Decision making in health care involves consideration of a complex set of diagnostic, therapeutic and prognostic uncertainties. Medical therapies have side effects, surgical interventions may lead to complications, and diagnostic tests can produce misleading results. Furthermore, patient values and service costs must be considered. Decisions in clinical and health policy require careful weighing of risks and benefits and are commonly a trade-off of competing objectives: maximizing quality of life vs maximizing life expectancy vs minimizing the resources required. This text takes a proactive, systematic and rational approach to medical decision making. It covers decision trees, Bayesian revision, receiver operating characteristic curves, and cost-effectiveness analysis, as well as advanced topics such as Markov models, microsimulation, probabilistic sensitivity analysis and value of information analysis. It provides an essential resource for trainees and researchers involved in medical decision modelling, evidence-based medicine, clinical epidemiology, comparative effectiveness, public health, health economics, and health technology assessment.
- Draws on evidence-based medicine, comparative effectiveness research, and health technology assessment, demonstrating the interdisciplinary nature of medical decision making
- Uses concepts from clinical medicine, public health, clinical epidemiology, biostatistics, health economics, psychology
- The accompanying website contains practical supplementary material for class assignments and as an aid to better understanding
Reviews & endorsements
Review of previous edition: 'This is an impressively comprehensive approach to clinical decision-making with every angle considered, advantages and disadvantages tabulated … there is a great deal of knowledge and information in these chapters, presented with masses of detailed mathematical and statistical analysis.' Journal of the Royal Society of Medicine
Review of previous edition: '… once I started to read the book, I was gripped. It is very readable, making a complex subject appear crystal clear and easy to understand … this book is a very useful addition to the literature on evidence-based health care, providing clear strategies for incorporating decision analysis into our daily decision making.' Family Practice
Review of previous edition: 'This book would be a useful acquisition for a statistician who needs the basics of decision-making, and it would certainly be a good book for a non-statistician.' Pharmaceutical Statistics
Table of Contents
About the authors
List of abbreviations
1. Elements of decision making in health care
2. Managing uncertainty
3. Choosing the best treatment
4. Valuing outcomes
5. Interpreting diagnostic information
6. Deciding when to test
7. Multiple test results
8. Finding and summarizing the evidence
9. Constrained resources
10. Recurring events
11. Estimation, calibration and validation
12. Heterogeneity and uncertainty
13. Psychology of judgment and choice
M. G. Myriam Hunink, Erasmus Universiteit Rotterdam
M. G. Myriam Hunink is Professor of Clinical Epidemiology and Radiology, Departments of Epidemiology and Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands, and Adjunct Professor of Health Decision Sciences, Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA, USA.
Milton C. Weinstein, Harvard University, Massachusetts
Milton C. Weinstein is the Henry J. Kaiser Professor of Health Policy and Management and Biostatistics at the Harvard School of Public Health, and Professor of Medicine at the Harvard Medical School, Harvard University, Boston, MA, USA.
Eve Wittenberg, Harvard School of Public Health, Massachusetts
Eve Wittenberg is a Senior Research Scientist at the Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA.
Michael F. Drummond, University of York
Michael F. Drummond is Professor of Health Economics and former Director of the Centre for Health Economics at the University of York, York, UK.
Joseph S. Pliskin, Ben Gurion University of the Negev, Israel
Joseph S. Pliskin is the Sidney Liswood Professor of Health Care Management at Ben-Gurion University of the Negev, Beer-Sheva, Israel, and Adjunct Professor in the Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA.
John B. Wong, Tufts University, Massachusetts
John B. Wong is Chief of the Division of Clinical Decision Making, Tufts Medical Center, and Professor of Medicine, Tufts University School of Medicine, Boston, MA, USA.
Paul P. Glasziou, Bond University, Queensland
Paul P. Glasziou is Professor of Evidence-Based Medicine, and Director, Centre for Research in Evidence-Based Practice, Bond University, Australia, and Honorary Professor at the Universities of Oxford and Sydney.