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

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  1. Correction of interpretation of equation 1.

    Jef Van den Ende, Institute of Tropical Medicine

    15 March 2011

    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

  2. Correction of interpretation of equation 1

    Athanasios Tsalatsanis, Center for Evidence-based Medicine and Health Outcomes Research, University of South Florida

    12 May 2011

    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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