{"id":1263,"date":"2022-07-25T11:31:33","date_gmt":"2022-07-25T02:31:33","guid":{"rendered":"https:\/\/info.zanet.biz\/?p=1263"},"modified":"2022-10-29T16:41:57","modified_gmt":"2022-10-29T07:41:57","slug":"%e6%b2%bb%e7%99%82%e9%96%be%e5%80%a4treatment-threshold","status":"publish","type":"post","link":"https:\/\/info.zanet.biz\/?p=1263","title":{"rendered":"\u6cbb\u7642\u95be\u5024Treatment threshold"},"content":{"rendered":"\n

\u6cbb\u7642\u95be\u5024\u306b\u3064\u3044\u3066\u7406\u89e3\u3059\u308b\u305f\u3081\u306b\u306f\u3001\u671f\u5f85\u52b9\u7528\u3001\u75be\u60a3\u78ba\u7387\u306b\u3064\u3044\u3066\u306e\u77e5\u8b58\u304c\u5fc5\u8981\u306b\u306a\u308a\u307e\u3059\u3002<\/p>\n\n\n\n

\u75be\u60a3\u78ba\u7387\u306f\u3001\u305d\u306e\u4eba\u304c\u60f3\u5b9a\u3059\u308b\u75be\u60a3\u306b\u7f79\u60a3\u3057\u3066\u3044\u308b\u78ba\u7387\u3067\u3059\u3002\u3053\u3053\u3067\u306fP(D+<\/sup>)\u3067\u8868\u3057\u3066\u3044\u307e\u3059\u3002\u78ba\u7387\u3067\u3059\u304b\u3089\u30010\uff5e1\u306e\u5024\u3092\u53d6\u308a\u307e\u3059\u3002100\u4eba\u306e\u4eba\u304c\u3044\u3066\u3001\u305d\u306e\u5185\u306e50\u4eba\u304c\u3042\u308b\u75be\u60a3\u306b\u7f79\u60a3\u3057\u3066\u3044\u308b\u3068\u3057\u307e\u3059\u3002\u305d\u306e100\u4eba\u306e\u4e2d\u304b\u3089\u30011\u4eba\u304c\u7279\u5225\u306a\u7406\u7531\u306a\u304f\u3001\u3084\u3063\u3066\u304d\u307e\u3057\u305f\u3002\u305d\u306e\u4eba\u304c\u305d\u306e\u75be\u60a3\u306b\u7f79\u60a3\u3057\u3066\u3044\u308b\u53ef\u80fd\u6027\u306f\u3069\u308c\u304f\u3089\u3044\u3067\u3057\u3087\u3046\u304b\uff1f\u305d\u308c\u3092\u75be\u60a3\u78ba\u7387\u3068\u8a00\u3044\u307e\u3059\u3002\u3053\u306e\u5834\u5408\u306f\u30010.5\u3067\u3059\u3002<\/p>\n\n\n\n

Utility\u30e6\u30c6\u30a3\u30ea\u30c6\u30a3\uff08\u52b9\u7528\uff09\u3092Neumann PJ\u3089\u306f\u6b21\u306e\u3088\u3046\u306b\u5b9a\u7fa9\u3057\u3066\u3044\u307e\u3059\u3002\u201cA utility is a measure of preference. In this context a utility is the measure of the preference or value that an individual or society places upon a particular health state. \u201d (Neumann PJ 2017) \u3064\u307e\u308a\u3001\u201c\u7279\u5b9a\u306e\u5065\u5eb7\u72b6\u614b\u306b\u500b\u4eba\u307e\u305f\u306f\u793e\u4f1a\u304c\u7f6e\u304f\u597d\u307f\u307e\u305f\u306f\u4fa1\u5024\u3092\u6e2c\u5b9a\u3057\u305f\u5024\u201d\u3092\u52b9\u7528\u3068\u547c\u3073\u307e\u3059\u3002\u5024\u306b\u3064\u3044\u3066\u306f\u3001\u52b9\u7528\u5024\u3068\u3044\u3046\u7528\u8a9e\u304c\u7528\u3044\u3089\u308c\u308b\u5834\u5408\u3082\u3042\u308a\u307e\u3059\u3002\u307e\u305f\u3001\u500b\u4eba\u306e\u8003\u3048\u308b\u52b9\u7528\u5024\u306f\u500b\u4eba\u500b\u4eba\u3067\u7570\u306a\u308a\u3001\u500b\u4eba\u306e\u8003\u3048\u308b\u52b9\u7528\u5024\u3068\u793e\u4f1a\u3092\u4ee3\u8868\u3059\u308b\u52b9\u7528\u5024\u306f\u7570\u306a\u308b\u5834\u5408\u3082\u3042\u308a\u307e\u3059\u3002\u306a\u304a\u3001\u7d4c\u6e08\u5b66\u3067\u306f\u5546\u54c1\u3001\u30b5\u30fc\u30d3\u30b9\u306b\u5bfe\u3059\u308b\u597d\u307f\uff08\u9078\u597d\uff09\u3092\u52b9\u7528\u3068\u8a00\u3063\u3066\u3044\u307e\u3059\u3002<\/p>\n\n\n\n

Expected Utility \u671f\u5f85\u52b9\u7528\u3068\u8a00\u3046\u5834\u5408\u306f\u3001\u305d\u306e\u5065\u5eb7\u72b6\u614b\u304c\u5b9f\u73fe\u3059\u308b\u524d\u306e\u6642\u70b9\u3067\u8ff0\u3079\u308b\u5834\u5408\u306e\u8868\u73fe\u3067\u3059\u3002<\/p>\n\n\n\n

