Snowsill Tristan
Health Economics Group, University of Exeter, Exeter, UK.
Pharmacoeconomics. 2023 Apr;41(4):339-351. doi: 10.1007/s40273-023-01241-2. Epub 2023 Jan 23.
Diagnostic tests are used to determine whether a disease or condition is present or absent in a patient, who will typically be suspected of having the disease or condition due to symptoms or clinical signs. Economic evaluations of diagnostic tests (e.g. cost-effectiveness analyses) can be used to determine whether a test produces sufficient benefit to justify its cost. Evidence on the benefits conferred by a test is often restricted to its accuracy, which means mathematical models are required to estimate the impact of a test on outcomes that matter to patients and health payers. It is important to realise the case for introducing a new test may not be restricted to its accuracy, but extend to factors such as time to diagnosis and acceptability for patients. These and other considerations may mean the common modelling approach, the decision tree, is inappropriate for underpinning an economic evaluation. There are no consensus guidelines on how economic evaluations of diagnostic tests should be conducted-this article attempts to explore the common challenges encountered in economic evaluations, suggests solutions to those challenges, and identifies some areas where further methodological work may be necessary.
诊断测试用于确定患者是否患有某种疾病或病症，通常是由于症状或临床体征而怀疑患者患有该疾病或病症。诊断测试的经济评估（例如成本效益分析）可用于确定一项测试是否能产生足够的益处来证明其成本的合理性。一项测试所带来益处的证据通常仅限于其准确性，这意味着需要数学模型来估计一项测试对患者和医疗支付方重要的结果的影响。重要的是要认识到，引入一项新测试的理由可能不仅限于其准确性，还可能扩展到诸如诊断时间和患者可接受性等因素。这些及其他考虑因素可能意味着常用的建模方法——决策树，并不适合作为经济评估的基础。目前对于应如何进行诊断测试的经济评估尚无共识性指南——本文试图探讨经济评估中遇到的常见挑战，提出应对这些挑战的解决方案，并确定一些可能需要进一步开展方法学研究的领域。
