Decision analysis

H. Raiffa, Decision Analysis—Introductory Tectures on Choices Under Uncertainty, Addison-Wesley, Rea ding, Mass., 1970. 

Weighted scoring methods, such as Kepner-Tregoe Decision Analysis and the Analytical Hierarchy Process (AHP)... 

TenBrook JA. Wolf MP. Hoffmann SN. Rosenwasser LJ. Konstam MA. Salem DN Should (3-blockers be given to patients with heart disease and peanut-induced anaphylaxis A decision analysis. J Allergy Clin Immunol 2004 113 977-982. 

Decision Analysis Approaches Relevant to R D Planning and Improvement... 

Explain the basis of decision analysis in R D management applications, including the use of multiple criteria... 

The best modeling framework for R D options is, however, more contentious. The famous, or infamous, Black-Scholes formula [8], based on valuation of traded hnancial options, has in our view impeded the practical use of decision analysis methods by scientihc managers ... 

DECISION ANALYSIS APPROACHES RELEVANT TO R D PLANNING AND IMPROVEMENT... 

R D management tends to be dominated by a project management paradigm, and most organizations develop systems based upon standard project management software, for example, Microsoft Project . This is very useful for project control, but of much less help in decision support. John Gittins claimed in 1997 [10] that very few pharmaceutical companies practice use of decision analysis in planning their work. Decisions tend to be made only for a baseline plan, and typically... 

Options analysis is a technique that can deal with such contingencies. It is a form of decision analysis that includes chance variables, initially hidden, representing states of nature that can be uncovered, in whole or in part, through a decision to carry out research. Such research creates options—the ability to progress, or abandon, one of several courses of action. This research might be technical or market research, in applications of option analysis to R D planning. 

When trade-offs exist, no single compound will stand out uniquely as the optimum drug for the market, ranked hrst on all measures of performance. Rather, a set of compounds will be considered that, on current knowledge, span the optimal solution to the problem. These compounds are those for which there is no other compound that offers equivalent performance across all criteria and superior performance in at least one. In multicriteria decision analysis (MCDA) terminology, they are known as Pareto-optimal solutions. This concept is illustrated by the two-criteria schematic in Figure 11.3. 

Any formal models of the conduct of research work and success are often soft or fuzzy in nature, and so may be distrusted by those used to hard evidence. There is a particular distrust of opaque, black box solutions, and numerate managers rightly demand to see the detailed assumptions made in any decision analysis. The most controversial assumptions tend to be those about project future costs, chance of success, and potential value within drug... 

Weinstein M, Fineberg H, Elstein A, et al. Clinical decisions and limited resources. In Weinstein M, editor. Clinical decision analysis. Philadelphia Saunders, 1980. pp. 228-265. 

Beck J, Salem D, Estes N, Pauker S. A computer-based Markov decision analysis of the management of symptomatic bifascicular block the threshold probability for pacing. J Am Coll Cardiol 1987 9 920-35. 

Byrom WD, Garratt CJ, Kilpatrick AT (1998b). Influence of antipsychotic profile on cost of treatment of schizophrenia a decision analysis approach. Inti J Psychiatry Clin Prac. 

Palmer CS, Revicld DA, Genduso LA, et al (1998). A cost-effectiveness clinical decision analysis model for schizophrenia. Am J Managed Care 4, 345-55. 

Decision analytic models, or simulation models of clinical decision analysis, usually involve the creation of a treatment decision/outcome tree based on a synthesis of expert opinion, sometimes using validated methods of canvassing opinion such as recruiting a Delphi panel (Hatziandreu et al, 1994 Einarson et al, 1995). The decision tree... 

In comparing drugs, a P T committee might use three different approaches inventory management, cost accounting, and clinical decision analysis [22]. The inventory management model assumes that all agents in a class are equivalent on safety, efficacy, and... 

Sarasin, F.P. and H. Bounameaux, "Decision Analysis Model of Prolonged Oral Anticoagulant Treatment in Factor V Leiden Carriers with First Episode of Deep Vein Thrombosis," BMJ, 316, 95-99 (1998). 

Palvia, S. C. and S. R. Gordon. Tables, Trees, and Formulas in Decision Analysis. Com-munA CM35, 104-113 (1992). 

Decision analysis provides a formal theory for choosing among alternatives whose consequences are uncertain. The key idea in decision analysis is the use of judgmental probability as a general way to quantify uncertainty. Decision analysis has been widely taught and practiced in the business community for more than a decade (2 -4). It provides a natural way to extend cost-benefit analysis to include uncertainty. 

This paper will summarize briefly some work my colleagues and I at Decision Focus Incorporated have carried out for EPA to show how decision analysis might be used to assist decision making under TSCA ( 5). I will first briefly review the concepts of quantitative risk assessment and cost-benefit analysis to show how decision analysis fits with these concepts and provides a natural way of extending them. Then I will illustrate the approach using a case study on a specific chemical, perchloroethylene. 

Decision Analysis. An alternative to making assumptions that select single estimates and suppress uncertainties is to use decision analysis methods, which make the uncertainties explicit in risk assessment and risk evaluation. Judgmental probabilities can be used to characterize uncertainties in the dose response relationship, the extent of human exposure, and the economic costs associated with control policies. Decision analysis provides a conceptual framework to separate the questions of information, what will happen as a consequence of control policy choice, from value judgments on how much conservatism is appropriate in decisions involving human health. 

I now shall present a summary of an application of decision analysis to a specific chemical, perchloroethylene (PCE), a widely used dry cleaning solvent (also called tetrachloroethylene). Full details of this application are presented in an EPA report (5). Perchloroethylene was selected for us by the staff of the EPA Office of Toxic Substances as representative of chemicals on which EPA needed to make an unreasonable risk determination under TSCA. Our analysis was carried out as an exercise in methodology development and not to support any specific regulatory activities by EPA concerning perchloroethylene. 

Our assignment for EPA was to apply quantitative risk analysis methods to the determination of risk for a particular chemical. The health risks for perchloroethylene turned out to be highly uncertain, but by using decision analysis concepts we were able to display this uncertainty in terms of alternative assumptions about the dose response relationship. Similar methods might be used to characterize uncertainties about human exposure to a chemical agent or about the costs to producers and consumers of a restriction on chemical use. 

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