\"\"
\u56f31. \u7121\u6cbb\u7642\u306e\u5834\u5408\u306e\u75be\u60a3\u78ba\u7387\u3068\u671f\u5f85\u52b9\u7528\u3002<\/figcaption><\/figure>\n\n\n\n

\u56f3\uff11\u3067\u306f\u3001U\u304c\u671f\u5f85\u52b9\u7528\u3092\u8868\u3057\u3066\u304a\u308a\u3001\u30ab\u30c3\u30b3\u5185\u306b\u305d\u306e\u6761\u4ef6\u3092\u75be\u60a3\u306e\u6709\u7121\u3092D\u3001\u6cbb\u7642\u307e\u305f\u306f\u30a2\u30af\u30b7\u30e7\u30f3\u3092A\u3067\u8868\u3057\u3066\u3044\u307e\u3059\u3002\u4f8b\u3048\u3070\u3001U(D+<\/sup>A–<\/sup>)\u306f\u75be\u60a3D\u304c\u3042\u308a\u691c\u67fb\u3082\u6cbb\u7642\u3082\u53d7\u3051\u306a\u3044\u5834\u5408\u306e\u671f\u5f85\u52b9\u7528\u3092\u8868\u3057\u3066\u3044\u307e\u3059\u3002<\/p>\n\n\n\n

\u671f\u5f85\u52b9\u7528\u306e\u5927\u304d\u3055\u306f0\uff5e1\u306e\u5024\u3067\u8868\u3055\u308c\u30010\u306f\u6b7b\u4ea1\u30011\u306f\u75be\u60a3\u304c\u7121\u304f\u3001\u691c\u67fb\u3082\u6cbb\u7642\u3082\u53d7\u3051\u306a\u3044\u72b6\u614b\u306b\u5bfe\u5fdc\u3057\u307e\u3059\u3002\u3057\u305f\u304c\u3063\u3066\u3001U(D–<\/sup>A–<\/sup>)=1\u3068\u306a\u308a\u307e\u3059\u3002<\/p>\n\n\n\n

\u671f\u5f85\u52b9\u7528\u306f\u3042\u308b\u5065\u5eb7\u72b6\u614b\u306b\u3064\u3044\u3066\u3069\u308c\u304f\u3089\u3044\u4fa1\u5024\u304c\u3042\u308b\u3068\u601d\u3046\u304b\u30920\uff5e1\u306e\u6570\u5024\u3067\u8868\u3057\u305f\u3082\u306e\u3068\u3044\u3046\u3053\u3068\u3082\u3067\u304d\u307e\u3059\u3002\u305d\u308c\u305e\u308c\u306e\u4fa1\u5024\u89b3\u306b\u57fa\u3065\u304f\u4fa1\u5024\u306e\u5927\u304d\u3055\u3068\u8a00\u3048\u307e\u3059\u3002<\/p>\n\n\n\n

\u56f31\u306f\u3001\u6cbb\u7642\u3092\u3057\u306a\u3044\u5834\u5408\u306e\u671f\u5f85\u52b9\u7528U(A–<\/sup>)\u3068\u75be\u60a3\u78ba\u7387P(D+<\/sup>)\u306e\u95a2\u4fc2\u3092\u6c7a\u5b9a\u6728\u3092\u7528\u3044\u3066\u89e3\u6790\u3059\u308b\u305f\u3081\u306bExcel\u3092\u7528\u3044\u3066\u4f5c\u6210\u3057\u305f\u3082\u306e\u3067\u3059\u3002\u6cbb\u7642\u3092\u3057\u306a\u3044\u5834\u5408\u306e\u671f\u5f85\u52b9\u7528U(A–<\/sup>)\u306f\u679d\u306e\u7d42\u672b\u306e\u671f\u5f85\u52b9\u7528\u306e\u5024\u306b\u305d\u306e\u679d\u306e\u8d77\u304d\u308b\u78ba\u7387\u3092\u639b\u3051\u7b97\u3057\u3066\u7dcf\u548c\u3092\u6c42\u3081\u308b\u3053\u3068\u3067\u8a08\u7b97\u3055\u308c\u307e\u3059\u3002\u4e0b\u306e\u65b9\u306e\u5f0f\u3067\u793a\u3059\u3088\u3046\u306b\u3001U(D–<\/sup>A–<\/sup>)\u3068U(D+<\/sup>A–<\/sup>)\u3092\u8a2d\u5b9a\u3059\u308b\u3068\u3001\u305d\u306e\u5dee\u306e\u8ca0\u306e\u5024\u3092\u4fc2\u6570\u3068\u3057\u3001U(D–<\/sup>A–<\/sup>)\u3092\u5207\u7247\u3068\u3059\u308b\u75be\u60a3\u78ba\u7387P(D+<\/sup>)\u306e\u4e00\u6b21\u95a2\u6570linear function\u3067\u3001U(A–<\/sup>)\u304c\u8a08\u7b97\u3055\u308c\u308b\u3053\u3068\u304c\u5206\u304b\u308a\u307e\u3059\u3002<\/p>\n\n\n\n

\u75be\u60a3\u78ba\u7387\u3068\u671f\u5f85\u52b9\u7528\u306f\u76f4\u7dda\u95a2\u4fc2\u306b\u3042\u308b\u3068\u3044\u3046\u3053\u3068\u304c\u5206\u304b\u308a\u307e\u3059\u3002<\/p>\n\n\n\n

