socscimed.2008.11.009 · Cited by 35
Ofstad, E., Frich, J., Schei, E., Frankel, R., & Gulbrandsen, P. (2014) · Patient Education and Counseling · doi:10.1016/j.pec.2014.08.005 · Cited by 34 · see citing works
Eckermann, S., & Coelli, T. (2013) · Social Science & Medicine (1967) · doi:10.1016/j.socscimed.2012.10.020 · Cited by 34 · see citing works
Distraction from randomization in diagnostic research.
Biesheuvel, C., Grobbee, D., & Moons, K. (2006) · Annals of Epidemiology · doi:10.1016/j.annepidem.2005.10.004 · Cited by 33
Miksch, F., Jahn, B., Espinosa, K., Chhatwal, J., Siebert, U., & Popper, N. (2019) · PLoS ONE · doi:10.1371/journal.pone.0221564 · Cited by 32 · see citing works
van Kempen, B. V., Ferket, B., Steyerberg, E., Max, W., Hunink, M. G. M., & Fleischmann, K. (2016) · International Journal of Cardiology · doi:10.1016/j.ijcard.2015.10.171 · Cited by 32 · see citing works
Self-citationPandya, A., Weinstein, M., Salomon, J., Cutler, D. M., & Gaziano, T. (2014) · Circulation. Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.113.000397 · Cited by 31 · see citing works
“Strategies were ranked by cost, and then incremental cost-effectiveness ratios were calculated; inefficient strategies were ruled out by strong dominance (higher incremental costs and lower incremental QALYs) or weak dominance (if they had higher incremental costs per QALY than a more effective strategy) per conventio…”
MethodSelf-citationKapoor, A., Chuang, W., Radhakrishnan, N. S., Smith, K. J., Berlowitz, D., Segal, J., Katz, J. N., & Losina, E. (2012) · PharmacoEconomics (Auckland) · doi:10.2165/11535210-000000000-00000 · Cited by 30 · see citing works
Health related quality of life in genital herpes: a pilot comparison of measures
Fisman, D. (2005) · Sexually Transmitted Infections · doi:10.1136/sti.2004.011619 · Cited by 30 · see citing works
Effectiveness, benefit harm and cost effectiveness of colorectal cancer screening in Austria
Jahn, B., Sroczynski, G., Bundo, M., Mühlberger, N., Puntscher, S., Todorović, J., Rochau, U., Oberaigner, W., Koffijberg, H., Fischer, T., et al. (2019) · BMC Gastroenterology · doi:10.1186/s12876-019-1121-y · Cited by 29 · see citing works
Should warfarin be discontinued before a dental extraction? A decision-tree analysis.
Balevi, B. (2010) · Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics · doi:10.1016/j.tripleo.2010.03.018 · Cited by 29 · see citing works
The Influence of Influence Diagrams in Medicine
Pauker, S., & Wong, J. (2005) · Decision Analytics · doi:10.1287/deca.1060.0060 · Cited by 29 · see citing works
“Of two recent texts that deal with decision modeling in medicine (Chapman and Sonnenberg 2000, Hunink et al. 2001), only one deals explicitly with the influence diagram representation, and only in passing; evaluation is not discussed, so it is really not presented as a practical tool (Chapman and…”
BackgroundSelf-citationPharmaceutical Benefit–Risk Communication Tools: A Review of the Literature
Way, D., Blazsin, H., Löfstedt, R., & Bouder, F. (2016) · Drug Safety · doi:10.1007/s40264-016-0466-1 · Cited by 29 · see citing works
Choice of a mechanical valve or a bioprosthesis for AVR: does CABG matter?
Puvimanasinghe, J., Takkenberg, J., Eijkemans, M., Steyerberg, E., van Herwerden, L. A., Grunkemeier, G., Habbema, J. F., & Bogers, A. (2003) · European Journal of Cardio-Thoracic Surgery · doi:10.1016/s1010-7940(03)00085-x · Cited by 28
“Further, it permits adjusting of hazards for the individual patient depending on prior events, thereby accommodating the variability with groups of subjects [15].”
Background
- Authors
- Hunink, M. G. M., Weinstein, M. C., Wittenberg, E., Drummond, M. F., Pliskin, J. S., Wong, J. B., & Glasziou, P. P.
- Affiliations
- Erasmus University Rotterdam (NL)
- Harvard University (US)
- University of York (GB)
- Ben-Gurion University of the Negev (IL)
- Tufts University (US)
- Bond University (AU)
- ORCID
- Venue
- Cambridge University Press eBooks
- Publisher
- Cambridge University Press
- Published
- 2014-10-05
- OpenAlex
- W3023658191
- Cited by
- 425
- References
- 0
- Citations by year
- 2026: 17 · 2025: 25 · 2024: 17 · 2023: 23 · 2022: 37 · 2021: 37 · 2020: 35 · 2019: 22 · 2018: 24 · 2017: 18 · 2016: 17 · 2015: 17 · 2014: 20 · 2013: 11 · 2012: 11
- FWCI
- 31.10
- Type
- book
- Language
- en
- Open access
- closed
- Locations
- Cambridge University Press eBooks (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Keywords
- clinical decision-making, clinical decision analysis, decision tree, receiver operating characteristic, cost-effectiveness analysis, Markov model, microsimulation, probabilistic sensitivity analysis, value of information analysis, health policy, risk-benefit trade-off, diagnostic uncertainty, treatment side effects, health economics, health technology assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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