Decision analysis: a basic overview for the pediatric surgeon

Decision making in medicine requires choosing the option that best maximizes benefit while minimizing risk and cost. Even though uncertainty is an inherent feature of any clinical issue, clinicians and policy makers frequently are required to evaluate the best evidence and make therapeutic or policy decisions based on that evidence. Decision analysis is a quantitative approach to decision making under conditions of uncertainty that can be applied to specific types of clinical problems. This method disaggregates a complex clinical problem into its most important components that then can be understood more easily and analyzed quantitatively. Decision analysis has many potential applications in medicine and can be applied to solve specific clinical problems, analyze health care costs, or develop health care policies. In this review, the basic methods for constructing and analyzing decision analyses will be presented, and specific applications of this method to pediatric surgery will be discussed.