\u4fc2\u6570\u304c\u8ca0\u306e\u5024\u3067\u3042\u308b\u3068\u3044\u3046\u3053\u3068\u306f\u3001\u75be\u60a3\u78ba\u7387\u304c\u9ad8\u307e\u308b\u307b\u3069\u3001\u671f\u5f85\u52b9\u7528\u304c\u4f4e\u4e0b\u3059\u308b\u3053\u3068\u3092\u793a\u3057\u3066\u3044\u307e\u3059\u3002\u4f8b\u3048\u3070\u3001\u305d\u306e\u75be\u60a3\u306b\u7f79\u60a3\u3057\u3066\u3044\u308b\u4eba\u304c100\u4eba\u3044\u3066\u3001\u6cbb\u7642\u3092\u3057\u306a\u3044\u3067\u653e\u7f6e\u3057\u305f\u5834\u5408\u3001100\u4eba\u5168\u54e1\u306b\u75be\u60a3\u306b\u3088\u308b\u671b\u307e\u3057\u304f\u306a\u3044\u30a2\u30a6\u30c8\u30ab\u30e0\u304c\u8d77\u304d\u3001U(D+<\/sup>A–<\/sup>)\u3067\u8868\u3055\u308c\u308b\u671f\u5f85\u52b9\u7528\u306f1\u3088\u308a\u306f\u5c0f\u3055\u306a\u5024\u306b\u306a\u308a\u307e\u3059\u3002\u3053\u308c\u306f\u75be\u60a3\u78ba\u7387P(D+<\/sup>)\u304c1\u306e\u5834\u5408\u306b\u76f8\u5f53\u3057\u307e\u3059\u3002\u3082\u3057\u3001\u305d\u306e\u75be\u60a3\u306b\u7f79\u60a3\u3057\u3066\u3044\u306a\u3044\u4eba\u304c100\u4eba\u3044\u3066\u3001\u6cbb\u7642\u3092\u3057\u306a\u3044\u3067\u653e\u7f6e\u3057\u305f\u5834\u5408\u3001\u305d\u306e\u75be\u60a3\u306b\u3088\u308b\u5f71\u97ff\u306f\u4f55\u3082\u306a\u3044\u306e\u3067\u3001\u75be\u60a3\u306b\u3088\u308b\u671b\u307e\u3057\u304f\u306a\u3044\u30a2\u30a6\u30c8\u30ab\u30e0\u306f\u4f55\u3082\u8d77\u304d\u307e\u305b\u3093\u3002\u3053\u306e\u5834\u5408\u306e\u671f\u5f85\u52b9\u7528U(D–<\/sup>A–<\/sup>)\u306f1\u3067\u6700\u5927\u3067\u3059\u3002\u3053\u308c\u306f\u75be\u60a3\u78ba\u7387P(D+<\/sup>)\u304c0\u306e\u5834\u5408\u306b\u76f8\u5f53\u3057\u307e\u3059\u3002\u3053\u308c\u3089\u306e\u4e8c\u3064\u306e\u5834\u5408\u306e\u4e2d\u9593\u3067\u3001100\u4eba\u4e2d50\u4eba\u304c\u305d\u306e\u75be\u60a3\u306b\u7f79\u60a3\u3057\u3066\u3044\u308b\u5834\u5408\u3092\u8003\u3048\u3066\u307f\u307e\u3057\u3087\u3046\u3002\u6cbb\u7642\u3092\u3057\u306a\u3044\u3067\u3001\u653e\u7f6e\u3057\u305f\u5834\u5408\u3001100\u4eba\u4e2d50\u4eba\u306b\u306f\u3001\u75be\u60a3\u306b\u3088\u308b\u671b\u307e\u3057\u304f\u306a\u3044\u30a2\u30a6\u30c8\u30ab\u30e0\u304c\u8d77\u304d\u3001U(D–<\/sup>A–<\/sup>)\u3068U(D+<\/sup>A–<\/sup>)\u306e\u5dee\u306e\u534a\u5206\u3060\u3051\u671f\u5f85\u52b9\u7528\u306e\u5024\u306f\u5c0f\u3055\u304f\u306a\u308a\u307e\u3059\u3002\u3053\u308c\u306f\u75be\u60a3\u78ba\u7387P(D+<\/sup>)\u304c0.5\u306e\u5834\u5408\u306b\u76f8\u5f53\u3057\u307e\u3059\u3002<\/p>\n\n\n\n

\u3053\u308c\u3089\u3092\u30b0\u30e9\u30d5\u3067\u793a\u3059\u3068\u3001\u53f3\u4e0b\u306e\u30b0\u30e9\u30d5\u306e\u69d8\u306b\u306a\u308a\u307e\u3059\u3002\u6a2a\u8ef8\u304c\u75be\u60a3\u78ba\u7387P(D+<\/sup>)\u3001\u7e26\u8ef8\u304c\u52b9\u7528\u5024U(A–<\/sup>)\u3067\u3059\u3002\u3069\u3061\u3089\u306e\u8ef8\u30820\uff5e1\u306e\u7bc4\u56f2\u306e\u5024\u3067\u3059\u3002<\/p>\n\n\n\n

P(D+<\/sup>)=0\u306e\u5834\u5408\u3001U(A–<\/sup>)=U(D–<\/sup>A–<\/sup>)\u3068\u306a\u308a\u307e\u3059\u3002\u305d\u3057\u3066\u3001P(D+<\/sup>)=1\u306e\u5834\u5408\u3001U(A–<\/sup>)=U(D+<\/sup>A–<\/sup>)\u3068\u306a\u308a\u307e\u3059\u3002\u3053\u308c\u3089\u306e2\u70b9\u3092\u76f4\u7dda\u3067\u7d50\u3076\u3068\u3001\u75be\u60a3\u78ba\u7387P(D+<\/sup>)\u3068\u6cbb\u7642\u3057\u306a\u3044\u5834\u5408\u306e\u671f\u5f85\u52b9\u7528U(A–<\/sup>)\u306e\u95a2\u4fc2\u304c\u793a\u3055\u308c\u307e\u3059\u3002<\/p>\n\n\n\n

