A pitfall in utility assessment--patients' undisclosed investment decisions.
Among those decisions that may be made by a patient in response to an illness, the authors single out a certain class: contingent investment decisions. They are characterized by the patient's committing him- or herself, on the basis of prognostic counseling, to a certain action or non-action that he or she may regret in retrospect. Examples show that, when assessing utilities, the decision analyst runs a risk of handling such investment decisions incorrectly, unless they are made explicit and incorporated into the medical decision process. The anomaly is explained as a violation of the structural rules for decision trees and is also interpreted in terms of "the price of prognostic ignorance," a quantity closely related to the expected utility value of perfect information.
Hilden
J
J
Institute of Medical Genetics (Biostatistics), University of Copenhagen, Denmark.
Glasziou
P P
PP
Habbema
J D
JD
D003142:Communication; D003376:Counseling / Q000592:standards; D003663:Decision Trees; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000592:standards; D010817:Physician-Patient Relations; D011379:Prognosis; D011788:Quality of Life; D026712:Value of Life