Therapeutic Decision Making: A Cost-Benefit Analysis

Abstract

To help the physician decide whether or not to treat a patient who may or may not have a disease, a method has been developed for calculating a therapeutic threshold. If the probability of disease in a given patient exceeds the threshold, the preferable course of action is to treat; if the probability is below the threshold, the preferable course of action is to withhold treatment. This method is applicable in many medical and surgical settings in which some diagnostic uncertainty exists after all appropriate studies have been carried out. The technic not only exposes some of the basic principles of therapeutic decision making in the face of diagnostic uncertainty but also forms a convenient framework for analyzing the impact of "soft" clinical data on the decision-making process. (N Engl J Med 293:229–234, 1975)