Decision analysis in cardiac surgery: a scoping review and methodological primer

Area of Science:

• Medical research methodology
• Health economics
• Cardiac surgery

Background:

• Randomized controlled trials (RCTs) are limited in generalizability and scope.
• Decision analysis (DA) models can simulate trials and extend analyses for clinical and economic outcomes.
• Cardiac surgery research can benefit from advanced modeling techniques.

Purpose of the Study:

• To conduct a scoping review of decision analysis studies in cardiac surgery.
• To present a methodological primer on decision analysis for cardiac surgery research.

Main Methods:

• Scoping review of cardiac surgery DA studies published up to December 2021.
• Searches conducted in PubMed/MEDLINE, EMBASE, and Web of Science.
• Descriptive summarization of trends and methodological consistency.

Main Results:

• 184 articles were identified, with Markov models being the most common (50.0%).
• Key outcomes included costs (58.2%), quality-adjusted life-years (52.2%), and incremental cost-effectiveness ratios (48.4%).
• Sensitivity analyses were frequent (89.7%), but guideline reporting was limited (22.3%).

Conclusions:

• Decision analysis methods are increasingly used but show variability in cardiac surgery.
• A methodological primer is provided to aid researchers and reviewers in DA application and evaluation.