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Open Access Highly Accessed Research article

A regret theory approach to decision curve analysis: A novel method for eliciting decision makers' preferences and decision-making

Athanasios Tsalatsanis, Iztok Hozo, Andrew Vickers and Benjamin Djulbegovic*

BMC Medical Informatics and Decision Making 2010, 10:51  doi:10.1186/1472-6947-10-51

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Correction of interpretation of equation 1

Athanasios Tsalatsanis   (2011-05-12 13:24)  Center for Evidence-based Medicine and Health Outcomes Research, University of South Florida email

Dear Editor,

I would like to thank Drs. Jef Van den Ende and Olivier Koole for their comment and to acknowledge the correction of the interpretation of equation 1 pointed out.

Sincerely,

Athanasios Tsalatsanis

Competing interests

Athanasios Tsalatsanis is the first author of the paper: A regret theory approach to decision curve analysis: A novel method for eliciting decision makers' preferences and decision-making.

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Correction of interpretation of equation 1.

Jef Van den Ende   (2011-03-15 10:58)  Institute of Tropical Medicine email

To the editor,

We recently read the article “A regret theory approach to decision curve analysis: A novel method for eliciting decision makers’ preferences and decision making” by Tsalatsanis et al. in BMC Medical Informatics and Decision Making 2010, 10:51.
We would like to discuss equation 1, because we are convinced the interpretation that follows in the text is erroneous. The equation states:
Pt=1/(1+(U1-U3)/(U4-U2))
where Pt is the treatment threshold, U1 to U4 the utilities to respectively treating a diseased, treating a non diseased, not treating a diseased, and not treating a non diseased.
If regret U4-U2 is zero, (U1-U3)/(U4-U2) becomes infinite (not “undefined”), so also 1+ (U1-U3)/(U4-U2). Pt will equal 1/infinite, this is zero. Consequently, our treatment threshold becomes zero, and not one, as the authors state.
This is also intuitively so: if administering a treatment is almost at no cost, and without harm, clinicians will treat at the slightest suspicion. This is e.g., what happens for malaria treatment in developing countries. The regret U1-U3 is considerable; malaria is a disease with a high mortality, if not treated. The treatment is cheap, almost without side effects. Hence a very low treatment threshold is applied.


Jef Van den Ende, Md, PhD
Olivier Koole, MD, MPH
Department of Clinical Sciences
Institute of Tropical Medicine
Antwerp

Competing interests

None declared

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