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Uncertainty and Patient Heterogeneity in Medical Decision Models

Author

Listed:
  • Bas Groot Koerkamp

    (Department of Surgery at Academic Medical Center, Amsterdam, The Netherlands, Program for the Assessment of Radiological Technology, Departments of Radiology and Epidemiology, Erasmus MC, Rotterdam, The Netherlands)

  • Milton C. Weinstein

    (Program in Health Decision Sciences, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts)

  • Theo Stijnen

    (Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands)

  • M.H. Heijenbrok-Kal

    (Program in Health Decision Sciences, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts)

  • M.G. Myriam Hunink

    (Program for the Assessment of Radiological Technology, Departments of Radiology and Epidemiology, Erasmus MC, Rotterdam, The Netherlands, m.hunink@erasmusmc.nl)

Abstract

Parameter uncertainty, patient heterogeneity, and stochastic uncertainty of outcomes are increasingly important concepts in medical decision models. The purpose of this study is to demonstrate the various methods to analyze uncertainty and patient heterogeneity in a decision model. The authors distinguish various purposes of medical decision modeling, serving various stakeholders. Differences and analogies between the analyses are pointed out, as well as practical issues. The analyses are demonstrated with an example comparing imaging tests for patients with chest pain. For complicated analyses step-by-step algorithms are provided. The focus is on Monte Carlo simulation and value of information analysis. Increasing model complexity is a major challenge for probabilistic sensitivity analysis and value of information analysis. The authors discuss nested analyses that are required in patient-level models, and in nonlinear models for analyses of partial value of information analysis.

Suggested Citation

  • Bas Groot Koerkamp & Milton C. Weinstein & Theo Stijnen & M.H. Heijenbrok-Kal & M.G. Myriam Hunink, 2010. "Uncertainty and Patient Heterogeneity in Medical Decision Models," Medical Decision Making, , vol. 30(2), pages 194-205, March.
    • Handle: RePEc:sae:medema:v:30:y:2010:i:2:p:194-205
    DOI: 10.1177/0272989X09342277
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    References listed on IDEAS

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    5. Cannon, Jeffrey W. & Mueller, Ute A. & Hornbuckle, Janet & Larson, Ann & Simmer, Karen & Newnham, John P. & Doherty, Dorota A., 2013. "Economic implications of poor access to antenatal care in rural and remote Western Australian Aboriginal communities: An individual sampling model of pregnancy," European Journal of Operational Research, Elsevier, vol. 226(2), pages 313-324.

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