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2017 | OriginalPaper | Buchkapitel

6. Treatment Decisions Under Comorbidity Risk

verfasst von : Stefan Felder, Thomas Mayrhofer

Erschienen in: Medical Decision Making

Verlag: Springer Berlin Heidelberg

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Abstract

This chapter introduces the role of uncontrollable risks such as a comorbidity for the physician’s decisions. With this type of risk underlying his test and treatment decisions, the concept of prudence becomes relevant. We demonstrate that prudent decision makers act even earlier than simply risk-averse decision makers.

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Vorheriges Kapitel Treatment Decisions with Diagnostic Tests

Nächstes Kapitel Optimal Strategy for Multiple Diagnostic Tests

Nur mit Berechtigung zugänglich

Kimball, M.—Precautionary Saving in the Small and in the Large—Econometrica, 58(1): 53–73, 1990, p. 54.

Of course, one could also assume that a comorbidity risk impacts all health states, i.e., the sick and the healthy. In this case, prudence is not sufficient for unambiguous results. However, Felder and Mayrhofer (2014) showed that the combination of prudence and temperance (4th order risk aversion) using the concept of risk vulnerability (Gollier and Pratt 1996) also leads to the same qualitative results as the model that considers comorbidity only for the sick health state.

Prudence is defined as a preference for disaggregating a sure loss and zero-mean background risk. In medical decisions, this means that an individual is more willing to accept an extra risk when his level of health is higher, i.e. the “bad” of an additional risk weighs less with an increase in health. The term prudence (also third-order or downside risk aversion) was introduced by Kimball (1990).

Imprudent behavior, where \( {u}^{{\prime\prime\prime} }(h)<0 \), is also possible; in this case, we have \( {p}_P^{Rx}>{p}_A^{Rx} \). A further case is that the decision maker is risk-loving (\( {u}^{{\prime\prime} }>0 \)) and, depending on the third derivative of his utility function, is also either prudent or imprudent.

The test and test-treatment thresholds can be found by setting the value of information in the two arms of Eq. (6.14) equal to zero and solving for p.

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Eeckhoudt, L. (2002). Risk and medical decision making. Boston: Kluwer.CrossRef

Eeckhoudt, L., & Kimball, M. (1992). Background risk, prudence and the demand for insurance. In G. Dionne (Ed.), Contributions to insurance economics (pp. 239–254). Boston: Kluwer.CrossRef

Felder, S., & Mayrhofer, T. (2014). Risk preferences: Consequences for test and treatment thresholds and optimal cutoffs. Medical Decision Making, 34, 33–41.CrossRef

Gollier, C., & Pratt, J. W. (1996). Risk vulnerability and the tempering effect of background risk. Econometrica, 64(5), 1109–1123.CrossRef

Kimball, M. (1990). Precautionary saving in the small and in the large. Econometrica, 58(1), 53–73.CrossRef

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Titel: Treatment Decisions Under Comorbidity Risk
verfasst von: Stefan Felder
Thomas Mayrhofer
Verlag: Springer Berlin Heidelberg
Buch: Medical Decision Making
Print ISBN: 978-3-662-53431-1

Electronic ISBN: 978-3-662-53432-8

Copyright-Jahr: 2017
DOI: https://doi.org/10.1007/978-3-662-53432-8_6