\u56f31\u304a\u3088\u3073\u56f32\u306b\u95a2\u4fc2\u3059\u308b\u6587\u732e\uff1a<\/p>\n\n\n\n

Neumann PJ, et al. ed. :Cost-Effectiveness in Health and Medicine. 2nd., 2017.<\/p>\n\n\n\n

Pauker SG, Kassirer JP: The threshold approach to clinical decision making. N Engl J Med 1980;302:1109-17. doi: 10.1056\/NEJM198005153022003 PMID: 7366635<\/p>\n\n\n\n

Kassirer J, Wong J, Kopelman R: Learning Clinical Reasoning. 2nd Edition. 2010, Wolters Kluber, Lippincott, Williams & Wilkins, PA, USA.<\/p>\n\n\n\n

Sox HC, Higgins M, Owens DK: Medical Decision Making (2nd ed.). 2013, Wiley-Blackwell.<\/p>\n\n\n\n

Straus SE, Glasziou P, Richardson WS, Haynes RB: Evidence-Based Medicine: How to practice and teach EBM. (5th edition) . 2019, Elsevier, London, UK.  \u7b2c5\u7248<\/p>\n\n\n\n

\"\"
\u56f32\uff0e\u6cbb\u7642\u3059\u308b\u5834\u5408\u306e\u75be\u60a3\u78ba\u7387\u3068\u671f\u5f85\u52b9\u7528\u3002<\/figcaption><\/figure>\n\n\n\n

\u56f32\u306f\u3001\u6cbb\u7642\u3059\u308b\u5834\u5408\u306e\u671f\u5f85\u52b9\u7528U(A+<\/sup>)\u3068\u75be\u60a3\u78ba\u7387P(D+<\/sup>)\u306e\u95a2\u4fc2\u3092\u6c7a\u5b9a\u6728\u3092\u7528\u3044\u3066\u89e3\u6790\u3059\u308b\u305f\u3081\u306e\u3082\u306e\u3067\u3059\u3002\u6cbb\u7642\u3057\u306a\u3044\u5834\u5408\u3068\u540c\u69d8\u306b\u3001\u75be\u60a3\u78ba\u7387P(D+<\/sup>)\u306e\u4e00\u6b21\u95a2\u6570linear function\u3067U(A+<\/sup>)\u304c\u8a08\u7b97\u3055\u308c\u3001\u4e21\u8005\u306e\u95a2\u4fc2\u306f\u3001\u50be\u304d\u304cU(D+<\/sup>A+<\/sup>)\u3068U(D–<\/sup>A+<\/sup>)\u306e\u5dee\u3001U(D–<\/sup>A+<\/sup>)\u3092\u5207\u7247\u3068\u3059\u308b\u76f4\u7dda\u3067\u8868\u3055\u308c\u307e\u3059\u3002<\/p>\n\n\n\n

U(D–<\/sup>A+<\/sup>)\u306f\u75be\u60a3\u3067\u306a\u3044\u306e\u306b\u6cbb\u7642\u3092\u53d7\u3051\u308b\u3053\u3068\u306b\u3088\u308b\u3001\u5bb3\u3001\u8ca0\u62c5\u3001\u8cbb\u7528\u306b\u3088\u308a\u6c7a\u307e\u308a\u307e\u3059\u3002\u3053\u308c\u3089\u306b\u3088\u308a\u3001\u75be\u60a3\u306b\u7f79\u60a3\u3057\u3066\u3044\u306a\u3044\u306b\u3082\u304b\u304b\u308f\u3089\u305a\u3001\u52b9\u7528\u5024\u304c\u4f4e\u4e0b\u3057\u307e\u3059\u3002<\/p>\n\n\n\n

U(D+<\/sup>A+<\/sup>)\u306f\u75be\u60a3\u304c\u3042\u3063\u3066\u3001\u6cbb\u7642\u3092\u53d7\u3051\u308b\u3053\u3068\u306b\u3088\u308a\u6539\u5584\u3057\u305f\u671f\u5f85\u52b9\u7528\u5024\u306e\u5024\u306b\u306a\u308a\u307e\u3059\u3002<\/p>\n\n\n\n

