Health Improvement Scotland, Glasgow, UK.
Department of Pure and Applied Chemistry, University of Strathclyde Technology and Innovation Centre, Glasgow, UK.
BMJ Open. 2018 May 24;8(5):e017593. doi: 10.1136/bmjopen-2017-017593.
To determine the potential costs and health benefits of a serum-based spectroscopic triage tool for brain tumours, which could be developed to reduce diagnostic delays in the current clinical pathway.
A model-based health pre-trial economic assessment. Decision tree models were constructed based on simplified diagnostic pathways. Models were populated with parameters identified from rapid reviews of the literature and clinical expert opinion.
Explored as a test in both primary and secondary care (neuroimaging) in the UK health service, as well as application to the USA.
Calculations based on an initial cohort of 10 000 patients. In primary care, it is estimated that the volume of tests would approach 75 000 per annum. The volume of tests in secondary care is estimated at 53 000 per annum.
The primary outcome measure was quality-adjusted life-years (QALY), which were employed to derive incremental cost-effectiveness ratios (ICER) in a cost-effectiveness analysis.
Results indicate that using a blood-based spectroscopic test in both scenarios has the potential to be highly cost-effective in a health technology assessment agency decision-making process, as ICERs were well below standard threshold values of £20 000-£30 000 per QALY. This test may be cost-effective in both scenarios with test sensitivities and specificities as low as 80%; however, the price of the test would need to be lower (less than approximately £40).
Use of this test as triage tool in primary care has the potential to be both more effective and cost saving for the health service. In secondary care, this test would also be deemed more effective than the current diagnostic pathway.
确定一种基于血清的光谱分诊工具用于脑瘤的潜在成本和健康效益，该工具可以开发出来，以减少当前临床路径中的诊断延迟。
基于模型的健康预试验经济评估。决策树模型根据简化的诊断途径构建。模型使用从文献快速审查和临床专家意见中确定的参数填充。
在英国卫生服务中探索作为初级和二级保健（神经影像学）的测试，以及在美国的应用。
基于最初的 10000 名患者队列进行计算。在初级保健中，估计每年的测试量将接近 75000 次。二级保健中的测试量估计为每年 53000 次。
主要结果测量是质量调整生命年（QALY），用于在成本效益分析中得出增量成本效益比（ICER）。
结果表明，在两种情况下使用基于血液的光谱测试具有在卫生技术评估机构决策过程中高度成本效益的潜力，因为 ICER 远低于每 QALY 20000-30000 英镑的标准阈值。在测试灵敏度和特异性低至 80%的情况下，该测试在两种情况下都可能具有成本效益；然而，测试的价格需要更低（低于约 40 英镑）。
在初级保健中使用这种测试作为分诊工具有可能对卫生服务更有效和节省成本。在二级保健中，与当前的诊断途径相比，该测试也将被认为更有效。
