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Medical Decision Making
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Solid Recommendations from Soft Numbers

The Test/Treatment Decision

Robert F. Nease, JR.

Yann Bonduelle

The authors review the probability threshold approach to test/treatment decisions developed by Pauker and Kassirer, 6,7 emphasizing that certain aspects of the nature of medical decisions call for a new approach. The utility threshold approach, while maintaining all the advantages of threshold methods in general, brings improvements. It diminishes the need to accurately assess one of the decision's parameters: the patient's utility for the outcome states. For a simple case of one disease with three outcome states (cured, diseased, dead) and one test, three utility thresholds are derived. The treat/no treat threshold, denoted by u*, separates the utility space in two. If the patient's value for the diseased state is greater than u*, the analyst can feel confident in recommending the patient forego treatment. Similar interpre tations are developed for u1, the no treatment/test utility threshold (the value u must take, given a positive test result, for the patient to be indifferent between foregoing and receiving treatment), and u2, the test/treatment utility threshold (the value u must take, given a negative test result, for the patient to be indifferent between foregoing and receiving treatment). Key words: medical decision analysis; threshold analysis; utility threshold. (Med Decis Making 7:220-233, 1987)

Medical Decision Making, Vol. 7, No. 4, 220-233 (1987)
DOI: 10.1177/0272989X8700700404
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