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Review The data for medical decision
analyses are often unrealiable. Traditional sensitivity analysis—varying one
or more probability or utility estimates from baseline values to see if the
optimal strategy changes—is cumbersome if more than two values are allowed
to vary concurrently. This paper describes a practical method for
probabilistic sensitivity analysism in which uncertainties in all values are
considered simultaneously. The uncertainty in each probability and utility
is assumed to possess a probability distribution. For ease of application we
specified by two values: the baseline estimate and a bound (upper or lower)
of the 95 percent confidence interval. Following multiple simulations of the
decision tree in which each probability and utility is randomly assigned a
value within its distribution, the following results are recorded: (a) the
mean and standard deviation of the expected utility of each strategy; (b)
the frequency with which each strategy is optimal; (c) the frequency with
which each strategy “buys” or “costs” a specified amount of utility relative
to the remaining strategies. As illustrated by an application to a
previously published decision analysis, this technique is easy to use and
can be a valuable addition to the armamentarium of the decision analyst. |