PMID: 8994158Jan 1, 1997Paper

Good technologies gone bad: how and why the cost-effectiveness of a medical intervention changes for different populations

Medical Decision Making : an International Journal of the Society for Medical Decision Making
C E Phelps

Abstract

Cost-effectiveness (CE) ratios vary considerably, not only across interventions, but within single interventions. Using a simple decision-tree model of the treat-vs no-treat decision to organize the analysis, four potential errors leading to these within-treatment differences in CE ratios are identified. These errors arise from estimates relating to 1) prior probabilities of disease; 2) treatment efficacies; 3) costs of treatment; and 4) patient preferences. Systematic biases, where present, suggest overuse of medical interventions. For diagnostic tests, two additional potential sources of error are considered (using a simple decision tree incorporating both test and treat decisions). These involve 5) sensitivity and specificity of the diagnostic test and 6) inappropriate choice of "cutoff" to determine abnormal patients, in part arising from errors in estimating prior probability of disease.

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Citations

Dec 26, 2001·Journal of Clinical Epidemiology·J L SeverensP F De Vries Robbé
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Jun 20, 2014·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Manuel A EspinozaMark J Sculpher
Apr 26, 2017·Medical Decision Making : an International Journal of the Society for Medical Decision Making·David D Kim, Anirban Basu
Feb 6, 2020·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Helen O'DonnellCathal Walsh
Mar 8, 1998·Journal of Health Services Research & Policy·S Bryan, J Brown

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