Uncertainty and the value of diagnostic information, with application to axillary lymph node dissection in breast cancer

Giovanni Parmigiani

Research output: Contribution to journalArticlepeer-review

Abstract

In clinical decision making, it is common to ask whether, and how much, a diagnostic procedure is contributing to subsequent treatment decisions. Statistically, quantification of the value of the information provided by a diagnostic procedure can be carried out using decision trees with multiple decision points, representing both the diagnostic test and the subsequent treatments that may depend on the test's results. This article investigates probabilistic sensitivity analysis approaches for exploring and communicating parameter uncertainty in such decision trees. Complexities arise because uncertainty about a model's inputs determines uncertainty about optimal decisions at all decision nodes of a tree. We present the expected utility solution strategy for multistage decision problems in the presence of uncertainty on input parameters, propose a set of graphical displays and summarization tools for probabilistic sensitivity analysis in multistage decision trees, and provide an application to axillary lymph node dissection in breast cancer.

Original languageEnglish (US)
Pages (from-to)843-855
Number of pages13
JournalStatistics in Medicine
Volume23
Issue number5
DOIs
StatePublished - Mar 15 2004

Keywords

  • Decision trees
  • Early breast cancer treatment
  • Expected utility
  • Probabilistic sensitivity analysis
  • Sequential decision making

ASJC Scopus subject areas

  • Epidemiology

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