Decision Making with Respect to Diagnostic Testing

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Abstract
This paper outlines a model for valuing the benefits of antenatal screening based on the analysis of individual decision making with respect to consequent diagnostic test ing. Central to the model is the idea that the benefits of screening can be measured by valuing the improved information generated from screening. The model is developed in the context of antenatal carrier screening for cystic fibrosis (CF). Benefits are as sessed by surveying women in the general population in order to establish their pref erences for two alternative methods of CF carrier screening—stepwise and couple screening. Preferences are elicited using standard-gamble questions in which women from a population-based random sample are asked to trade off risk of fetal loss with improved information from diagnostic testing. A series of standard-gamble questions is employed to elicit utility values for each of the possible information outcomes from screening. The expected utilities of both screening methods are calculated at both individual and group levels. The results suggest that the use of individual decision making with respect to diagnostic testing as a means of valuing the benefits of screen ing may have wide applications. Key words: benefits; antenatal screening; information; standard gamble; expected utility. (Med Decis Making 1996;16:161-168)