Commentary: trials versus models in appraising screening programmes.
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Biomedical subjects
G Royston
Publications and source records attributed to G Royston.
Decision analysis in the selection, design and application of clinical and health services research.
Research evidence will never be sufficient to tell us how treatments compare in every group or class of patients. It will always be necessary to particularize from the general to the specific. The ad hoc way this is normally done contrasts with the rigour of the research process. However, extrapolating from the general to the particular can be made equally rigorous by Decision Analytic modelling. Furthermore, research evidence is not enough when decisions turn on multiple objectives, which must be traded off against each other. Research evidence and patients' preferences can be reconciled, again rigorously, by using Decision Analysis to show how probabilities and values interact. In addition, research should be designed around likely clinical impact, and this in turn can be made explicit by Decision Analytic modelling. In particular, sample size calculations should be based on such explicit modelling, rather than current procedures, which seldom seek to defend the size of clinical effects sought.
Decision Support Techniques↗
Use of nondifferentiable optimization in a health care problem.
Those who study health care systems (HSC) seek to model the features of health care systems of societies that are common to different countries, so as to assist those who plan health services. The mathematicians interested in nondifferentiable optimization (NDO) seek to extend the classical optimization techniques to functions that have "non-smooth" regions where no unique gradient can be defined. This article reports how a health resource allocation model was solved by minimizing a function with points of nondifferentiability. It describes how an example of the model arose in the joint strategic planning of health and personal social services in a county in England with a population of about one million. It also formulates the model as a problem of NDO. Ways to obtain numerical solutions are reviewed, and the solution of the example by NDO is compared to another method based on linear approximation.
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