Decision analysis: a practical example

Cancer treatment is often perceived as too toxic, ineffective, and costly, compared with other medical treatments. Decision analysis attempts to define the effectiveness of alternative strategies, then incorporates patient preferences and the cost of care to allow comparisons of cost effectiveness. The provider benefits by being forced to "quantify the qualifiers" and explicitly determine which treatment is better and by how much. The health economist can use decision analysis to allocate resources based on the maximum years of life gained for the least amount of dollars spent. Clinical trialists can use decision analysis to ask "what if" questions about different alternative strategies or assumptions of effectiveness, or to perform computer simulations of interesting but untried clinical trials. Providers and payers can use dollars per life-year gained as one index to help rationally allocate resources. The authors present a practical example of the uses of decision analysis in determining the value to society of high-dose chemotherapy for high-risk stage II breast cancer patients.