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Markov Chain Monte Carlo Estimation of a Multiparameter Decision Model: Consistency of Evidence and the Accurate Assessment of Uncertainty

Medical Research Council, Health Services Research Collaboration, University of Bristol, Bristol, United Kingdom

S. Cliffe, MPH

Communicable Disease Surveillance Centre, Public Health Laboratory Service, Colindale, United Kingdom, and the Department of Epidemiology and Biostatistics, Institute of Child Health, University College London, London, United Kingdom

Decision models are usually populated 1 parameter at a time, with 1 item of information informing each parameter. Often, however, data may not be available on the parameters themselves but on several functions of parameters, and there may be more items of information than there are parameters to be estimated. The authors show how in these circumstances all the model parameters can be estimated simultaneously using Bayesian Markov chain Monte Carlo methods. Consistency of the information and/or the adequacy of the model can also be assessed within this framework. Statistical evidence synthesis using all available data should result in more precise estimates of parameters and functions of parameters, and is compatible with the emphasis currently placed on systematic use of evidence. To illustrate this, WinBUGS software is used to estimate a simple 9-parameter model of the epidemiology of HIV in women attending prenatal clinics, using information on 12 functions of parameters, and to thereby compute the expected net benefit of 2 alternative prenatal testing strategies, universal testing and targeted testing of high-risk groups. The authors demonstrate improved precision of estimates, and lower estimates of the expected value of perfect information, resulting from the use of all available data.

Key Words: evidence synthesis • decision analysis • Markov chain Monte Carlo • Bayesian methods • incremental net benefit • expected value of perfect information • epidemiology • HIV • screening

Medical Decision Making, Vol. 22, No. 4, 359-371 (2002)
DOI: 10.1177/0272989X0202200414


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