A CONTINUOUS-RISK DECISION-ANALYSIS OF TOTAL HIP-REPLACEMENT

Stochastic trees are stochastic processes, such as continuous-time Mar kov chains, which may be represented using tree diagrams. Continuous-r isk utility assessment is a methodology that differs from standard ass essment protocols by offering choices between alternatives which are n ot 'sure' things, thus enabling more realistic and familiar assessment scenarios to be posed. In this paper we develop, using information fr om the medical literature, stochastic tree models of the total hip rep lacement decision alternatives facing a patient with advanced osteoart hritis or the hip. We describe a decision analytic approach to the pro blem which uses continuous-risk utility assessment, and present empiri cal assessment results. We explore the sensitivity of the subjects' tr eatment recommendations to changes in model parameters and elicited pr eference values, offering insights into the variety of patient risk at titudes and preferences about functional well-being and the robustness of the total hip replacement decision to them.