Development of a Transparent Interactive Decision Interrogator to Facilitate the Decision-Making Process in Health Care
Development of a Transparent Interactive Decision Interrogator to Facilitate the Decision-Making Process in Health Care
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DOI：
10.1016/j.jval.2010.12.002
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发表时间：
2011-07-01
期刊：
影响因子：
4.5
通讯作者：
Sutton, Alex J.
中科院分区：
文献类型：
--
作者：
Bujkiewicz, Sylwia;Jones, Hayley E.;Sutton, Alex J.
背景：关于在卫生保健中使用新技术的决定往往基于复杂的经济模型。决策者经常对支持这些模型的证据、不确定性和假设作出非正式的判断。目的：透明的交互式决策询问器（TIDI）便于决策者对决策模型进行更正式的批评，例如英国国家健康和临床卓越研究所的评估委员会成员。通过允许他们在不同场景下实时运行高级统计模型，TIDI可以使决策过程更加高效和透明，同时避免对预先准备的分析的限制。方法：TIDI是用Visual Basic编写的，用于Excel内的应用程序，通过使用RExcel和R2WinBUGS链接软件包，提供了一个接口，用于控制在适当软件（例如Win-BUGS中的元分析和R中的决策模型）中开发的决策模型的所有组件。TIDI的图形化控件允许用户修改假设并运行决策模型，结果返回到Excel电子表格中。显示龙卷风图的工具有助于评估单个参数对模型结果的影响，交互式元分析模块允许用户选择可用研究的任何组合，探索偏差调整的影响，并使用森林图查看结果。我们用一个产前保健决策模型的例子来演示TIDI。结论：在NICE评估肿瘤坏死因子- α抑制剂（银屑病关节炎）的过程中，使用TIDI成功地证明了它能够促进决策者对决策模型的批评。
Background: Decisions about the use of new technologies in health care are often based on complex economic models. Decision makers frequently make informal judgments about evidence, uncertainty, and the assumptions that underpin these models. Objectives: Transparent interactive decision interrogator (TIDI) facilitates more formal critique of decision models by decision makers such as members of appraisal committees of the National Institute for Health and Clinical Excellence in the UK. By allowing them to run advanced statistical models under different scenarios in real time, TIDI can make the decision process more efficient and transparent, while avoiding limitations on pre-prepared analysis. Methods: TIDI, programmed in Visual Basic for applications within Excel, provides an interface for controlling all components of a decision model developed in the appropriate software (e. g., meta-analysis in Win-BUGS and the decision model in R) by linking software packages using RExcel and R2WinBUGS. TIDI's graphical controls allow the user to modify assumptions and to run the decision model, and results are returned to an Excel spreadsheet. A tool displaying tornado plots helps to evaluate the influence of individual parameters on the model outcomes, and an interactive meta-analysis module allows the user to select any combination of available studies, explore the impact of bias adjustment, and view results using forest plots. We demonstrate TIDI using an example of a decision model in antenatal care. Conclusion: Use of TIDI during the NICE appraisal of tumor necrosis factor-alpha inhibitors (in psoriatic arthritis) successfully demonstrated its ability to facilitate critiques of the decision models by decision makers.