Merck & Co., Inc., Kenilworth, NJ, USA.
, WP37A-150, PO Box 1000, West Point, PA, 19486, USA.
Pharmacoeconomics. 2022 May;40(5):497-507. doi: 10.1007/s40273-021-01123-5. Epub 2022 Feb 9.
Accounting for risk attitudes in medical decision making under uncertainty has attracted little research. A recent proposal recommended using the results of a cost-effectiveness analysis to construct a cost-effectiveness risk-aversion curve (CERAC) to inform risk-averse decision makers choosing among healthcare programs with uncertain costs and effects. The CERAC is based on a risk-adjusted performance measure widely used in financial economics called the Sortino ratio. This paper evaluates the CERAC based on the Sortino ratio, derives its various properties, discusses the implications of using it to inform decision making under uncertainty, and compares it with the expected-utility approach. Analytic formulae for the CERAC, relating it to the means and standard deviations of costs and effects of a healthcare program, are derived for both approaches. Compared with the expected-utility approach, the CERAC based on the Sortino ratio implicitly assumes that the decision maker is highly risk averse.
在不确定的医疗决策中考虑风险态度的问题，这方面的研究很少。最近有一项建议建议使用成本效益分析的结果来构建成本效益风险厌恶曲线（CERAC），以告知在具有不确定成本和效果的医疗保健计划中进行风险厌恶型决策的决策者。CERAC 基于金融经济学中广泛使用的风险调整绩效衡量指标，即索提诺比率。本文基于索提诺比率对 CERAC 进行评估，推导出它的各种特性，讨论了使用它在不确定情况下进行决策的意义，并将其与预期效用方法进行比较。针对这两种方法，推导出了 CERAC 的解析公式，将其与医疗保健计划的成本和效果的平均值和标准差联系起来。与预期效用方法相比，基于索提诺比率的 CERAC 隐含地假设决策者非常厌恶风险。
