Decision making nelle anemie

Decision making is the most frequently performed cognitive activity in medicine. An epistemological and an operational model of the decision allow to classify the different types of complexity in medical decision making. Decision analysis is a technique that allows to help physician in decision making. It quantifies outcomes valuable for deriving answer to medical decisions since it gives structure to the problem, allows open consideration of all relevant effects of the decision and forces the explicit treatment of key assumptions. Decision analysis has been used to decide whether splenectomy provides utility to patients with mild hereditary spherocytosis. The model suggested that combined prophylactic splenectomy and cholecystectomy provide a substantial gain in quality-adjusted life expectancy for young patients and adults with mild HS and gallstones. A study attempted to determine the cost-effectiveness of performing screening for anemia before starting rHuEPO in new onset end stage renal disease patients. Anemia screening before initiating rHuEPO therapy should be limited to tests to identify iron deficiency. Decision analysis was used to compare the cost- effectiveness of rHuEPO supplemented with red blood cell (RBC) transfusions with conventional treatment with RBC transfusions alone in patients with chemotherapy induced anemia. The incremental cost was greater than $100,000 per quality-adjusted life-year (QALY).