Abstract | BACKGROUND: METHODS: We used decision analysis to combine published estimates of the probabilities of various adverse outcomes of treatment ( bleeding, pulmonary embolism, postphlebitic syndrome, and death) with the values patients placed on these outcomes. We questioned 36 patients about the values they attached to each outcome. Sixteen patients had had deep-vein thrombosis, and 20 had not. RESULTS: By the values they attached to the outcomes, all 36 patients indicated that they were unwilling to accept an increased risk of death to avoid postphlebitic syndrome. According to the decision analysis, heparin alone was the better treatment for all 36 patients. As compared with streptokinase plus heparin, heparin alone provided 29 days of additional life expectancy over the predicted life expectancy of 20 years. Although the difference between the two treatments was small, heparin alone remained the better treatment in sensitivity analyses that examined the reasonable ranges of probabilities of the clinical outcomes. CONCLUSIONS:
|
Authors | J J O'Meara 3rd, R A McNutt, A T Evans, S W Moore, S M Downs |
Journal | The New England journal of medicine
(N Engl J Med)
Vol. 330
Issue 26
Pg. 1864-9
(Jun 30 1994)
ISSN: 0028-4793 [Print] United States |
PMID | 8196729
(Publication Type: Journal Article, Meta-Analysis)
|
Chemical References |
|
Topics |
- Cerebral Hemorrhage
(chemically induced)
- Decision Support Techniques
- Heparin
(administration & dosage, adverse effects, therapeutic use)
- Humans
- Middle Aged
- Patient Participation
(statistics & numerical data)
- Postphlebitic Syndrome
(chemically induced)
- Probability
- Pulmonary Embolism
(chemically induced)
- Randomized Controlled Trials as Topic
- Risk
- Sensitivity and Specificity
- Streptokinase
(administration & dosage, adverse effects, therapeutic use)
- Thrombolytic Therapy
(adverse effects)
- Thrombophlebitis
(drug therapy)
- Treatment Outcome
|