\"\"
\u56f33\uff0e\u6cbb\u7642\u95be\u5024\u3002<\/figcaption><\/figure>\n\n\n\n

\u6cbb\u7642\u95be\u5024Therapeutic threshold\u3068\u306f\u3001Kassirer J 2010\u306eFigure 4.9\u306e\u89e3\u8aac\u304b\u3089\u5f15\u7528\u3059\u308b\u3068\uff1a \u201c\u75be\u60a3\u78ba\u7387\u30920\u304b\u30891\u307e\u3067\u6c34\u5e73\u7dda\u3067\u8868\u3057\u3066\u3044\u308b\u3002\u6cbb\u7642\u95be\u5024\u306f\u3001\u3042\u308b\u75c5\u6c17\u306e\u53ef\u80fd\u6027\u3068\u3001\u5229\u7528\u53ef\u80fd\u306a\u6cbb\u7642\u6cd5\u306e\u76ca\u3068\u30ea\u30b9\u30af\u306b\u95a2\u3059\u308b\u30c7\u30fc\u30bf\u304b\u3089\u7b97\u51fa\u3055\u308c\u308b\u3002\u3053\u306e\u95be\u5024\u306f\u3001\u6cbb\u7642\u306e\u57fa\u6e96\uff08\u30d9\u30f3\u30c1\u30de\u30fc\u30af\uff09\u3068\u306a\u308b\u3082\u306e\u3067\u3042\u308b\u3002\u95be\u5024\u3088\u308a\u4f4e\u3044\u75be\u60a3\u78ba\u7387\u3067\u306f\u6cbb\u7642\u3092\u63a7\u3048\u3001\u95be\u5024\u3088\u308a\u9ad8\u3044\u75be\u60a3\u78ba\u7387\u3067\u306f\u6cbb\u7642\u304c\u884c\u308f\u308c\u308b\u3002\u75be\u60a3\u78ba\u7387\u3092\u3055\u3089\u306b\u8a55\u4fa1\u3059\u308b\u305f\u3081\u306e\u8ffd\u52a0\u691c\u67fb\u304c\u306a\u3044\u3053\u3068\u304c\u524d\u63d0\u3067\u3042\u308b\u3002\u305d\u306e\u3088\u3046\u306a\u691c\u67fb\u304c\u306a\u3044\u5834\u5408\u3001\u3053\u306e\u95be\u5024\u304c\u9069\u7528\u3055\u308c\u308b\u3002\u201d<\/p>\n\n\n\n

\u201c\u6cbb\u7642\u95be\u5024Rx\u306f\u3001\u75be\u60a3\u78ba\u7387\u306e\u63a8\u5b9a\u5024\u304c\u3001\u305d\u306e\u5024\u3088\u308a\u5c0f\u3055\u3051\u308c\u3070\u3001\u6cbb\u7642\u3092\u63a7\u3048\u3001\u5927\u304d\u3051\u308c\u3070\u6cbb\u7642\u3092\u884c\u3046\u5024\u3067\u3042\u308b\u3002\u6cbb\u7642\u95be\u5024\u306f\u305d\u306e\u6cbb\u7642\u6cd5\u306e\u76ca\u3068\u30ea\u30b9\u30af\u3092\u8a18\u8ff0\u3057\u3066\u3044\u308b\u30c7\u30fc\u30bf\u304b\u3089\u8a08\u7b97\u3055\u308c\u308b\u201d\uff08Pauker SG 1980\uff09\u3002<\/p>\n\n\n\n

Kassirer J\u306f\u30ea\u30b9\u30afrisks\u3068\u3044\u3046\u8a00\u8449\u3092\u7528\u3044\u3066\u3044\u307e\u3059\u304c\u3001Sox HC\u3089\u306f\u5bb3Harm\u3068\u3044\u3046\u8a00\u8449\u3092\u7528\u3044\u3066\u3044\u307e\u3059\u3002\u3055\u3089\u306b\u3001Sox HC\u3089\u306f\u5358\u306a\u308b\u5bb3\u3067\u306f\u306a\u304f\u3001net harm \u3059\u306a\u308f\u3061\u6b63\u5473\u306e\u5bb3\u3068\u8ff0\u3079\u3066\u3044\u307e\u3059\u3002\u305d\u306e\u610f\u5473\u3059\u308b\u3068\u3053\u308d\u306f\u3001\u75be\u60a3\u78ba\u7387\u304c1\u3067\u306a\u3044\u5834\u5408\u306f\u3001\u75be\u60a3\u3067\u306a\u3044\u8005\u304c1 \u2013 P(D+<\/sup>)\u306e\u78ba\u7387\u3067\u542b\u307e\u308c\u3001\u3053\u308c\u3089\u306e\u4eba\u306f\u672c\u5f53\u306f\u75be\u60a3\u3067\u306f\u306a\u3044\u306e\u306b\u3001\u6cbb\u7642\u3092\u53d7\u3051\u308b\u3053\u3068\u306b\u306a\u308a\u3001\u305d\u306e\u6cbb\u7642\u306b\u3088\u3063\u3066\u3082\u305f\u3089\u3055\u308c\u308b\u52b9\u679c\u306f\u3059\u3079\u3066\u305d\u306e\u6cbb\u7642\u306e\u5bb3\u3068\u3057\u3066\u53d6\u308a\u6271\u3046\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002\u9593\u9055\u3063\u3066\u3001\u305d\u306e\u6cbb\u7642\u3092\u53d7\u3051\u305f\u5834\u5408\u3001\u3082\u3057\u3001\u305d\u306e\u6cbb\u7642\u3092\u53d7\u3051\u306a\u3044\u5834\u5408\u3068\u6bd4\u3079\u3066\u3001\u671b\u307e\u3057\u3044\u3053\u3068\u304c\u3082\u305f\u3089\u3055\u308c\u305f\u5834\u5408\u306f\u3001\u305d\u308c\u306f\u5f15\u304d\u7b97\u3057\u305f\u6b63\u5473\u306e\u5bb3\u3092\u7528\u3044\u308b\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002\u3057\u304b\u3057\u3001\u307b\u3068\u3093\u3069\u306e\u5834\u5408\u3001\u75be\u60a3\u304c\u306a\u3044\u5834\u5408\u306b\u4e0d\u5fc5\u8981\u306a\u6cbb\u7642\u3092\u53d7\u3051\u308b\u3053\u3068\u306b\u3088\u308b\u76ca\u306f\u307b\u3068\u3093\u3069\u7121\u3044\u3068\u8a00\u3048\u308b\u3067\u3057\u3087\u3046\u3002<\/p>\n\n\n\n

