A Decision Analysis Approach to the Swine Influenza Vaccination Decision for an Individual

• Published in: Medical care 1980-01, Vol.18 (1), p.59-72
• Main Authors: Zalkind, David L., Shachtman, Richard H.
• Format: Article
• Language: English
• Subjects: Adult; Attitude; Bioethics; Decision Making; Decision Theory; Humans; Influenza Vaccines - adverse effects; Influenza Vaccines - therapeutic use; Informed Consent; Models, Theoretical; National Health Programs; Orthomyxoviridae Infections - prevention & control; Patient Participation; Polyradiculoneuropathy - etiology; Probability; Risk Assessment; Social Values; United States; Vaccination - psychology
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/00005650-198001000-00005

We present a method to analyze the decision by an individual whether to receive the swine influenza (A/New Jersey) vaccine, including an approach for health care personnel to use in informing an individual about the personal costs, benefits and probabilities, as well as indicated choices of actions, associated with such decisions. This analysis is a prototype for cases where informed consent requirements have prompted increased patient involvement in personal medical decisions. Probabilities and personally assessed values that affect the decision are: reaction to the injection, attack rates, vaccine efficacy, chances for an epidemic and concomitant probabilities of contracting influenza, and mortality. We specify a preference ordering for consequences of receiving the vaccine. The analysis yields a preference ordering for possible actions because relative values reflecting preferences are compared on a fixed consistent scale. The solution exhibited, determined in the fall of 1976, indicates conditions when selection of the action to receive the vaccine is automatic. In cases where the decision is not automatic, an individual needs additional information about the personal value of death (life), relative to other possible outcomes. We previously have developed a noneconomic approach to the determination of the value of death and the results, briefly described in this paper, are used to construct a decision region for the choice of receiving the vaccine that depends on both the probability of an epidemic and the value of death. Surprisingly, inclusion of information about the Guillain-Barré syndrome does not necessarily alter the decision to receive the vaccine, even though recognition of the increased incidence of the syndrome caused by the vaccine caused cancellation of the federal program.