Selecting treatments: a decision theoretic approach

The paper looks at the problem of comparing two treatments, for a particular population of patients, where one is the current standard treatment and the other a possible alternative under investigation. With limited (finite) financial resources the decision whether to replace one by the other will not be based on health benefits alone. This motivates an economic evaluation of the two competing treatments where the cost of any gain in health benefit is scrutinized; it is whether this cost is acceptable to the relevant authorities which decides whether the new treatment can become the standard. We adopt a Bayesian decision theoretic framework in which a utility function is introduced describing the consequences of making a particular decision when the true state of nature is expressed via an unknown parameter theta (this parameter denotes cost, effectiveness, etc.). The treatment providing the maximum posterior expected utility summarizes the decision rule, expectations taken over the posterior distribution of the parameter theta.