The analysis of decision making under uncertainty is closely related to the analysis of probabilistic inference. Indeed, much of the research into efficient methods for probabilistic inference in expert systems has been motivated by the fundamental normative arguments of decision theory. In this paper we show how the developments underlying those efficient methods can be applied immediately to decision problems. In addition to general approaches which need know nothing about the actual probabilistic inference method, we suggest some simple modifications to the clustering family of algorithms in order to efficiently incorporate decision making capabilities.