Evidence-based medicine as Bayesian decision-making

We review two recent trends: the emergence of evidence-based medicine and t he growing use of Bayesian statistics in medical applications. Evidence-bas ed medicine requires an integrated assessment of the available evidence, an d associated uncertainty, but there is also an emphasis on decision-making, for individual patients, or at other points in the health-care system. Thi s demands consideration of the values and costs associated with potential o utcomes. We argue that the natural statistical framework for evidence-based medicine is a Bayesian approach to decision-making that incorporates an in tegrated summary of the available evidence and associated uncertainty with assessment of utilities. We outline a practical agenda for further developm ent. Copyright (C) 2000 John Wiley & Sons, Ltd.