Three studies that are related to the choice of treatment have been done.
In Chapter I, the treatment of hyperthyroidism has been analyzed. There are three different treatments for hyperthyroidism: medical, surgical, and radiation therapy. It is rather difficult to choose the best treatment for every given patient with the disease. Trade-offs among these various treatment modalities foster disagreement over the patient’s indication for choice of one of the various therapeutic modalities over the others for treatment of hyperthyroidism. The three treatment strategies, their respective trade-offs and outcome preferences were modeled using SMLTREE, a microcomputer program for clinical decision analysis. The results of utility analysis show that radiation therapy is the preferable choice although the expected value of the three therapies are quite close. The sensitivity analysis and cost-effectiveness analysis were also done.
Chapter II is a study of treatment for gallbladder cancer. The medical records of 121 patients with the diagnosis of gallbladder carcinoma during the years 1960 to 1989 were reviewed retrospectively. The survival rate for the five different operations were calculated using Kaplan-Meier survival analysis. Cox’s survival analysis was also applied. There was no statistically significant increas e in survival rate between cholecystectomy alone and cholecystectomy with hepatic wedge resection. Simple cholecystectomy with postoperative chemotherapy could be the best treatment choice for patients with Nevin Stage I, II, or III disease. Cholecystectomy with an accompanying bypass procedure will be the best choice for more extensive diseases.
In Chapter III, a comparison of outcome and cost for open cholecystectomy and laparoscopic cholecystectomy was done. One hundred patients with laparoscopic cholecystectomy and one hundred patients with open cholecystectomy as control group were studied. Both groups were comparable with regard to height, weight, and severity of the disease. Statistical analysis has been performed using t-test, analysis of covariance, and logistic regression. The results of this study support that laparoscopic cholecystectomy is a safe and effective alternative to open cholecystectomy and results in significantly shorter hospital stay with considerable cost savings.