Sensitivity Oriented Decision Analytic Approach to Medical Decisions: Application to the Management of a Contact to Gonorrhea

摘要

A number of modeling and analytical techniques are employed in studying the management of a female patient who comes to a VD clinic because a sexual partner has gonorrhea. Results of the analysis indicate the decision alternative associated with the lowest cost or utility, i.e., the oprimal strategy, calls for immediate treatment with the antibiotic tetracycline. Alternatives in which the same antibiotic therapy is started (a) following a gram stain or (b) at the same time a culture is taken, are associated with only slightly higher utility values. The latter option may be considered optimal, however, when the value associated with beneficial aspects of taking a culture (which are not reflected by the utility structue) are greater (in absolute value) than a small negative amount. Higher utility values, indicating less desirability, are associated with alternatives in which either no antibiotics are given or in which therapy is delayed until the patient returns after the result of the cervical cultue is obtaine. APPG was the close second choice of antibiotic for treating patients.