Medical Decision Making: A Health Economic Primer

Preface to the Third Edition
Preface to the Second Edition
Preface to the First Edition
Contents
List of Figures
List of Tables
List of Boxes
1 Introduction
	1.1 Outline
	1.2 Notes
	References
2 Basic Tools in Medical Decision Making
	2.1 Prevalence, Incidence and Risk
	2.2 Discriminatory Power and Predictive Values
	2.3 Probability, Odds and the Likelihood Ratio
	2.4 Continuous Test Outcomes and Cut-off Values
	2.5 Notes
	2.6 Exercises
	References
3 Basic Tools in Economics: Preferences, Expected Utility, Risk Aversion  and Prudence
	3.1 Preferences and Utility
	3.2 Decisions Under Uncertainty: Menu of Actions, States of Nature and Consequences
	3.3 The Elementary Utility Function and the Expected Utility Rule
	3.4 The Axiom of Independence and the Expected Utility Rule
	3.5 The QALY Concept
	3.6 Risk Aversion
	3.7 Prudence
	3.8 Medical Decision Making: An Economic Perspective
	3.9 Non-Expected Utility Theories
	3.10 Notes
	3.11 Exercises
	References
4 Treatment Decisions
	4.1 The Treatment Decision under Diagnostic Risk
		4.1.1 The Treatment Threshold
		4.1.2 The Protective Effect of Treatment
		4.1.3 Risk Aversion and the Treatment Decision
		4.1.4 Preventive Treatment
		4.1.5 Choosing Between Several Treatments
	4.2 The Treatment Decision Under Therapeutic Risk
		4.2.1 The Treatment Success Probability Threshold
		4.2.2 Including the Protective Effect of Treatment
		4.2.3 The Role of Risk Aversion
		4.2.4 Choosing Between Several Treatments
	4.3 The Treatment Decision under Diagnostic and Therapeutic Risk
	4.4 Notes
	4.5 Exercises
	References
5 Test and Treatment Decisions
	5.1 The Value of Information of a Diagnostic Test
		5.1.1 The Perfect Test
		5.1.2 The Imperfect Test
		5.1.3 Decision Curve Analysis
		5.1.4 Threshold Analysis with Several Treatment Options
		5.1.5 Threshold Analysis with a Genetic Test
	5.2 Risk Attitude and the Test and Test-Treatment Thresholds
		5.2.1 The Perfect Test
		5.2.2 The Imperfect Test
	5.3 Testing Under the Therapeutic Risk
	5.4 The Test and Test-Treatment Thresholds when both the Diagnostic and the Therapeutic Risk are Present
	5.5 Potential Harm from a Test
	5.6 Notes
	5.7 Exercises
	References
6 Prudence and Medical Decision Making
	6.1 Prudence and the Treatment Threshold
	6.2 Prudence and the Test and Treatment Decisions
		6.2.1 The Perfect Test
		6.2.2 The Imperfect Test
	6.3 Prudence and Protection
	6.4 Prudence and Prevention
	6.5 Prudence and the Therapeutic Risk
	6.6 Notes
	6.7 Exercises
	References
7 Optimal Strategy for Multiple Diagnostic  Tests
	7.1 Choosing among Two Tests
	7.2 Combining Two Tests
	7.3 Test and Test-Treatment Thresholds for Composite Tests
	7.4 The Optimal Sequence of and Potential Harm from Testing
	7.5 Parallel or Sequential Testing?
	7.6 Notes
	7.7 Exercises
	References
8 The Optimal Cutoff of a Diagnostic Test
	8.1 Endogenous Test Characteristics
	8.2 The Optimal Cut-Off
	8.3 Test and Test-Treatment Thresholds and the Optimal Cut-Off
	8.4 Multiple Tests with Endogenous Sensitivity and Specificity: Triple Test and Amniocentesis
		8.4.1 The ROC Curve of the Triple Test
		8.4.2 The Value of Information and Optimal Use of the Triple Test with Amniocentesis
		8.4.3 Deciding on the Test Outcome
	8.5 Notes
	8.6 Exercises
	References
9 The Total Value of Information of a Test
	9.1 Exogenous Test Characteristics
		9.1.1 Performance as a Function of the Prior Probability of Disease
		9.1.2 Overall Performance
		9.1.3 A Social Perspective
	9.2 Endogenous Test Characteristics
		9.2.1 Performance as a Function of the Prior Probability of Disease
		9.2.2 Overall Performance
	9.3 Application to Prenatal Diagnostics
		9.3.1 Age-Specific Performance
		9.3.2 Overall Performance
	9.4 Notes
	9.5 Exercises
	References
10 The Economics of Medical Decision  Making
	10.1 Welfarism and Non-Welfarism
		10.1.1 The QALY Approach
		10.1.2 The Welfarist Approach
	10.2 The Diagnostic Risk
		10.2.1 The Treatment Decision
		10.2.2 Risk Aversion and the Treatment Decision
		10.2.3 Prudence and the Treatment Decision
		10.2.4 Treatment and Testing
		10.2.5 Treatment and Composite Testing
	10.3 The Therapeutic Risk
		10.3.1 Risk Aversion and the Treatment Decision
	10.4 Treatment Decision with Both Risks
	10.5 The Effect of Income, Health and Death on the Treatment Decision
	10.6 Notes
	10.7 Exercises
	References
11 Valuing Health and Life
	11.1 Treatment and Health
	11.2 Treatment and Survival
	11.3 The Value of Health and Life
	11.4 Optimal Allocation of Health Across Individuals
		11.4.1 The Health Model
		11.4.2 The Health-Survival Model
		11.4.3 The QALY Model
	11.5 Conclusion
	11.6 Appendix
	11.7 Notes
	11.8 Exercises
	References
12 Revealed Preference in Medical Decisions
	12.1 The Diagnostic Risk
		12.1.1 The Pauker–Kassirer Model
		12.1.2 Adding the Test Option
		12.1.3 The Protective Effect of Treatment
		12.1.4 Revealing a Lower Bound on the Value of Life
	12.2 The Therapeutic Risk
		12.2.1 The Eeckhoudt Model
		12.2.2 The Protective Effect of Treatment
	12.3 Regulation and Revealed Preferences
		12.3.1 Prenatal Diagnostics
		12.3.2 PSA Test
		12.3.3 Primary Prevention of Atherosclerotic Cardiovascular Disease
		12.3.4 Ventral Hernia Repairs: Laparoscopic or Open?
	12.4 Notes
	12.5 Exercises
	References
13 Imperfect Agency and Non-expected Utility Models
	13.1 Imperfect Physician Agency
	13.2 Non-expected Utility Theories Under Risk
	13.3 Non-expected Utility Theories Under Uncertainty
	13.4 Conclusion
	13.5 Notes
	13.6 Exercises
	References
References
Index