\u3053\u3053\u3067\u306f\u3001\u30b3\u30b9\u30c8\u3068\u3044\u3046\u610f\u5473\u3067C\u3092\u7528\u3044\u3066\u3044\u307e\u3059\u3002\u6cbb\u7642\u3092\u53d7\u3051\u308b\u3053\u3068\u3067\u3082\u305f\u3089\u3055\u308c\u308b\u3059\u3079\u3066\u306e\u671b\u307e\u3057\u304f\u306a\u3044\u30a2\u30a6\u30c8\u30ab\u30e0\u306b\u7f6e\u304f\u4fa1\u5024\u306e\u5927\u304d\u3055\u3068\u3082\u8a00\u3048\u307e\u3059\u3057\u3001\u6cbb\u7642\u306e\u671b\u307e\u3057\u304f\u306a\u3044\u3059\u3079\u3066\u306e\u52b9\u679c\u306b\u7f6e\u304f\u4fa1\u5024\u306e\u5927\u304d\u3055\u3068\u3082\u8a00\u3048\u307e\u3059\u3002Kassirer J\u306e\u30ea\u30b9\u30af\u3084Sox HC\u306eHarm\u3068\u540c\u3058\u610f\u5473\u3067\u3059\u3002<\/p>\n\n\n\n

\u6cbb\u7642\u95be\u5024\u306f\uff1a<\/p>\n\n\n\n

\u2460\u75be\u60a3\u78ba\u7387\u304c\u305d\u306e\u5024\u3092\u8d85\u3048\u308b\u3068\u6cbb\u7642\u3092\u3057\u305f\u5834\u5408\u306e\u671f\u5f85\u52b9\u7528\u304c\u6cbb\u7642\u3092\u3057\u306a\u3044\u5834\u5408\u306e\u671f\u5f85\u52b9\u7528\u3092\u4e0a\u56de\u308b\u306e\u3067\u6cbb\u7642\u304c\u884c\u308f\u308c\u308b\u3002<\/p>\n\n\n\n

\u2461\u305d\u306e\u75be\u60a3\u306b\u5bfe\u3059\u308b\u305d\u306e\u6cbb\u7642\u6cd5\u306e\u5c5e\u6027\u3067\u3042\u308a\u3001\u30d9\u30f3\u30c1\u30de\u30fc\u30af\u3067\u3042\u308b\u3002<\/p>\n\n\n\n

\u2462\u305d\u306e\u6cbb\u7642\u6cd5\u306e\u76ca\u3068\u30b3\u30b9\u30c8\uff08\u5bb3\u3001\u8ca0\u62c5\u3001\u8cbb\u7528\uff09\u304b\u3089\u8a08\u7b97\u3055\u308c\u308b\u3002\u6cbb\u7642\u95be\u5024Rx=C\/(C+B)=1\/(1+B\/C)
C=U(D–<\/sup>A–<\/sup>) – U(D–<\/sup>A+<\/sup>)\u00a0\u00a0\u00a0\u00a0 B=U(D+<\/sup>A+<\/sup>) – U(D+<\/sup>A–<\/sup>)<\/p>\n\n\n\n

\u2463\u75be\u60a3\u78ba\u7387\u3092\u3055\u3089\u306b\u8a55\u4fa1\u3059\u308b\u8ffd\u52a0\u691c\u67fb\u304c\u7121\u3044\u3053\u3068\u304c\u524d\u63d0\u3067\u3042\u308b\u3002<\/p>\n\n\n\n

\u3053\u308c\u3089\u306b\u3064\u3044\u3066\u89e3\u8aac\u3057\u307e\u3059\u3002<\/p>\n\n\n\n

\u2460\u306f\u5f53\u305f\u308a\u524d\u3067\u3059\u306d\u3002\u3059\u3067\u306b\u89e3\u8aac\u3057\u305f\u3088\u3046\u306b\u75be\u60a3\u78ba\u7387\u3068\u6cbb\u7642\u3057\u306a\u3044\u5834\u5408\u3042\u308b\u3044\u306f\u6cbb\u7642\u3057\u305f\u5834\u5408\u306e\u52b9\u7528\u5024\u306f\u76f4\u7dda\u95a2\u4fc2\u306b\u3042\u308a\u307e\u3059\u3002\u50be\u304d\u304c\u7570\u306a\u308c\u3070\u3001\u3069\u3053\u304b\u3067\u3001\u4ea4\u5dee\u3057\u3001\u305d\u306e\u5de6\u53f3\u3067\u306f\u3001\u3069\u3061\u3089\u304b\u306e\u3001\u3064\u307e\u308a\u3001\u6cbb\u7642\u3057\u306a\u3044\u5834\u5408\u304b\u6cbb\u7642\u3059\u308b\u5834\u5408\u306e\u52b9\u7528\u5024\u306e\u65b9\u304c\u3088\u308a\u5927\u304d\u304f\u306a\u308a\u307e\u3059\u3002\u306a\u304a\u3001\u6a2a\u8ef8\u304c\u75be\u60a3\u78ba\u7387\u3067\u7e26\u8ef8\u304c\u52b9\u7528\u5024\u3067\u3001\u3044\u305a\u308c\u30820\uff5e1\u306e\u7bc4\u56f2\u3067\u3059\u3002<\/p>\n\n\n\n

\u3055\u3066\u3001\u2461\u306b\u3064\u3044\u3066\u8003\u3048\u3066\u307f\u307e\u3057\u3087\u3046\u3002\u6cbb\u7642\u95be\u5024\u306f\u3001\u6cbb\u7642\u6cd5\u306e\u5c5e\u6027\u3067\u3001\u6cbb\u7642\u95be\u5024\u304c\u5c0f\u3055\u3051\u308c\u3070\u30b3\u30b9\u30c8\u304c\u5c0f\u3055\u304f\u3001\u76ca\u304c\u5927\u304d\u3044\u3053\u3068\u3092\u793a\u3057\u3001\u6cbb\u7642\u95be\u5024\u304c\u5927\u304d\u3051\u308c\u3070\u3001\u30b3\u30b9\u30c8\u304c\u5927\u304d\u304f\u3001\u76ca\u304c\u5c0f\u3055\u3044\u3053\u3068\u793a\u3057\u307e\u3059\u3002\u3053\u308c\u306f\u3001\u2462\u306e\u8a08\u7b97\u5f0f\u304b\u3089\u308f\u304b\u308a\u307e\u3059\u3002<\/p>\n\n\n\n

