Assessing multiple medication use with probabilities of benefits and harms.

Abstract

A quantitative framework to assess harms and benefits of candidate medications in the context of drugs that a patient is already taking is proposed. Probabilities of harms and benefits of a given medication are averaged to yield a utility value. The utility values of all medications under consideration are combined as a geometric mean to yield an overall measure of favorability. The grouping of medications yielding the highest favorability value is chosen. Five examples of choosing between widely used candidate medications demonstrate the feasibility of the proposed framework. The framework proposed provides a simple method for considering the trade-offs involved in prescribing multiple medications. It can be adapted to include additional parameters representing severity of condition, prioritization of outcomes, patient preferences, dosages, and medication interactions. Inconsistent reporting in the medical literature of data about benefits and harms of medications, dosages, and interactions constitutes its primary limitation.