Kerry

Heinecke Med Inf 406-DL Assignment #2 1. What would be the preferred option? Medicine with an expected value (EV) of 871.50. If the condition worsens, amputation is the preferred next step (EV=686.00). Decision Tree:

Expected Value (in terms of life expectancy score): Medicine option 871.50 this is the preferred option since the life expectancy score is higher than amputation Amputation option 841.50

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Kerry Heinecke Med Inf 406-DL Assignment #2 2. Should a coronary artery bypass be performed to decrease the operative risk during colectomy? Yes What is the gain in life expectancy (in years) that can be expected from the preferred approach? 4.03 Decision Tree:

Preferred option in terms of life expectancy is CABG followed by colectomy (EV=4.03).

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Kerry Heinecke Med Inf 406-DL Assignment #2 3. Answer the following questions: a. Create a decision tree for this problem to calculate the expected value of each option in terms of QALYs. What would be the preferred option? Surgery with QALYs of 7.72

b. Perform a sensitivity analysis of the effect of operative mortality on QALYs. What is the probability of operative death at which No surgery option becomes preferable? 0.261 see sensitivity analysis screenshot below. I believe this means that any probability lower than 0.261 will offer Surgery as the preferred option. If the probability is higher, then No Surgery is preferred. To arrive at this, I had to really spread out the probability values from Low=0.001 to High=0.900. Ive also included a screen shot of the text report.

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Kerry Heinecke Med Inf 406-DL Assignment #2

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Kerry Heinecke Med Inf 406-DL Assignment #2 c. Perform a second sensitivity analysis of the effect of a successful operative result on QALYs. What is the minimum probability of a successful result after which surgery becomes preferable? I interpret a successful operative result as being no postop infection and full mobility. So I selected the variables for pPoorMobilityAfterSurgery and pInfection and ran a one-way sensitivity analysis for each individually. Surgery is preferable when the probability of postop infection is 0.376 or lower and pPoorMobilityAfterSurgery is 0.875 or lower. Screenshots below (also ran 2-way sensitivity beneath those screenshots but I really dont understand how to interpret the results).

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Kerry Heinecke Med Inf 406-DL Assignment #2

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Kerry Heinecke Med Inf 406-DL Assignment #2

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Kerry Heinecke Med Inf 406-DL Assignment #2 4. Answer the following questions: a. Create a decision tree for the clinical case. What is the preferred course of action? Preferred course is to not perform PCR (EV=70.30). For this course, the preferred next step is split between whether the infant is HIV+ or HIV-. If HIV+, infant should be treated (EV=10.50). If HIV-, infant should not be treated (EV=75.50). NOTE: in all cases where the infant is HIV+, the preferred course is to treat (EV=10.50). In all cases where infant is HIV-, the preferred course is to not treat (EV=75.50). In conclusion, it appears that even though the preferred course is to not perform PCR, if the test is not performed, I dont believe it will be clear whether or not the infant should be treated.

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Kerry Heinecke Med Inf 406-DL Assignment #2 b. Extra credit: draw a simple influence diagram for the problem above. (Note: you dont need to perform any numerical calculation in this regard. Only highlight the probabilistic relationship in an influence diagram). Heres my attempt at an influence diagram for this case:

Explanation: the ultimate goal is to have a healthy infant. Infants HIV status cannot be controlled. Unknown HIV status gives two choices: order the PCR and treat the patient.

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