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Decision-Analytic Modeling to Evaluate Benefits and Harms of Medical Tests: Uses and Limitations

Author

Listed:
  • Thomas A. Trikalinos

    (Tufts Evidence-based Practice Center and Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, Massachusetts, ttrikalin@mac.com)

  • Uwe Siebert

    (Department of Public Health, Medical Decision Making and Health Technology Assessment UMIT-University for Health Sciences, Medical Informatics and Technology, Hall I. T., Austria, Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical, School and Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts)

  • Joseph Lau

    (Tufts Evidence-based Practice Center and Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, Massachusetts)

Abstract

The clinical utility of medical tests is measured by whether the information they provide affects patient-relevant outcomes. To a large extent, effects of medical tests are indirect in nature. In principle, a test result affects patient outcomes mainly by influencing treatment choices. This indirectness in the link between testing and its downstream effects poses practical challenges to comparing alternate test-and-treat strategies in clinical trials. Keeping in mind the broader audience of researchers who perform comparative effectiveness reviews and technology assessments, the authors summarize the rationale for and pitfalls of decision modeling in the comparative evaluation of medical tests by virtue of specific examples. Modeling facilitates the interpretation of test performance measures by connecting the link between testing and patient outcomes, accounting for uncertainties and explicating assumptions, and allowing the systematic study of tradeoffs and uncertainty. The authors discuss challenges encountered when modeling test-and-treat strategies, including but not limited to scarcity of data on important parameters, transferring estimates of test performance across studies, choosing modeling outcomes, and obtaining summary estimates for test performance data.

Suggested Citation

  • Thomas A. Trikalinos & Uwe Siebert & Joseph Lau, 2009. "Decision-Analytic Modeling to Evaluate Benefits and Harms of Medical Tests: Uses and Limitations," Medical Decision Making, , vol. 29(5), pages 22-29, September.
    • Handle: RePEc:sae:medema:v:29:y:2009:i:5:p:e22-e29
    DOI: 10.1177/0272989X09345022
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    References listed on IDEAS

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    1. Jeroen G. Lijmer & Mariska Leeflang & Patrick M. M. Bossuyt, 2009. "Proposals for a Phased Evaluation of Medical Tests," Medical Decision Making, , vol. 29(5), pages 13-21, September.
    2. Uwe Siebert, 2003. "When should decision-analytic modeling be used in the economic evaluation of health care?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 4(3), pages 143-150, September.
    3. Sarah J. Lord & Les Irwig & Patrick M. M. Bossuyt, 2009. "Using the Principles of Randomized Controlled Trial Design to Guide Test Evaluation," Medical Decision Making, , vol. 29(5), pages 1-12, September.
    4. Nicola J. Cooper & Alex J. Sutton & Keith R. Abrams & David Turner & Allan Wailoo, 2004. "Comprehensive decision analytical modelling in economic evaluation: a Bayesian approach," Health Economics, John Wiley & Sons, Ltd., vol. 13(3), pages 203-226, March.
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    Cited by:

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