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Dictionary of Evidence-based Medicine 159 forgo to regain complete health; (iii) standard gamble whereby patients are asked to choose between living the rest of their lives in their current state or a gamble which, if won, will mean perfect health and, if lost, will mean death. The probability of winning the gamble is altered until the point of indifference is reached. Utility theory Utility theory or expected utility theory is a formal model, first proposed by von Neumann and Morgenstern to deal with choice in the presence of risk. They described a set of axioms (see below) for characterizing rational behaviour and proposed a strategy for choosing among alternatives under such circumstances. When measuring utilities, the person's risk preference is assumed to follow the following five axioms: • Completeness. When choosing between two outcomes (o v o 2 ) there are three possibilities: o a is preferred to o 2 , neither is preferred or o 2 is preferred to o r • Transitivity. If o a is preferred to o 2 and o 2 is preferred to o 3 , then o l should be preferred to o 3 . Likewise, if o 2 and o l are considered equivalent and o 3 and o 2 are considered similarly, then o a and o 3 should be equivalent too. • Continuity. If o l is preferred to o 2 and o 2 to o 3/ then there exists a probability p that the lottery shown in Figure 27 is preferred to the certainty of receiving outcome o 2 . • Independence (or substitution). If o l and o 2 are equally attractive under conditions of certainty, then the lottery shown in Figure 27 and the lottery shown in Figure 28 will be equally attractive for any value of p oro 3 . • Reduction of compound lotteries. A lottery whose initial outcomes are themselves lotteries (i.e. a compound lottery) is as attractive as the simple lottery that is obtained when multiplying through probabilities as shown in Figures 29 and 30. From those axioms, the expected utility (EU) theorem follows: a utility function U can be defined on the outcomes with the property that a choice with a higher expected utility is always preferred to one with a lower expected utility (von Neumann J, Morgenstern O (1947) Theory of games and economic behavior. 2nd edn. John Wiley, New York).
160 Dictionary of Evidence-based Medicine Figure 27 Lottery I Figure 28 Lottery II
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Dictionary of Evidence-based Medici
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Preface This book was conceived at
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A Ability to pay Ability to pay is
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Figure I Audit: Clinical audit cycl
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B Balanced design In an experiment,
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Figure 9 Concept of externality Dic
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G Game theory Game theory, first de
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I ICD (see International Classifica
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K Keynes, John Maynard (1883-1946)
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M Macroeconomics Macroeconomics is
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N N of I trial An N of 1 trial is a
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Page 116 and 117: o OBM (see Opinion-based medicine)
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Page 150 and 151: S Scarcity Scarcity is often referr
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Page 162 and 163: u Unique value effect This term is
Page 170: Z Z variate A random variable which
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