Assessing multiple medication use with probabilities of benefits and harms.
OBJECTIVE
A quantitative framework to assess harms and benefits of candidate medications in the context of drugs that a patient is already taking is proposed.


METHODS
Probabilities of harms and benefits of a given medication are averaged to yield a utility value. The utility values of all medications under consideration are combined as a geometric mean to yield an overall measure of favorability. The grouping of medications yielding the highest favorability value is chosen.


RESULTS
Five examples of choosing between widely used candidate medications demonstrate the feasibility of the proposed framework.


CONCLUSIONS
The framework proposed provides a simple method for considering the trade-offs involved in prescribing multiple medications. It can be adapted to include additional parameters representing severity of condition, prioritization of outcomes, patient preferences, dosages, and medication interactions. Inconsistent reporting in the medical literature of data about benefits and harms of medications, dosages, and interactions constitutes its primary limitation.
Murphy
Terrence E
TE
Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. terrence.murphy@yale.edu
Agostini
Joseph V
JV
Van Ness
Peter H
PH
Peduzzi
Peter
P
Tinetti
Mary E
ME
Allore
Heather G
HG
D000368:Aged; D004358:Drug Therapy / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions; D006299:Health Services for the Aged / Q000706:statistics & numerical data; D006801:Humans; D015233:Models, Statistical; D019338:Polypharmacy; D014481:United States