decision and sensitivity analysis - dr. gilmore

what is an application of analytical method for systematically comparing different decision options and assists with selecting the best/most cost-effective alternative?

decision analysis

list the steps for decision analysis

1. identify the specific decision

2. specify alternatives

3. draw the decision analysis structure

4. specify possible costs, outcomes, and probabilities

5. perform calculations

6. conduct a sensitivity analysis

list the components of step 1 of decision analysis: identify the specific decision

what is the objective of the study?

over what period of time will the analysis be conducted?

what is the perspective?

what can be compared in step 2 of decision analysis: specify alternatives? (SATA)

a. most effective treatments/alternatives

b. new product and standard treatment

c. more than 2 options

d. intervention vs. no intervention

a. b. c. d.

which kind of node is this: a choice is allowed (antibiotic A vs antibiotic B)?

a. choice node

b. chance node

c. terminal node

a.

what kind of node is this: chance comes into the equation (clinical success or clinical failure/ADR vs no ADR)?

a. choice node

b. chance node

c. terminal node

b.

what kind of node is this: the final outcome of interest for each option?

a. choice node

b. chance node

c. terminal node

c.

nodes are drawn on the decision analysis tree where _________

different options are available and branching of the tree then occurs

in step 4 of decision analysis, probabilites are assigned to each branch and must add up to _____ and consequences are reported as ______

must add up to 1 (100%)

consequences are reported as monetary outcomes, health related outcomes, or both

T/F the process to complete a decision analysis is fairly straight forward and can be done graphically

TRUE

decision analysis

at each terminal node, the probability of a patient having that outcome is calculated by multiplying the probability of each arm from the ________ to the ______

choice node to the terminal node

decision analysis

the total costs for each terminal node are calculated by adding up _________

the costs over all of the branches from the choice node to the terminal node

decision analysis

how do you calculate an incremental cost effectiveness ratio?

change in costs / change in outcomes

when conducting a sensitivity analysis _________ are inserted into the decision tree to determine a range of answers to ensure that your decision is sound based on uncertainty in some of the variables

high and low estimates

decision analysis

___________ can be used for a more accurate presentation of complex health scenarios that happen over a number of cycles or intervals

Markov Modeling

in Markov Modeling, each state is represented by a _______

a. circle

b. arrows

a.

in Markov Modeling, ______ connecting the states designate transitions

a. circle

b. arrows

b.

in Markov Modeling, what do states with an arrow back to itself indicate?

pt may remain in that state for more than 1 cycle

what retains study design, but mathematically manipulates the study variables and is used to determine the effect of data uncertainty or assumptions on the conclusions of the study?

a. decision analysis

b. sensitivity analysis

b.

what variables are most often tested with sensitivity analysis?

measures of drug effectiveness or efficacy

prevalence of adverse effects

resource unit costs

discount rates

list the types of sensitivity analysis

simple

threshold

analysis of extremes

monte carlo

what is the most common type of sensitivity analysis that helps improve generalizability of evaluation?

a. simple sensitivity

b. threshold

c. analysis of extremes

d. monte carlo

a.

what type of sensitivity analysis finds point at which two options are equal, needs actual data, and doesn’t work well with ratios?

a. simple sensitivity

b. threshold

c. analysis of extremes

d. monte carlo

b.

what type of sensitivity analysis compares best and worst case scenarios and is useful if extremes of data are known?

a. simple sensitivity

b. threshold

c. analysis of extremes

d. monte carlo

c.

what type of sensitivity analysis varies multiple variables within plausible ranges, but relies on a computer to do it?

a. simple sensitivity

b. threshold

c. analysis of extremes

d. monte carlo

d.

sensitivity analysis

what is a graphical display of one-way sensitivity analysis from the variables which change the answer the most to those that have the least impact?

tornado diagram

________ helps assess uncertainty within pharmacoeconomic evaluations

sensitivity analyses