DECISION-ANALYSIS IN ENDOCRINOLOGY AND METABOLISM

Decision analysis is a powerful tool for synthesizing and analyzing cl inical decisions in the practice of endocrinology and metabolism. The technique involves defining strategies for comparison, choosing a time horizon, constructing a decision tree and model, selecting outcomes a nd assigning probabilities, taking into account the value of time, cal culating the net clinical and cost outcomes, and performing sensitivit y analysis. This technique and its utility for different populations,u rd changing health care settings are illustrated for the decision of s creening for mild thyroid failure with a thyroid-stimulating hormone a ssay at the periodic health examination. The strengths and limitations of decision analysis and future applications in endocrinology and met abolism are explored.