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To address controversies in the applications of cost-effectiveness analysis, we investigate the principles underlying the technique and discuss the implications for the evaluation of medical interventions. Using a standard von Neumann-Morgenstern utility framework, we show how a cost-effectiveness criterion can be derived to guide resource allocation(More)
Increased use of antibiotics in any community increases the risks that future bacterial strains will resist the effects of current antibiotics. The consequences of a resistant bacterial strain include costs for more expensive and powerful drugs, additional hospital days, and on rare occasion, death. A key to understanding the importance of this problem is(More)
BACKGROUND- Obstructive coronary artery disease diagnosis in symptomatic patients often involves noninvasive testing before invasive coronary angiography. A blood-based gene expression score (GES) was previously validated in nondiabetic patients referred for invasive coronary angiography but not in symptomatic patients referred for myocardial perfusion(More)
BACKGROUND Risk stratification for comparison of outcomes after coronary artery bypass grafting (CABG) typically includes only clinical measures of risk. Patient-reported health status may be an important independent predictor of short-term health outcomes. OBJECTIVE To determine whether patient-reported health status, as measured by the Physical and(More)
BACKGROUND Exercise testing with echocardiography or myocardial perfusion imaging is widely used to risk-stratify patients with suspected coronary artery disease. However, reports of diagnostic performance rarely adjust for referral bias, and this practice may adversely influence patient care. Therefore, we evaluated the potential impact of referral bias on(More)
We prospectively studied the relationship between interdisciplinary collaboration and patient outcomes in the medical intensive care unit (MICU) using nurses' and residents' reports of amount of collaboration involved in making decisions about transferring patients from the MICU to a unit with a less intense level of care. Either readmission to the MICU or(More)
Combining medical decision theory and epidemiologic information, the authors have developed a strategy to assess diagnostic technologies. For any patient, patient utilities with new diagnostic information are compared with the preferred fallback action absent that diagnostic information. After determination of whether the expected value of diagnostic(More)
This study uses Monte Carlo methods to analyze the consequences of having a criterion standard ("gold standard") that contains some error when analyzing the accuracy of a diagnostic test using ROC curves. Two phenomena emerge: 1) When diagnostic test errors are statistically independent from inaccurate ("fuzzy") gold standard (FGS) errors, estimated test(More)
BACKGROUND Recent studies have estimated the prevalence of hereditary hemochromatosis to be 3 to 8 per 1000. Early detection and treatment can prevent disease manifestations and normalize life expectancy. We used decision analysis techniques to determine whether screening the population at large for hereditary hemochromatosis would be cost-effective. (More)