Invited Commentary
April 11, 2011

What We Can Learn From a Decision ModelComment on “Cost-effectiveness of Adding Magnetic Resonance Imaging to Rheumatoid Arthritis Management"

Author Affiliations

Author Affiliation: Division of Health Services, Department of Health Research and Policy, and Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California.


Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011

Arch Intern Med. 2011;171(7):667-668. doi:10.1001/archinternmed.2011.67

All models are wrong, but some are useful.—George Box

Only a few of the many clinical problems in medicine can be addressed by performing a randomized clinical trial. Consequently, we need additional tools to identify the optimal clinical management strategies for patients. One set of tools is the analyses of clinical registries and databases to assess diagnostic tests or to compare treatments—activities now termed comparative effectiveness research. Another powerful tool is the use of a model, or simulation, of a clinical decision to examine the likely consequences of alternative choices. A model is particularly useful in scenarios with multiple clinical options because it is difficult to study several strategies in a single clinical trial.

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