\u2462\u306b\u3064\u3044\u3066\u306f\u3001\u3069\u3046\u3067\u3057\u3087\u3046\u304b\u3002Rx=1\/(1+B\/C)\u306e\u5f0f\u304b\u3089\u3001\u76ca\u3068\u5bb3\u306e\u6bd4\u306b\u3088\u3063\u3066\u6cbb\u7642\u95be\u5024\u304c\u6c7a\u307e\u308b\u3053\u3068\u304c\u5206\u304b\u308a\u307e\u3059\u3002\u6bd4\u3067\u3059\u304b\u3089\u3001\u76ca\u3068\u5bb3\u306e\u7d76\u5bfe\u7684\u306a\u5927\u304d\u3055\u3084\u3001\u76ca\u3068\u5bb3\u306e\u5dee\u304c\u7570\u306a\u3063\u3066\u3044\u3066\u3082\u3001\u6bd4\u3067\u3042\u308bB\/C\u304c\u540c\u3058\u306a\u3089\u540c\u3058\u6cbb\u7642\u95be\u5024\u306b\u306a\u308a\u307e\u3059\u3002\u4f8b\u3048\u3070\u3001B\uff1d0.5, C=0.2\u3067\u3082B=0.1, C=0.04\u3067\u3082\u6cbb\u7642\u95be\u5024\u306f0.2\/(0.2+0.5)=0.04\/(0.04+0.1)=0.28\u3068\u306a\u308a\u307e\u3059\u3002\u3053\u306e\u70b9\u306f\u3088\u304f\u8003\u3048\u308b\u5fc5\u8981\u304c\u3042\u308a\u307e\u3059\u3002\u6b63\u5473\u306e\u76ca\u3092\u76ca\u304b\u3089\u5bb3\u3092\u5f15\u304d\u7b97\u3057\u305f\u5024\u3067\u6c42\u3081\u305f\u5834\u5408\u3001\u3064\u307e\u308a\u6b63\u5473\u306e\u76canet benefit=B-C\u3067\u8a08\u7b97\u3059\u308b\u3068\u3001\u540c\u3058\u6cbb\u7642\u95be\u5024\u3067\u3082\u6b63\u5473\u306e\u76ca\u304c\u5927\u304d\u3044\u5834\u5408\u3068\u5c0f\u3055\u3044\u5834\u5408\u304c\u3042\u308b\u3068\u3044\u3046\u3053\u3068\u306b\u306a\u308a\u307e\u3059\u3002\u4eca\u306e\u4f8b\u3067\u3044\u3046\u3068\u3001\u524d\u8005\u306e\u6b63\u5473\u306e\u76ca0.3\u3001\u5f8c\u8005\u306e\u6b63\u5473\u306e\u76ca0.06\u3067\u524d\u8005\u306e\u65b9\u304c\u660e\u3089\u304b\u306b\u5927\u304d\u304f\u306a\u308a\u307e\u3059\u3002\u6b63\u5473\u306e\u76ca\u306e\u5927\u304d\u3055\u304c\u3001\u6cbb\u7642\u958b\u59cb\u3059\u3079\u304d\u304b\u3069\u3046\u304b\u306e\u6c7a\u65ad\u306b\u5f71\u97ff\u3092\u4e0e\u3048\u308b\u304b\u3069\u3046\u304b\u3088\u304f\u8003\u3048\u308b\u5fc5\u8981\u304c\u3042\u308a\u307e\u3059\u3002<\/p>\n\n\n\n

\u307e\u305f\u3001\u2463\u3082\u975e\u5e38\u306b\u91cd\u8981\u3067\u3059\u3002\u3082\u3057\u3001\u8a3a\u65ad\u80fd\u304c\u9ad8\u3044\u3001\u3059\u306a\u308f\u3061\u611f\u5ea6\u30fb\u7279\u7570\u5ea6\u306e\u9ad8\u3044\u691c\u67fb\u3092\u65bd\u884c\u3057\u3066\u3001\u9670\u6027\u306e\u7d50\u679c\u304c\u51fa\u305f\u5834\u5408\u3001\u75be\u60a3\u78ba\u7387\u304c\u4f4e\u4e0b\u3057\u3001\u6cbb\u7642\u95be\u5024\u3092\u4e0b\u56de\u308b\u3053\u3068\u304c\u8d77\u304d\u5f97\u307e\u3059\u3002\u8907\u6570\u306e\u8a3a\u65ad\u6cd5\u3092\u5b9f\u65bd\u3059\u308b\u5834\u5408\u306f\u3001\u7d50\u679c\u304c\u3069\u306e\u3088\u3046\u306a\u7d44\u307f\u5408\u308f\u305b\u306b\u306a\u308b\u304b\u3001Sox HC 2013\u306e\u8a18\u8ff0\u3092\u5f15\u7528\u3059\u308b\u3068\u3001\u201dgamble\u201d\u3067\u3059\u3002\u691c\u67fb\u7d50\u679c\u304c\u9670\u6027\u3067\u3001\u75be\u60a3\u78ba\u7387\u304c\u4f4e\u4e0b\u3057\u305f\u5834\u5408\u3067\u3082\u3001\u6cbb\u7642\u95be\u5024\u3092\u8d85\u3048\u3066\u3044\u308b\u3053\u3068\u3092\u78ba\u8a8d\u3059\u308b\u5fc5\u8981\u304c\u3042\u308b\u3068\u601d\u3046\u306e\u306f\u6b63\u3057\u3044\u8003\u3048\u65b9\u3067\u3059\u3002\u305d\u308c\u306f\u3001\u8a3a\u65ad\u6cd5\u306e\u6cbb\u7642\u691c\u67fb\u95be\u5024Test-treatment threshold\u306b\u3088\u3063\u3066\u77e5\u308b\u3053\u3068\u304c\u3067\u304d\u307e\u3059\u3002\u3053\u308c\u306b\u3064\u3044\u3066\u306f\u3001\u5f8c\u8ff0\u3059\u308b\u4e88\u5b9a\u3067\u3059\u3002<\/p>\n\n\n\n

