Improving Public Interpretation of Probabilistic Test Results: Distributive Evaluations
Health service users err in posttest probability evaluations. Here we document for the first time that users succeed when they reason about numbers of cases and make distributive evaluations. A sample of women interested in prenatal testing incorrectly evaluated the posttest probability that a given fetus had an anomaly, but regardless of their numeracy level, they correctly apportioned the cases for and against that hypothesis. This finding shows that health service users are not doomed to fail in dealing with single-case probabilities and suggests that probabilistic data can be used effectively for communicating test res...
Source: Medical Decision Making - December 17, 2014 Category: Health Management Authors: Pighin, S., Gonzalez, M., Savadori, L., Girotto, V. Tags: Brief Reports Source Type: research
Subjective Numeracy and Preference to Stay with the Status Quo
Conclusions: Subjective numeracy is independently associated with younger, but not older, RA patients’ preferences for the status quo. Our results add to the literature demonstrating age and numeracy differences in treatment preferences and medical decision-making processes. (Source: Medical Decision Making)
Source: Medical Decision Making - December 17, 2014 Category: Health Management Authors: Fraenkel, L., Cunningham, M., Peters, E. Tags: Brief Reports Source Type: research
Angelina Jolie and Medical Decision Science
(Source: Medical Decision Making)
Source: Medical Decision Making - December 17, 2014 Category: Health Management Authors: Bhatti, J., Redelmeier, D. A. Tags: Editorial Source Type: research
36th Annual Meeting of the Society for Medical Decision Making: Abstracts
(Source: Medical Decision Making)
Source: Medical Decision Making - December 17, 2014 Category: Health Management Tags: Web-Only Abstracts Source Type: research
Not Simply More of the Same: Distinguishing between Patient Heterogeneity and Parameter Uncertainty
In cost-effectiveness (CE) Markov models, heterogeneity in the patient population is not automatically taken into account. We aimed to compare methods of dealing with heterogeneity on estimates of CE, using a case study in chronic obstructive pulmonary disease (COPD). We first present a probabilistic sensitivity analysis (PSA) in which we sampled only from distributions representing parameter uncertainty. This ignores any heterogeneity. Next, we explored heterogeneity by presenting results for subgroups, using a method that samples parameter uncertainty simultaneously with heterogeneity in a single-loop PSA. Finally, we di...
Source: Medical Decision Making - October 17, 2014 Category: Health Management Authors: Vemer, P., Goossens, L. M. A., Rutten-van Molken, M. P. M. H. Tags: Original Articles Source Type: research
Early Benefit Assessment of Pharmaceuticals in Germany: Manufacturers' Expectations versus the Federal Joint Committee's Decisions
Conclusions. While the FJC tends to disagree with the rating of benefit by manufacturers, it softens IQWiG’s decisions, potentially to make the final outcome more acceptable. Concerns voiced that the FJC might be exceeding its statutory authority by taking cost or procedural considerations into account appear to be unfounded. Choosing appropriate evidence to submit for each endpoint remains a challenge, as submission of health outcomes evidently influences decisions. (Source: Medical Decision Making)
Source: Medical Decision Making - October 17, 2014 Category: Health Management Authors: Fischer, K. E., Stargardt, T. Tags: Original Articles Source Type: research
Opportunity Cost of Funding Drugs for Rare Diseases: The Cost-Effectiveness of Eculizumab in Paroxysmal Nocturnal Hemoglobinuria
Conclusions. This study demonstrates the feasibility of conducting economic evaluations in the context of rare diseases. Eculizumab may provide substantive benefits to patients with PNH in terms of life expectancy and quality of life but at a high incremental cost and a substantial opportunity cost. Decision makers should fully consider the opportunity costs before making positive reimbursement decisions. (Source: Medical Decision Making)
Source: Medical Decision Making - October 17, 2014 Category: Health Management Authors: Coyle, D., Cheung, M. C., Evans, G. A. Tags: Original Articles Source Type: research
Decision to Adopt Medical Technology: Case Study of Breast Cancer Radiotherapy Techniques
Conclusions. Technology adoption is based on financial and social pressures, along with often-limited scientific evidence and what seems "best" for patients. For technology adoption and diffusion to be rational and evidence-based, we must encourage appropriate financial payment models to curb use outside of research studies and promote development of additional treatment registries until sufficient evidence is gathered. (Source: Medical Decision Making)
