Jalal Hawre, Goldhaber-Fiebert Jeremy D, Kuntz Karen M
Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California (HJ)
Center for Health Policy/Center for Primary Care & Outcomes Research, School of Medicine, Stanford University, Stanford, California (HJ, JDGF)
Med Decis Making. 2015 Jul;35(5):584-95. doi: 10.1177/0272989X15578125. Epub 2015 Apr 3.
Decision makers often desire both guidance on the most cost-effective interventions given current knowledge and also the value of collecting additional information to improve the decisions made (i.e., from value of information [VOI] analysis). Unfortunately, VOI analysis remains underused due to the conceptual, mathematical, and computational challenges of implementing Bayesian decision-theoretic approaches in models of sufficient complexity for real-world decision making. In this study, we propose a novel practical approach for conducting VOI analysis using a combination of probabilistic sensitivity analysis, linear regression metamodeling, and unit normal loss integral function--a parametric approach to VOI analysis. We adopt a linear approximation and leverage a fundamental assumption of VOI analysis, which requires that all sources of prior uncertainties be accurately specified. We provide examples of the approach and show that the assumptions we make do not induce substantial bias but greatly reduce the computational time needed to perform VOI analysis. Our approach avoids the need to analytically solve or approximate joint Bayesian updating, requires only one set of probabilistic sensitivity analysis simulations, and can be applied in models with correlated input parameters.
决策者通常既希望根据当前知识获得关于最具成本效益干预措施的指导,也希望了解收集更多信息以改善决策的价值(即通过信息价值[VOI]分析)。不幸的是,由于在足够复杂的模型中实施贝叶斯决策理论方法以用于现实世界决策时面临概念、数学和计算方面的挑战,VOI分析仍然未得到充分利用。在本研究中,我们提出了一种新颖的实用方法,通过结合概率敏感性分析、线性回归元建模和单位正态损失积分函数(一种VOI分析的参数方法)来进行VOI分析。我们采用线性近似并利用VOI分析的一个基本假设,即要求准确指定所有先验不确定性的来源。我们提供了该方法的示例,并表明我们所做的假设不会导致实质性偏差,但能大大减少执行VOI分析所需的计算时间。我们的方法避免了对联合贝叶斯更新进行解析求解或近似的需要,只需要一组概率敏感性分析模拟,并且可以应用于具有相关输入参数的模型。