The Optimal Treatment Strategy---A Patient's Perspective

In this paper we present a general model that enables us to better understand the decision of a patient whether or not to participate in a treatment, and, if so, the optimal timing for the treatment, from his point of view. The model takes into account both "objective information" which represents medical technology as well as "subjective information" which represents the patient's preference. By doing so it is attuned to the school of thought that medical care is not required for its own sake but for the sake of its effect on health as perceived by the patient himself. The framework presented is used to analyze the optimal decision for the individual for several different cases: One disease-one treatment; one disease-several alternative treatments; many diseases-many treatments; direct payment vs. full insurance; and the effect of the possible future introduction of a better treatment. The optimal decision of treatment for the individual is also analyzed under different assumptions in relation to the parameters. For example, both quality of life in a state of disease and the probability of success of the treatment are constant versus the case where both decrease over time; the comparison between the use of population and individual mortality rates by individuals for decision making; and treatment affecting only quality of life vs. treatment which also affects the individual's life span. The most common decision that results from our model (especially when treatment affects only quality of life) is a bang-bang solution. That is, the optimal timing of a treatment is now or never.