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Medical Decision Making
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What's this?

Development of a Clinical Prediction Model to Calculate Patient Life Expectancy: The Measure of Actuarial Life Expectancy (MALE)

M.G. Clarke, MD, MRCS

Department of General Surgery & Urology, Taunton & Somerset Hospital, Musgrove Park, Taunton, UK, mgclarkey{at}doctors.org.uk

K.P. Kennedy, MRCS

Department of General Surgery & Urology, Taunton & Somerset Hospital, Musgrove Park, Taunton, UK

R.P. MacDonagh, MD, FRCS

Department of General Surgery & Urology, Taunton & Somerset Hospital, Musgrove Park, Taunton, UK

Objectives. To develop a clinical prediction model enabling the calculation of an individual patient's life expectancy (LE) and survival probability based on age, sex, and comorbidity for use in the joint decision-making process regarding medical treatment. Methods. A computer software program was developed with a team of 3 clinicians, 2 professional actuaries, and 2 professional computer programmers. This incorporated statistical spreadsheet and database access design methods. Data sources included life insurance industry actuarial rating factor tables (public and private domain), Government Actuary Department UK life tables, professional actuarial sources, and evidence-based medical literature. The main outcome measures were numerical and graphical display of comorbidity-adjusted LE; 5-, 10-, and 15-year survival probability; in addition to generic UK population LE. Results. Nineteen medical conditions, which impacted significantly on LE in actuarial terms and were commonly encountered in clinical practice, were incorporated in the final model. Numerical and graphical representations of statistical predictions of LE and survival probability were successfully generated for patients with either no comorbidity or a combination of the 19 medical conditions included. Validation and testing, including actuarial peer review, confirmed consistency with the data sources utilized. Conclusions. The evidence-based actuarial data utilized in this computer program design represent a valuable resource for use in the clinical decision-making process, where an accurate objective assessment of patient LE can so often make the difference between patients being offered or denied medical and surgical treatment. Ongoing development to incorporate additional comorbidities and enable Web-based access will enhance its use further.

Key Words: life expectancy • actuarial analysis • comorbidity • computer-assisted decision making.

This version was published on March 1, 2009

Medical Decision Making, Vol. 29, No. 2, 239-246 (2009)
DOI: 10.1177/0272989X08327114
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