From accuracy to patient outcome and cost-effectiveness evaluations of diagnostic tests and biomarkers: an exemplary modelling study.
From accuracy to patient outcome and cost-effectiveness evaluations of diagnostic tests and biomarkers: an exemplary modelling study.
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DOI：
10.1186/1471-2288-13-12
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发表时间：
2013-01-31
影响因子：
4
通讯作者：
Moons KG
中科院分区：
文献类型：
--
作者：
Koffijberg H;van Zaane B;Moons KG
需要对新的诊断测试进行适当的评估，以减少过度使用，并限制潜在的负面健康影响和与测试有关的费用。当诊断性随机对照试验不可行时，决策分析建模方法可能是值得的。我们通过评估改良经食管超声心动图（TEE）与手动触诊检测升主动脉粥样硬化的成本效益来证明这一点。根据以前的诊断准确性研究，实际荷兰报销数据，并从文献中的证据，我们开发了一个马尔可夫决策分析模型。从生命周期和医疗保健角度评估改良TEE的成本效益。动脉粥样硬化的患病率与年龄相关，并且应用了低和高的患病率。应用概率敏感性分析。该模型综合了有关心脏手术患者中风风险的所有可用证据。改良的TEE策略始终导致更适合的外科手术，因此，卒中风险较低，生命年数略高。在动脉粥样硬化患病率为10%的情况下，55岁男性和女性每质量调整生命年的增量成本-效果比分别为4，651欧元和481欧元。在所有65岁或以上的患者中，改良的TEE策略节省了成本，并带来了额外的健康益处。决策分析模型，以评估成本效益的一个新的诊断测试的基础上的特点，成本和效果的测试本身和随后的治疗方案是可行的和有价值的。我们对改良TEE的病例研究表明，在可接受的成本效益水平下，它可以降低55岁以上心脏手术患者的卒中风险。
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. 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. 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. 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.
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影响因子：
158.5
作者：
AMARENCO, P;COHEN, A;BOUSSER, MG
通讯作者：
BOUSSER, MG
影响因子：
3.4
作者：
Nashef, SAM;Rogues, F;Salamon, R
通讯作者：
Salamon, R
影响因子：
5.6
作者：
Biesheuvel, Cornelis J.;Grobbee, Diederick E.;Moons, Karel G. M.
通讯作者：
Moons, Karel G. M.
影响因子：
1.9
作者：
MOHAN, R;AMSEL, BJ;WALTER, PJ
通讯作者：
WALTER, PJ
DOI：
10.1053/j.jvca.2008.07.017
发表时间：
2008-10-01
影响因子：
2.8
作者：
Nierich, Arno P.;van Zaane, Bas;Moons, Karel G. M.
通讯作者：
Moons, Karel G. M.