title: Development of a transparent interactive decision interrogator to facilitate the decision-making process in health care.
abstract: BACKGROUND
  Decisions about the use of new technologies in health care are often based on complex economic models. Decision makers frequently make informal judgments about evidence, uncertainty, and the assumptions that underpin these models.
  
  
  OBJECTIVE
  Transparent interactive decision interrogator (TIDI) facilitates more formal critique of decision models by decision makers such as members of appraisal committees of the National Institute for Health and Clinical Excellence in the UK. By allowing them to run advanced statistical models under different scenarios in real time, TIDI can make the decision process more efficient and transparent, while avoiding limitations on pre-prepared analysis.
  
  
  METHODS
  TIDI, programmed in Visual Basic for applications within Excel, provides an interface for controlling all components of a decision model developed in the appropriate software (e.g., meta-analysis in WinBUGS and the decision model in R) by linking software packages using RExcel and R2WinBUGS. TIDI's graphical controls allow the user to modify assumptions and to run the decision model, and results are returned to an Excel spreadsheet. A tool displaying tornado plots helps to evaluate the influence of individual parameters on the model outcomes, and an interactive meta-analysis module allows the user to select any combination of available studies, explore the impact of bias adjustment, and view results using forest plots. We demonstrate TIDI using an example of a decision model in antenatal care.
  
  
  CONCLUSIONS
  Use of TIDI during the NICE appraisal of tumor necrosis factor-alpha inhibitors (in psoriatic arthritis) successfully demonstrated its ability to facilitate critiques of the decision models by decision makers.
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK. sb309@leicester.ac.uk
authors.forename: Sylwia
authors.initials: S
authors.lastname: Bujkiewicz
authors.forename: Hayley E
authors.initials: HE
authors.lastname: Jones
authors.forename: Monica C W
authors.initials: MC
authors.lastname: Lai
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Cooper
authors.forename: Neil
authors.initials: N
authors.lastname: Hawkins
authors.forename: Hazel
authors.initials: H
authors.lastname: Squires
authors.forename: Keith R
authors.initials: KR
authors.lastname: Abrams
authors.forename: David J
authors.initials: DJ
authors.lastname: Spiegelhalter
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Sutton
mesh_terms: D015535:Arthritis, Psoriatic / Q000188:drug therapy / Q000191:economics / Q000276:immunology; D015982:Bias; D003196:Computer Graphics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016527:Drug Costs; D019317:Evidence-Based Medicine / Q000191:economics / Q000706:statistics & numerical data; D005333:Fetus / Q000276:immunology; D006302:Health Services Research; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics / Q000627:therapeutic use; D018803:Models, Economic; D015233:Models, Statistical; D010043:Outcome and Process Assessment, Health Care / Q000191:economics; D011296:Prenatal Diagnosis / Q000191:economics; D012203:Rh Isoimmunization / Q000175:diagnosis / Q000191:economics / Q000276:immunology / Q000517:prevention & control; D012204:Rh-Hr Blood-Group System / Q000276:immunology; D018029:Rho(D) Immune Globulin / Q000191:economics / Q000627:therapeutic use; D012984:Software; D013673:Technology Assessment, Biomedical / Q000191:economics / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D035501:Uncertainty; D006113:United Kingdom; D014584:User-Computer Interface
chemical_list: D007166:Immunosuppressive Agents; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin; C026410:Rho(D) antigen; D014409:Tumor Necrosis Factor-alpha