Markov Models in Medical Decision Making

Medical Decision Making - Tập 13 Số 4 - Trang 322-338 - 1993
Frank A. Sonnenberg1, J. Robert Beck
1Department of Medicine, UMDNJ Robert Wood Johnson Medical School, New Brunswick 08903.

Tóm tắt

Markov models are useful when a decision problem involves risk that is continuous over time, when the timing of events is important, and when important events may happen more than once. Representing such clinical settings with conventional decision trees is difficult and may require unrealistic simplifying assumptions. Markov models assume that a patient is always in one of a finite number of discrete health states, called Markov states. All events are represented as transitions from one state to another. A Markov model may be evaluated by matrix algebra, as a cohort simulation, or as a Monte Carlo simulation. A newer repre sentation of Markov models, the Markov-cycle tree, uses a tree representation of clinical events and may be evaluated either as a cohort simulation or as a Monte Carlo simulation. The ability of the Markov model to represent repetitive events and the time dependence of both probabilities and utilities allows for more accurate representation of clinical settings that involve these issues. Key words: Markov models; Markov-cycle decision tree; decision mak ing. (Med Decis Making 1993;13:322-338)

Từ khóa


Tài liệu tham khảo

10.1177/0272989X8900900209

10.1098/rstl.1825.0026

National Center for Health Statistics., 1988, Vital Statistics of the United States

10.1177/0272989X8300300403

10.1001/jama.1990.03440110079032

10.7326/0003-4819-113-11-852

10.1001/jama.1992.03480150061038

10.1016/0140-6736(92)91717-M

10.1056/NEJM197703312961304

10.7326/0003-4819-113-2-147

10.1177/0272989X8300300110

10.7326/0003-4819-98-4-504

Kemeny JB, 1976, Finite Markov Chains

Hollenberg JP, 1984, Med Decis Making., 4, 529

Kassirer JP, 1988, Decision analysis

Sonnenberg FA, 1987, Decision Maker: an advanced personal computer tool for clinical decision analysis. Proceedings of the Eleventh Annual Symposium on Computer Applications in Medical Care

Hollenberg J., 1985, SMLTREE: The All Purpose Decision Tree Builder

10.1177/0272989X9301300215