Decision Analysis in Obstetrics and Gynecology

Abstract

After completion of this article, the reader should be able to summarize that decision analysis will: help to compare different medical choices; supply additional perspectives to information provided by observational and interventional studies; and allow comparison of medical strategies that involve health outcomes, cost, or combined cost-effectiveness measures.

Clinical decision analysis and model‐based economic evaluation studies in perinatology: A systematic review

“…Consideration should be given to obtaining utilities for combined maternal‐fetal health states using the standard gamble and involving pregnant women and their partners/family members . Reporting inconsistencies related to costs did not always adhere to published standards: “Charges” are not representative of the actual economic consequences of an event and any estimates obtained as charges should be converted to costs by using appropriate cost:charge ratio for each estimate. Similarly, all costs should use equivalent units, ie, expressed in the same currency and from the same year.…”

“…Fewer studies described and reported other attributes adequately: assessment of structural uncertainty (70%), cycle length (60%), external consistency (58%), quality of utilities (54%), disease states/pathways (38%), assessment of parameter uncertainty (35%), source of costs (31%), treatment effects (30%), time horizon (26%), assessment of heterogeneity (4%), assessment of methodological uncertainty (0%) and internal consistency (0%). Reporting inconsistencies related to costs did not always adhere to published standards: 16 "Charges" are not representative of the actual economic consequences of an event and any estimates obtained as charges should be converted to costs by using appropriate cost:charge ratio for each estimate. Similarly, all costs should use equivalent units, ie, expressed in the same currency and from the same year.…”

Pelvic Floor Consequences of Cesarean Delivery on Maternal Request in Women with a Single Birth: A Cost-effectiveness Analysis

“…14 The method has been widely applied to inform difficult clinical and public health decisions and has been used to assess the relative cost and benefit trade-offs of alternative healthcare interventions in gynecologic oncology, gynecologic surgery, maternal-fetal medicine, infertility treatment, and other subspecialties in the field of obstetrics and gynecology. [15][16][17] A decision tree is a visual tool to illustrate how each compared intervention relates to the possible outcomes. 18 In this study, a decision tree model containing 249 chance events and 101 parameters was constructed mapping the sequence of most relevant clinical outcomes after each delivery management scheme (CDMR or TOL) throughout the mother and the newborn's lifetime (Fig.…”

Prophylactic anticoagulation for preterm premature rupture of membranes: a decision analysis

“…Decision analyses have allowed for critical, practice-changing guidelines in the field of obstetrics and gynecology, including the timing of delivery in placenta and vasa previa, 10,11 and when used appropriately are reasonable alternatives to other study designs. 12 In this study, we constructed a decision analysis to determine whether the use of prophylactic anticoagulation with either LMWH or heparin for women admitted to the hospital for PPROM between 24 0/7 weeks' and 33 6/7 weeks' gestation optimized maternal outcomes compared with no anticoagulation.…”