2020 年 41 巻 1 号 p. 55-91
It is common to use hypothesis testing to decide whether an investigational drug is ineffective and to determine sample size. However, it may not be good practice that only hypothesis testing is used for sample size determination, go/no-go decision making, and drug development decisions, especially in exploratory clinical trials. That is because important factors for decision making, such as treatment effects, drug development costs, and gains after launch, are not considered in hypothesis testing. The Bayesian decision theory is one of the approaches to consider such factors for decision making. The utility, which is defined by using important information such as cost, benefit, and disease severity, is used for decision making in the decision theory. In consideration of uncertainties of data and parameters, the expected value of the utility is used for decision making in the Bayesian decision theory. In this article, we explain basic concepts of the Bayesian decision theory, backward induction for calculation of expected value of utility in sequential decision-making, and introduce some approaches using the Bayesian decision theory in clinical trials. We summarize actions, utilities and sample size determination for applications of Bayesian decision theory in future clinical trials.