Cost-effectiveness Analysis with Influence Diagrams

Methods of Information in Medicine
M Arias, F J Díez

Abstract

Cost-effectiveness analysis (CEA) is used increasingly in medicine to determine whether the health benefit of an intervention is worth the economic cost. Decision trees, the standard decision modeling technique for non-temporal domains, can only perform CEA for very small problems. To develop a method for CEA in problems involving several dozen variables. We explain how to build influence diagrams (IDs) that explicitly represent cost and effectiveness. We propose an algorithm for evaluating cost-effectiveness IDs directly, i.e., without expanding an equivalent decision tree. The evaluation of an ID returns a set of intervals for the willingness to pay - separated by cost-effectiveness thresholds - and, for each interval, the cost, the effectiveness, and the optimal intervention. The algorithm that evaluates the ID directly is in general much more efficient than the brute-force method, which is in turn more efficient than the expansion of an equivalent decision tree. Using OpenMarkov, an open-source software tool that implements this algorithm, we have been able to perform CEAs on several IDs whose equivalent decision trees contain millions of branches. IDs can perform CEA on large problems that cannot be analyzed with decision ...Continue Reading

References

Mar 31, 1977·The New England Journal of Medicine·M C Weinstein, W B Stason
May 5, 1998·Medical Decision Making : an International Journal of the Society for Medical Decision Making·D A AschM T Mennuti
May 5, 1998·Medical Decision Making : an International Journal of the Society for Medical Decision Making·A A Stinnett, J Mullahy
Mar 11, 2009·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·Milton C WeinsteinAlistair McGuire
Aug 1, 2014·PharmacoEconomics·Manuel Arias, Francisco Javier Díez
Jan 28, 2016·BMC Medical Informatics and Decision Making·Manuel LuqueCarlos Disdier

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Citations

Jan 12, 2017·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Francisco J DíezJorge Pérez-Martín
Nov 7, 2018·Journal of Innovation in Health Informatics·Tanisha Tate WoodsonDeborah J Cohen
Jun 16, 2021·Artificial Intelligence in Medicine·Francisco Javier DíezJorge Pérez-Martín

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