Using decision analytic methods to assess the utility of family history tools

Family history may be a useful tool for identifying people at increased risk of disease and for developing targeted interventions for individuals at higher-than-average risk. This article addresses the issue of how to examine the utility of a family history tool for public health and preventive medicine. We propose the use of a decision analytic framework for the assessment of a family history tool and outline the major elements of a decision analytic approach, including analytic perspective, costs, outcome measurements, and data needed to assess the value of a family history tool. We describe the use of sensitivity analysis to address uncertainty in parameter values and imperfect information. To illustrate the use of decision analytic methods to assess the value of family history, we present an example analysis based on using family history of colorectal cancer to improve rates of colorectal cancer screening.