Source: Medical Decision Making - October 17, 2014 Category: Health Management Authors: Gold, H. T., Pitrelli, K., Hayes, M. K., Murphy, M. M. Tags: Original Articles Source Type: research
Comparing Decisions for Malaria Testing and Presumptive Treatment: A Net Health Benefit Analysis
Conclusions. A threshold transmission rate exists under which malaria testing confers more health and financial benefits to patients than presumptive treatment. Studying local transmission rates and testing and treatment costs may facilitate an approach to align the interests of individual patients, public health officials, and distributors of tests and therapies. (Source: Medical Decision Making)
Source: Medical Decision Making - October 17, 2014 Category: Health Management Authors: Basu, S., Modrek, S., Bendavid, E. Tags: Original Articles Source Type: research
A Model to Support Shared Decision Making in Electronic Health Records Systems
This article discusses potential solutions, including the concept of a "personalize button" for EHRs. Leveraging a 4-phase clinical model for SDM, this article describes how computer decision support (CDS) technologies integrated into EHRs can help ensure that health care is delivered in a way that is respectful of those preferences. The architecture described herein, called CDS for SDM, is built on recognized standards that are currently integrated into certification requirements for EHRs as part of meaningful use regulations. While additional work is needed on modeling of preferences and on techniques for rapid communica...
Source: Medical Decision Making - October 17, 2014 Category: Health Management Authors: Lenert, L., Dunlea, R., Del Fiol, G., Hall, L. K. Tags: Original Articles Source Type: research
Are Waiting List Prioritization Guidelines Being Followed in Australia?
Conclusion. The presence of a simple clinical priority guideline at the procedural level has not produced systematic, clinically based prioritization behaviors among doctors. The New South Wales priority guideline has curtailed assignments to the highest priority. This result raises a question concerning the usefulness of such a guideline in improving timely and equitable access to health care. (Source: Medical Decision Making)
Source: Medical Decision Making - October 17, 2014 Category: Health Management Authors: Johar, M. Tags: Original Articles Source Type: research
STAR--People-Powered Prioritization: A 21st-Century Solution to Allocation Headaches
The aim of cost effectiveness analysis (CEA) is to inform the allocation of scarce resources. CEA is routinely used in assessing the cost-effectiveness of specific health technologies by agencies such as the National Institute for Health and Clinical Excellence (NICE) in England and Wales. But there is extensive evidence that because of barriers of accessibility and acceptability, CEA has not been used by local health planners in their annual task of allocating fixed budgets to a wide range of types of health care. This paper argues that these planners can use Socio Technical Allocation of Resources (STAR) for that task. S...
Source: Medical Decision Making - October 17, 2014 Category: Health Management Authors: Airoldi, M., Morton, A., Smith, J. A. E., Bevan, G. Tags: Original Articles Source Type: research
The Value of Heterogeneity for Cost-Effectiveness Subgroup Analysis: Conceptual Framework and Application
This study presents the expected net benefits under current and perfect information when subgroups are defined based on the use and combination of 6 binary covariates. The results of the case study confirm the theoretical expectations. As more subgroups are considered, the marginal net benefit gains obtained under the current information show diminishing marginal returns, and the expected value of perfect information shows a decreasing trend. We present a suggested algorithm that synthesizes the results to guide policy. (Source: Medical Decision Making)
Source: Medical Decision Making - October 17, 2014 Category: Health Management Authors: Espinoza, M. A., Manca, A., Claxton, K., Sculpher, M. J. Tags: Original Articles Source Type: research
Adopting Medical Technology
(Source: Medical Decision Making)
Source: Medical Decision Making - October 17, 2014 Category: Health Management Authors: Berliner, E. Tags: Editorials Source Type: research
Tackling Heterogeneity: The Full Costs Include Those of Research Necessary to Support the Analyses
(Source: Medical Decision Making)
Source: Medical Decision Making - October 17, 2014 Category: Health Management Authors: Phelps, C. E. Tags: Editorials Source Type: research
