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The threshold model revisited.

Benjamin Djulbegovic1,2, Iztok Hozo3, Thomas Mayrhofer4

  • 1Department of Supportive Care Medicine, Department of Hematology, City of Hope National Medical Center, Duarte, California, USA.

Journal of Evaluation in Clinical Practice
|December 22, 2018
PubMed
Summary
This summary is machine-generated.

This study reformulates the threshold model for medical decision-making, accounting for disease definitions including health outcomes and decision-maker values. The revised model offers a more accurate threshold for treatment decisions, especially when outcomes are part of disease definition.

Keywords:
decision analysisdecision-makingevidence-based medicinethreshold model

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Area of Science:

  • Medical Decision-Making
  • Health Economics
  • Clinical Informatics

Background:

  • The classic threshold model is a significant advance in medical decision-making.
  • It has limitations in clinical scenarios where disease is defined by health outcomes.
  • The original model did not explicitly incorporate decision-maker values and preferences.

Purpose of the Study:

  • To reformulate the threshold model for broader clinical applicability.
  • To integrate health outcomes into the disease definition within the threshold model.
  • To explicitly account for decision-maker values and preferences.

Main Methods:

  • Reformulated the threshold model by applying it to clinical scenarios defining disease by outcomes.
  • Incorporated decision-maker values and preferences into the model.
  • Analyzed the model by assuming diagnosis certainty (P=1) to avoid outcome double-counting.

Main Results:

  • The classic threshold model is not applicable when outcomes are integral to disease definition, leading to double-counting.
  • A new threshold for disease outcomes (Mt) was derived, where Mt ≤ Pt (threshold for disease probability).
  • This revised threshold model can generate descriptively accurate decision thresholds by accounting for differing values of benefits and harms.

Conclusions:

  • Threshold model calculations are contingent on precise definitions of disease and utility.
  • Decision-maker values and preferences are critical for accurate threshold determination.
  • The reformulated model offers improved accuracy for clinical decision-making, particularly in outcome-defined diseases.