Abstract
BackgroundThe threshold model represents one of the most significant advances in the field of medical decision‐making, yet it often does not apply to the most common class of clinical problems, which include health outcomes as a part of definition of disease. In addition, the original threshold model did not take a decision‐maker's values and preferences explicitly into account.MethodsWe reformulated the threshold model by (1) applying it to those clinical scenarios, which define disease according to outcomes that treatment is designed to affect, (2) taking into account a decision‐maker's values.ResultsWe showed that when outcomes (eg, morbidity) are integral part of definition of disease, the classic threshold model does not apply (as this leads to double counting of outcomes in the probabilities and utilities branches of the model). To avoid double counting, the model can be appropriately analysed by assuming diagnosis is certain (). This results in deriving a different threshold—the threshold for outcome of disease (M t ) instead of threshold for probability of disease (P t ) above which benefits of treatment outweigh its harms.We found that M t ≤ P t, which may explain differences between normative models and actual behaviour in practice. When a decision‐maker values outcomes related to benefit and harms differently, the new threshold model generates decision thresholds that could be descriptively more accurate.ConclusionsCalculation of the threshold depends on careful disease versus utility definitions and a decision‐maker's values and preferences.
Highlights
The development of threshold model[1] is considered as one of the most important advances in medical decision‐making.[2]
One possible reason for the difference between behaviour and the threshold model guidance is that people often violate expected utility theory (EUT) that served as a theoretical framework for derivation of the original threshold model.[3,4]
The threshold model is probably one of the most important advances in the field of medical decision‐making,[1,9] which links evidence with decision‐making.[2]
Summary
The development of threshold model[1] is considered as one of the most important advances in medical decision‐making.[2] It is a normative decision model, originally applied to diagnosis that calculates the probability of disease/diagnosis at which a decision‐maker should or ought to choose a treatment when no further diagnostic information is available.[1] the model has not been widely used in clinical practice because, as originally described from the expected utility theory (EUT) point of view, the probability of disease at which we should opt for. The terms such as disease events, outcomes, (dis)‐utilities, and risks of morbidity are often used interchangeably (see Appendix for definition)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
