Determining Utilities

After reviewing the available literature regarding cancer control and treatment morbidity, the patient and clinician then have to derive order and understanding from all of the statistics, advantages and indications in order to make a decision. One way to order or categorize different scenarios is to assign value or utility to different states of health associated with prostate cancer. Markov models, as shown in Fig. 24.4, are used to simulate decision-making, by categorizing each exclusive health state that a patient may be in at a point in time.102 Thus, for prostate cancer in Fig. 24.4, a patient moves from one health state to the next as his life progresses. Patients will not value each of these health states equally, allowing quality

Table 24.4. Advantages and disadvantages of prostate cancer treatment modalities. Adapted from Ohori and Scardino (in press).113



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