The role of decision-analytic models in the prevention, diagnosis and treatment of coronary heart disease.
BACKGROUND
The rapidly expanding number and scope of health technologies used in the prevention, diagnosis, and treatment of coronary heart disease present physicians and policy makers with complex decisions that must be made even under uncertainty about the risks and benefits of these procedures. A physician must determine which procedures offer the best trade-off between potential harm and benefit, and yield the maximum expected health benefit for the patient. In addition, the cost-effectiveness of alternative choices must be considered to optimize resource allocations from a societal perspective, further complicating the decision making process.


METHODS
Decision analysis is the application of explicit and quantitative methods to analyze decisions under conditions of uncertainty. Briefly, the basic concepts of decision analysis and cost-effectiveness analysis are described. Three examples of decision-analytic models for the prevention, diagnosis, and treatment of coronary heart disease are discussed to demonstrate situations in which decision analysis may be helpful, and to introduce different methodological approaches.


CONCLUSIONS
Decision analysis may aid clinical decisions affecting individual patients as well as inform clinical policy decisions and decisions regarding national health policy. However, this method is not a complete procedure for determining resource allocation decisions in health care, because it cannot incorporate all the values relevant to such decisions.
Siebert
Uwe
U
Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians University of Munich, Marchioninistr. 15 81377 Munich, Germany. sieb@lrz.uni-muenchen.de
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control / Q000628:therapy; D003362:Cost-Benefit Analysis; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006291:Health Policy; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D040841:Resource Allocation; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome