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February 14, 1977

Decision Analysis-Reply

JAMA. 1977;237(7):643. doi:10.1001/jama.1977.03270340027009

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In Reply.—  It is pleasing to us that the article in The Journal on clinical decision analysis has generated interest in this approach to the solution of medical problems.Dr Borak states that our conclusion is wrong in choosing not to perform the liver scan for the patient with bronchogenic carcinoma because we ignored the costs of the operation. Although not explicit in the article, the values assigned to the operation incorporated an arbitrary monetary cost along with the risks of morbidity and mortality and potential benefit from the procedure. If one accepts this inclusion in a simplified version of a decision analysis tree, then our conclusions are correct. Obviously, if the tree were to be used for a patient, it should be more complex to account for each important factor bearing on the decision. Our purpose in writing was not to demonstrate irrefutably that the liver scan would erroneously