\u5b9f\u969b\u306e\u8a3a\u7642\u3067\u306f\u3001\u75be\u60a3\u78ba\u7387\u304c\u6cbb\u7642\u95be\u5024\u3092\u8d85\u3048\u3066\u3082\u3001\u75be\u60a3\u3067\u306a\u3044\u5272\u5408\u3001\u3059\u306a\u308f\u3061\u30011-P(D+<\/sup>)\u304c\u3069\u308c\u304f\u3089\u3044\u3042\u308b\u306e\u304b\u306f\u3001\u81e8\u5e8a\u6c7a\u65ad\u306b\u5927\u304d\u304f\u5f71\u97ff\u3057\u307e\u3059\u3002\u60a3\u8005\u306e\u7acb\u5834\u3067\u3001\u8003\u3048\u308b\u3068\u3001\u305f\u3068\u3048\u75be\u60a3\u78ba\u7387\u304c\u6cbb\u7642\u95be\u5024\u3092\u8d85\u3048\u305f\u3068\u3057\u3066\u3082\u3001\u672c\u5f53\u306f\u305d\u306e\u75be\u60a3\u3067\u306f\u306a\u3044\u306e\u306b\u3001\u307e\u3061\u304c\u3063\u3066\u6cbb\u7642\u3092\u53d7\u3051\u308b\u78ba\u7387\u304c\u3069\u308c\u304f\u3089\u3044\u306a\u3089\u8a31\u5bb9\u3067\u304d\u308b\u304b\u8003\u3048\u3055\u305b\u3066\u307b\u3057\u3044\u3068\u3044\u3046\u3053\u3068\u306b\u306a\u308b\u3067\u3057\u3087\u3046\u3002Shared Decision Making \u5354\u50cd\u610f\u601d\u6c7a\u5b9a\u3067\u75be\u60a3\u78ba\u7387\u3082\u8b70\u8ad6\u306e\u5bfe\u8c61\u306b\u305b\u3056\u308b\u3092\u5f97\u306a\u3044\u72b6\u6cc1\u304c\u3042\u308b\u3068\u8003\u3048\u3089\u308c\u307e\u3059\u3002<\/p>\n\n\n\n

\u56f33\u306b\u95a2\u4fc2\u3059\u308b\u6587\u732e\uff1a<\/p>\n\n\n\n

Kassirer J, Wong J, Kopelman R: Learning Clinical Reasoning. 2nd Edition. 2010, Wolters Kluwer, Lippincott, Williams & Wilkins, PA, USA.<\/p>\n\n\n\n

Pauker SG, Kassirer JP: Therapeutic decision making: a cost-benefit analysis. N Engl J Med 1975;293:229-34. doi: 10.1056\/NEJM197507312930505 PMID: 1143303<\/p>\n\n\n\n

Sox HC, Higgins M, Owens DK: Medical Decision Making (2nd ed.). 2013, Wiley-Blackwell.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u6cbb\u7642\u95be\u5024\u306b\u3064\u3044\u3066\u7406\u89e3\u3059\u308b\u305f\u3081\u306b\u306f\u3001\u671f\u5f85\u52b9\u7528\u3001\u75be\u60a3\u78ba\u7387\u306b\u3064\u3044\u3066\u306e\u77e5\u8b58\u304c\u5fc5\u8981\u306b\u306a\u308a\u307e\u3059\u3002 \u75be\u60a3\u78ba\u7387\u306f\u3001\u305d\u306e\u4eba\u304c\u60f3\u5b9a\u3059\u308b\u75be\u60a3\u306b\u7f79\u60a3\u3057\u3066\u3044\u308b\u78ba\u7387\u3067\u3059\u3002\u3053\u3053\u3067\u306fP(D+)\u3067\u8868\u3057\u3066\u3044\u307e\u3059\u3002\u78ba\u7387\u3067\u3059\u304b\u3089\u30010\uff5e1\u306e\u5024\u3092\u53d6\u308a\u307e\u3059\u3002100\u4eba … “\u6cbb\u7642\u95be\u5024Treatment threshold” \u306e<\/span>\u7d9a\u304d\u3092\u8aad\u3080<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[27,3,6],"tags":[],"class_list":["post-1263","post","type-post","status-publish","format-standard","hentry","category-benefit-harm-assessment","category-mdm","category-sdm"],"_links":{"self":[{"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/posts\/1263","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1263"}],"version-history":[{"count":3,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/posts\/1263\/revisions"}],"predecessor-version":[{"id":1269,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/posts\/1263\/revisions\/1269"}],"wp:attachment":[{"href":"https:\/\/info.zanet.biz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1263"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1263"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1263"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}