Dataset Information

From accuracy to patient outcome and cost-effectiveness evaluations of diagnostic tests and biomarkers: an exemplary modelling study.

ABSTRACT: BACKGROUND: Proper evaluation of new diagnostic tests is required to reduce overutilization and to limit potential negative health effects and costs related to testing. A decision analytic modelling approach may be worthwhile when a diagnostic randomized controlled trial is not feasible. We demonstrate this by assessing the cost-effectiveness of modified transesophageal echocardiography (TEE) compared with manual palpation for the detection of atherosclerosis in the ascending aorta. METHODS: Based on a previous diagnostic accuracy study, actual Dutch reimbursement data, and evidence from literature we developed a Markov decision analytic model. Cost-effectiveness of modified TEE was assessed for a life time horizon and a health care perspective. Prevalence rates of atherosclerosis were age-dependent and low as well as high rates were applied. Probabilistic sensitivity analysis was applied. RESULTS: The model synthesized all available evidence on the risk of stroke in cardiac surgery patients. The modified TEE strategy consistently resulted in more adapted surgical procedures and, hence, a lower risk of stroke and a slightly higher number of life-years. With 10% prevalence of atherosclerosis the incremental cost-effectiveness ratio was € 4,651 and € 481 per quality-adjusted life year in 55-year-old men and women, respectively. In all patients aged 65 years or older the modified TEE strategy was cost saving and resulted in additional health benefits. CONCLUSIONS: Decision analytic modelling to assess the cost-effectiveness of a new diagnostic test based on characteristics, costs and effects of the test itself and of the subsequent treatment options is both feasible and valuable. Our case study on modified TEE suggests that it may reduce the risk of stroke in cardiac surgery patients older than 55 years at acceptable cost-effectiveness levels.

SUBMITTER: Koffijberg H

PROVIDER: S-EPMC3724486 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

From accuracy to patient outcome and cost-effectiveness evaluations of diagnostic tests and biomarkers: an exemplary modelling study.

Koffijberg Hendrik H van Zaane Bas B Moons Karel G M KG

BMC medical research methodology 20130131

<h4>Background</h4>Proper evaluation of new diagnostic tests is required to reduce overutilization and to limit potential negative health effects and costs related to testing. A decision analytic modelling approach may be worthwhile when a diagnostic randomized controlled trial is not feasible. We demonstrate this by assessing the cost-effectiveness of modified transesophageal echocardiography (TEE) compared with manual palpation for the detection of atherosclerosis in the ascending aorta.<h4>Me ...[more]

PMID: 23368927

Similar Datasets

Project description:BackgroundPrevious studies have showed that the early diagnosis of threatened preterm labor decreases neonatal morbidity and mortality, avoids maternal morbidity induced by antepartum bed rest and unnecessary treatment, and reduces costs. Although there are many diagnostic tests, none is clearly recommended by international guidelines. The aim of our study was to compare seven diagnostic methods in terms of effectiveness and cost using a decision analysis model in singleton pregnancy presenting threatened preterm labor, between 24 and 34 weeks of gestation.MethodsSeven diagnostic strategies based on individual or combined use of the following tests: cervical length, cervical fibronectin test, cervical interleukin test and protein in maternal serum, were compared using a decision analysis model. Effectiveness was expressed in terms of serious adverse neonatal events avoided (neonatal morbidity and mortality) at the hospital discharge. The economic analysis was performed from the health care system perspective. Deterministic and probabilistic analyses were performed to test the robustness of the model.ResultsAt 24-34 weeks of gestation, the association of cervical length and qualitative fibronectin was the most efficient strategy dominating all alternatives, reducing the perinatal death or severe neonatal morbidity rate up to 15% and the costs up to 31% according to the gestational age. This result was confirmed by the deterministic sensitivity analyses. The probabilistic analysis showed that the association of cervical length and qualitative fibronectin dominated cervical length < 15 mm in more than 90% of the simulations. The comparison with the other tests revealed more uncertainty.ConclusionsA test using cervical length and qualitative fetal fibronectin appears to be the best diagnostic strategy. Decisions regarding its generalization and funding in France in this population of women should take into account the high, lifetime costs induced by prematurity.

Project description:BackgroundMany patients with non-metastatic non-small cell lung cancer (NSCLC) are cured by surgery but part of them develop recurrence. Strategies are needed to identify these relapses. Currently, there is no consensus on the follow-up schedule after curative resection for patients with NSCLC. The objective of this study is to analyze the diagnostic capacity of the tests performed during follow-up after surgery.MethodsWe retrospectively reviewed 392 patients with stage I-IIIA NSCLC who underwent surgery. Data were collected from patients diagnosed between January 1st, 2010 and December 31st, 2020. Demographic and clinical data were analyzed, as well as the tests performed during their follow-up. We identified as relevant in the diagnosis of relapses those tests that prompted further investigation and change of treatment.ResultsThe number of tests matches those included in clinical practice guidelines. A total of 2,049 clinical follow-up consultations were performed, of which 2,004 were scheduled (0.59% informative). A total of 1,796 blood tests were performed, of which 1,756 were scheduled (0.17% informative). A total of 1,940 chest computer tomography (CT) scans were performed, of which 1,905 were scheduled and 128 were informative (6.7%). A total of 144 positron emission tomography (PET)-CT scans were performed, 132 of which were scheduled, of which 64 (48%) were informative. In all cases, the tests performed by unscheduled request exceeded the informative result of the scheduled ones several fold.ConclusionsMost of the scheduled follow-up consultations were not relevant for the patients' management, and only body CT scan exceeded the threshold of 5% profitability, without reaching 10% even in stage IIIA. The profitability of the tests increased when performed in unscheduled visits. New follow-up strategies based on scientific evidence must be defined and follow-up schemes should be tailored focused on agile attention of the unscheduled demand.

Dataset Information

From accuracy to patient outcome and cost-effectiveness evaluations of diagnostic tests and biomarkers: an exemplary modelling study.

Publications

From accuracy to patient outcome and cost-effectiveness evaluations of diagnostic tests and biomarkers: an exemplary modelling study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets