Diagnostic information as a commodity

1995 ◽  
Vol 41 (5) ◽  
pp. 781-784 ◽  
Author(s):  
H A Johnson
Keyword(s):  
Diagnostic Tests ◽  
Multiple Testing ◽  
Cost Effective ◽  
Diagnostic Procedures ◽  
Diagnostic Information ◽  
Unit Price ◽  
Screening Tests ◽  
The Cost ◽  
Effective Conditions ◽  
Test Result

Abstract In estimating the cost-effectiveness of diagnostic procedures, it is helpful to treat diagnostic information as a commodity with a unit price. The amount of useful information provided by a test result can be measured in binary units (bits), and the unit price of the information produced by the test result can be expressed in dollars per bit in much the same way that the price of gold is given in dollars per ounce. This allows comparison of the unit prices of various diagnostic tests, examination of the effect of multiple testing, and calculation of the most cost-effective conditions for screening tests.

scholarly journals Cost Effectiveness of Transbronchial Needle Aspiration

1999 ◽  
Vol 6 (4) ◽  
pp. 332-335 ◽  
Author(s):  
Jennifer A Crocket ◽  
Eric YL Wong ◽  
Dale C Lien ◽  
Khanh Gia Nguyen ◽  
Michelle R Chaput ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Diagnostic Procedures ◽  
Needle Aspiration ◽  
Benign Disease ◽  
University Hospital ◽  
High Yield ◽  
Transbronchial Needle Aspiration ◽  
Computed Tomographic ◽  
The Cost

OBJECTIVE: To evaluate the yield and cost effectiveness of transbronchial needle aspiration (TBNA) in the assessment of mediastinal and/or hilar lymphadenopathy.DESIGN: Retrospective study.SETTING: A university hospital.POPULATION STUDIED: Ninety-six patients referred for bronchoscopy with computed tomographic evidence of significant mediastinal or hilar adenopathy.RESULTS: Ninety-nine patient records were reviewed. Three patients had two separate bronchoscopy procedures. TBNA was positive in 42 patients (44%) and negative in 54 patients. Of the 42 patients with a positive aspirate, 40 had malignant cytology and two had cells consistent with benign disease. The positive TBNA result altered management in 22 of 40 patients with malignant disease and one of two patients with benign disease, thereby avoiding further diagnostic procedures. The cost of these subsequent procedures was estimated at $27,335. No complications related to TBNA were documented.CONCLUSIONS: TBNA is a high-yield, safe and cost effective procedure for the diagnosis and staging of bronchogenic cancer.

scholarly journals Screening for Melanoma by Primary Health Care Physicians: A Cost—Effectiveness Analysis

1996 ◽  
Vol 3 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Afaf Girgis ◽  
Philip Clarke ◽  
Robert C Burton ◽  
Rob W Sanson—Fisher
Keyword(s):  
Cost Effectiveness ◽  
Screening Programme ◽  
Cost Effective ◽  
Economic Assessment ◽  
Screening Tests ◽  
Family Practitioners ◽  
Effectiveness Analysis ◽  
The Cost ◽  
Primary Health Care Physicians ◽  
Melanoma Screening

Background and design— Australia has the highest rates of skin cancer in the world, and the incidence is estimated to be doubling every 10 years. Despite advances in the early detection and treatment of melanoma about 800 people still die nationally of the disease each year. A possible strategy for further reducing the mortality from melanoma is an organised programme of population screening for unsuspected lesions in asymptomatic people. Arguments against introducing melanoma screening have been based on cost and the lack of reliable data on the efficacy of any screening tests. To date, however, there has been no systematic economic assessment of the cost effectiveness of melanoma screening. The purpose of this research was to determine whether screening may be potentially cost effective and, therefore, warrants further investigation. A computer was used to simulate the effects of a hypothetical melanoma screening programme that was in operation for 20 years, using cohorts of Australians aged 50 at the start of the programme. Based on this simulation, cost—effectiveness estimates of melanoma screening were calculated. Results— Under the standard assumptions used in the model, and setting the sensitivity of the screening test (visual inspection of the skin) at 60%, cost effectiveness ranged from Aust$6853 per life year saved for men if screening was undertaken five yearly to $12137 if screening was two yearly. For women, it ranged from $11 102 for five yearly screening to $20 877 for two yearly screening. Conclusion— The analysis suggests that a melanoma screening programme could be cost effective, particularly if five yearly screening is implemented by family practitioners for men over the age of 50.

scholarly journals Diagnostic performance of rapid antigen tests (RATs) for SARS-CoV-2 and their efficacy in monitoring the infectiousness of COVID-19 patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
John G. Routsias ◽  
Maria Mavrouli ◽  
Panagiota Tsoplou ◽  
Kyriaki Dioikitopoulou ◽  
Athanasios Tsakris
Keyword(s):  
Diagnostic Performance ◽  
Limit Of Detection ◽  
High Sensitivity ◽  
Cost Effective ◽  
Clinical Samples ◽  
True Positive ◽  
Antigen Tests ◽  
The Cost ◽  
Very High ◽  
Test Result

AbstractThe most widely used test for the diagnosis of SARS-CoV-2 infection is a PCR test. PCR has very high sensitivity and is able to detect very low amounts of RNA. However, many individuals receiving a positive test result in a context of a PCR-based surveillance might be infected with SARS-CoV-2, but they are not contagious at the time of the test. The question arises regards if the cost effective, portable rapid antigen tests (RATs) have a better performance than PCR in identification of infectious individuals. In this direction, we examined the diagnostic performance of RATs from 14 different manufacturers in 400 clinical samples with known rRT-PCR cycles threshold (cT) and 50 control samples. Substantial variability was observed in the limit of detection (LOD) of different RATs (cT = 26.8–34.7). The fluorescence-based RAT exhibited a LOD of cT = 34.7. The use of the most effective RATs leads to true positive rates (sensitivities) of 99.1% and 90.9% for samples with cT ≤ 30 and cT ≤ 33, respectively, percentages that can guarantee a sensitivity high enough to identify contagious patients. RAT testing may also substantially reduce the quarantine period for infected individuals without compromising personal or public safety.

scholarly journals Pharmacoeconomics of three therapeutic schemes for anti-tuberculosis therapy induced liver injury in China

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 53-63 ◽  
Author(s):  
Yu Chen ◽  
Peng Ye ◽  
Chongwu Ren ◽  
Pengfei Ren ◽  
Zheng Ma ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Liver Injury ◽  
Controlled Trial ◽  
Cost Effective ◽  
Unit Price ◽  
Sensitivity Analyses ◽  
Expert Advice ◽  
Cost Effectiveness Ratio ◽  
Tree Model ◽  
The Cost

AbstractTo evaluate the pharmacoeconomics of three therapeutic schemes in treating anti-tuberluosis therapy -induced liver injury (anti-TB DILI).MethodsIn the construction of a decision tree model, the efficacy and safety parameters came from the results of the randomized, controlled trial conducted here, the effect parameters were derived from expert advice, and the cost parameters, such as usage specification, number, and unit price, came from literature, expert advice, and so on.ResultsThe cost-effectiveness analysis (CEA) based on the effect degrees showed that bicyclol had the best effect (4.63562). The incremental cost-effectiveness ratio (ICER) (206.03270) of bicyclol was the lowest. The cost-effectiveness ratio of silibinin was the lowest (68.59987). The CEA based on the complete normalization rate showed that bicyclol had the highest complete normalization rate (83.562%), the lowest cost-effectiveness ratio (4.63627), and the smallest ICER (4.63504). Sensitivity analyses proved the robustness of the results.ConclusionsBicyclol is the most cost-effective therapy and the preferred choice for treating anti-TB DILI.

scholarly journals Two interferon gamma release assays for predicting active tuberculosis: the UK PREDICT TB prognostic test study

2018 ◽  
Vol 22 (56) ◽  
pp. 1-96 ◽  
Author(s):  
Ibrahim Abubakar ◽  
Ajit Lalvani ◽  
Jo Southern ◽  
Alice Sitch ◽  
Charlotte Jackson ◽  
...  
Keyword(s):  
Positive Result ◽  
Interferon Gamma ◽  
Cost Effective ◽  
Negative Results ◽  
Testing Strategies ◽  
Interferon Gamma Release Assays ◽  
The Uk ◽  
The Cost ◽  
Ltbi Testing ◽  
Test Result

Background Despite a recent decline in the annual incidence of tuberculosis (TB) in the UK, rates remain higher than in most Western European countries. The detection and treatment of latent TB infection (LTBI) is an essential component of the UK TB control programme. Objectives To assess the prognostic value and cost-effectiveness of the current two interferon gamma release assays (IGRAs) compared with the standard tuberculin skin test (TST) for predicting active TB among untreated individuals at increased risk of TB: (1) contacts of active TB cases and (2) new entrants to the UK from high-TB-burden countries. Design A prospective cohort study and economic analysis. Participants and setting Participants were recruited in TB clinics, general practices and community settings. Contacts of active TB cases and migrants who were born in high-TB-burden countries arriving in the UK were eligible to take part if they were aged ≥ 16 years. Main outcome measures Outcomes include incidence rate ratios comparing the incidence of active TB in those participants with a positive test result and those with a negative test result for each assay, and combination of tests and the cost per quality-adjusted life-year (QALY) for each screening strategy. Results A total of 10,045 participants were recruited between May 2010 and July 2015. Among 9610 evaluable participants, 97 (1.0%) developed active TB. For the primary analysis, all test data were available for 6380 participants, with 77 participants developing active TB. A positive result for TSTa (positive if induration is ≥ 5 mm) was a significantly poorer predictor of progression to active TB than a positive result for any of the other tests. Compared with TSTb [positive if induration is ≥ 6 mm without prior bacillus Calmette–Guérin (BCG) alone, T-SPOT®.TB (Oxford Immunotec Ltd, Oxford, UK), TSTa + T-SPOT.TB, TSTa + IGRA and the three combination strategies including TSTb were significantly superior predictors of progression. Compared with the T-SPOT.TB test alone, TSTa + T-SPOT.TB, TSTb + QuantiFERON® TB Gold In-Tube (QFT-GIT; QIAGEN GmbH, Hilden, Germany) and TSTb + IGRA were significantly superior predictors of progression and, compared with QFT-GIT alone, T-SPOT.TB, TSTa + T-SPOT.TB, TSTa + QFT-GIT, TSTa + IGRA, TSTb + T-SPOT.TB, TSTb + QFT-GIT and TSTb + IGRA were significantly superior predictors of progression. When evaluating the negative predictive performance of tests and strategies, negative results for TSTa + QFT-GIT were significantly poorer predictors of non-progression than negative results for TSTa, T-SPOT.TB and TSTa + IGRA. The most cost-effective LTBI testing strategies are the dual-testing strategies. The cost and QALY differences between the LTBI testing strategies were small; in particular, QFT-GIT, TSTb + T-SPOT.TB and TSTb + QFT-GIT had very similar incremental net benefit estimates. Conclusion This study found modest differences between tests, or combinations of tests, in identifying individuals who would go on to develop active TB. However, a two-step approach that combined TSTb with an IGRA was the most cost-effective testing option. Implications for practice and future research The two-step TSTb strategy, which stratified the TST by prior BCG vaccination followed by an IGRA, was the most cost-effective approach. The limited ability of current tests to predict who will progress limits the clinical utility of tests. The implications of these results for the NHS England/Public Health England national TB screening programme for migrants should be investigated. Study registration This study is registered as NCT01162265. Funding The National Institute for Health Research Health Technology Assessment programme.

scholarly journals Modelling the cost-effectiveness of introducing subsidised malaria rapid diagnostic tests in the private retail sector in sub-Saharan Africa

2020 ◽  
Vol 5 (5) ◽  
pp. e002138
Author(s):  
David Bath ◽  
Catherine Goodman ◽  
Shunmay Yeung
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Tests ◽  
Cost Effective ◽  
Rapid Diagnostic Tests ◽  
Sub Saharan Africa ◽  
Small Scale ◽  
Retail Sector ◽  
First Line ◽  
Sub Saharan ◽  
The Cost

BackgroundOver the last 10 years, there has been a huge shift in malaria diagnosis in public health facilities, due to widespread deployment of rapid diagnostic tests (RDTs), which are accurate, quick and easy to use and inexpensive. There are calls for RDTs to be made available at-scale in the private retail sector where many people with suspected malaria seek care. Retail sector RDT use in sub-Saharan Africa (SSA) is limited to small-scale studies, and robust evidence on value-for-money is not yet available. We modelled the cost-effectiveness of introducing subsidised RDTs and supporting interventions in the SSA retail sector, in a context of a subsidy programme for first-line antimalarials.MethodsWe developed a decision tree following febrile patients through presentation, diagnosis, treatment, disease progression and further care, to final health outcomes. We modelled results for three ‘treatment scenarios’, based on parameters from three small-scale studies in Nigeria (TS-N), Tanzania (TS-T) and Uganda (TS-U), under low and medium/high transmission (5% and 50% Plasmodium falciparum (parasite) positivity rates (PfPR), respectively).ResultsCost-effectiveness varied considerably between treatment scenarios. Cost per disability-adjusted life year averted at 5% PfPR was US$482 (TS-N) and US$115 (TS-T) and at 50% PfPR US$44 (TS-N) and US$45 (TS-T), from a health service perspective. TS-U was dominated in both transmission settings.ConclusionThe cost-effectiveness of subsidised RDTs is strongly influenced by treatment practices, for which further evidence is required from larger-scale operational settings. However, subsidised RDTs could promote increased use of first-line antimalarials in patients with malaria. RDTs may, therefore, be more cost-effective in higher transmission settings, where a greater proportion of patients have malaria and benefit from increased antimalarial use. This is contrary to previous public sector models, where RDTs were most cost-effective in lower transmission settings as they reduced unnecessary antimalarial use in patients without malaria.

A Novel Micro Mirror Spectrometer and Test Experiment

2012 ◽  
Vol 503 ◽  
pp. 266-271
Author(s):  
Biao Luo ◽  
Zhi Yu Wen ◽  
Hai Tao Liu ◽  
Li Chen ◽  
Rong Rong Qian
Keyword(s):  
Spectral Line ◽  
Spectral Resolution ◽  
Cost Effective ◽  
Test Experiment ◽  
Near Ir ◽  
Spectral System ◽  
Line Scanning ◽  
Set Up ◽  
The Cost ◽  
Test Result

In order to realize more compact and in particular cost-effective spectrometers MOEMS technology offers attractive possibilities. Based Littrow spectrometer structure for the near-IR, a micro mirror grating spectrometer has been designed and developed. The ZEMAX was used for designed this structure. The resolution of this design is 10nm, the spectral range from 900nm to 1400nm. A scanning micro mirror is the key element of this IR spectrometer set-up. This micro mirror is driven by electromagnetic force. Before fix the micro mirror, it was calibrated. Meanwhile, for reducing the cost of this system, the silicon silt was designed and fabricated. For resolution testing of this spectral system, we used one light correction filters finished this experiment. The test result has shown the resolution of this spectrometer is16.8nm. Finally, the relation between the spectral line scanning characteristic and wavelength spectral resolution was discussed.

scholarly journals A programme of studies including assessment of diagnostic accuracy of school hearing screening tests and a cost-effectiveness model of school entry hearing screening programmes

2016 ◽  
Vol 20 (36) ◽  
pp. 1-178 ◽  
Author(s):  
Heather Fortnum ◽  
Obioha C Ukoumunne ◽  
Chris Hyde ◽  
Rod S Taylor ◽  
Mara Ozolins ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Accuracy ◽  
Hearing Impairment ◽  
Cost Effective ◽  
Health Technology ◽  
Hearing Screening ◽  
School Entry ◽  
Screening Tests ◽  
The Uk ◽  
The Cost

BackgroundIdentification of permanent hearing impairment at the earliest possible age is crucial to maximise the development of speech and language. Universal newborn hearing screening identifies the majority of the 1 in 1000 children born with a hearing impairment, but later onset can occur at any time and there is no optimum time for further screening. A universal but non-standardised school entry screening (SES) programme is in place in many parts of the UK but its value is questioned.ObjectivesTo evaluate the diagnostic accuracy of hearing screening tests and the cost-effectiveness of the SES programme in the UK.DesignSystematic review, case–control diagnostic accuracy study, comparison of routinely collected data for services with and without a SES programme, parental questionnaires, observation of practical implementation and cost-effectiveness modelling.SettingSecond- and third-tier audiology services; community.ParticipantsChildren aged 4–6 years and their parents.Main outcome measuresDiagnostic accuracy of two hearing screening devices, referral rate and source, yield, age at referral and cost per quality-adjusted life-year.ResultsThe review of diagnostic accuracy studies concluded that research to date demonstrates marked variability in the design, methodological quality and results. The pure-tone screen (PTS) (Amplivox, Eynsham, UK) and HearCheck (HC) screener (Siemens, Frimley, UK) devices had high sensitivity (PTS ≥ 89%, HC ≥ 83%) and specificity (PTS ≥ 78%, HC ≥ 83%) for identifying hearing impairment. The rate of referral for hearing problems was 36% lower with SES (Nottingham) relative to no SES (Cambridge) [rate ratio 0.64, 95% confidence interval (CI) 0.59 to 0.69;p < 0.001]. The yield of confirmed cases did not differ between areas with and without SES (rate ratio 0.82, 95% CI 0.63 to 1.06;p = 0.12). The mean age of referral did not differ between areas with and without SES for all referrals but children with confirmed hearing impairment were older at referral in the site with SES (mean age difference 0.47 years, 95% CI 0.24 to 0.70 years;p < 0.001). Parental responses revealed that the consequences to the family of the referral process are minor. A SES programme is unlikely to be cost-effective and, using base-case assumptions, is dominated by a no screening strategy. A SES programme could be cost-effective if there are fewer referrals associated with SES programmes or if referrals occur more quickly with SES programmes.ConclusionsA SES programme using the PTS or HC screener is unlikely to be effective in increasing the identified number of cases with hearing impairment and lowering the average age at identification and is therefore unlikely to represent good value for money. This finding is, however, critically dependent on the results of the observational study comparing Nottingham and Cambridge, which has limitations. The following are suggested: systematic reviews of the accuracy of devices used to measure hearing at school entry; characterisation and measurement of the cost-effectiveness of different approaches to the ad-hoc referral system; examination of programme specificity as opposed to test specificity; further observational comparative studies of different programmes; and opportunistic trials of withdrawal of SES programmes.Trial registrationCurrent Controlled Trials ISRCTN61668996.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 36. See the NIHR Journals Library website for further project information.

Screening in Child Health Care: Where Are We Now and Where Are We Going?

PEDIATRICS ◽  
1974 ◽  
Vol 54 (5) ◽  
pp. 631-640
Author(s):  
A. Frederick North
Keyword(s):  
Neonatal Screening ◽  
Low Frequency ◽  
Cost Effective ◽  
Direct Costs ◽  
Screening Tests ◽  
Child Health Care ◽  
False Negatives ◽  
Future Directions ◽  
Screening Programs ◽  
The Cost

The preceding papers1-7 in this symposium discuss criteria for evaluating screening tests and screening programs and demonstrate how these criteria can be applied to several screening techniques of particular current interest. This paper will briefly review how a number of procedures measure up to the suggested criteria for screening tests and suggest some future directions which must be pursued if screening is to be based on science rather than on polemic. WHERE ARE WE NOW? Table I lists a number of diseases, functions and tests which have been considered to be of use in screening. For each of these it also gives my own estimate of how well each disease meets the criteria listed by Frankenburg2 and how well the available tests meet his criteria for effectiveness, direct costs, costs of false positives, and costs of false negatives. In the following paragraphs some of the considerations which led to these judgments are discussed. Phenyketonuria Despite its low frequency, the cost effectiveness of screening for PKU is well demonstrated, tests are adequately sensitive and specific, and with expert management the potentially high costs of false-positive tests can largely be eliminated.3 Galactosemia Though even rarer than PKU, current methods make routine neonatal screening both feasible and cost effective, provided that the test is combined with routine PKU screening.8 Other Inborn Metabolic Errors With the kind of regionalized facilities and planning discussed by Scriver,3 testing for these diseases can be added to routine neonatal screening at very little additional cost. Some of them lend themselves to effective early treatment; with others, genetic counsulling is the only currently available useful intervention.

scholarly journals Cost-effectiveness of rapid diagnostic tests, compared to microscopic tests, for the diagnosis and treatment of gestational malaria in Colombia from an institutional perspective

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Deisy Cristina Restrepo-Posada ◽  
Jaime Carmona-Fonseca ◽  
Jaiberth Antonio Cardona-Arias
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Tests ◽  
Cost Effective ◽  
Rapid Diagnostic Tests ◽  
Diagnosis And Treatment ◽  
Thick Blood Smear ◽  
Institutional Perspective ◽  
Monetary Benefit ◽  
The Cost ◽  
Net Monetary Benefit

Abstract Background Gestational malaria is associated with negative outcomes in maternal and gestational health; timely diagnosis is crucial to avoid complications. However, the limited infrastructure, equipment, test reagents, and trained staff make it difficult to use thick blood smear tests in rural areas, where rapid testing could be a viable alternative. The purpose of this study was to estimate the cost-effectiveness of rapid tests type III (Plasmodium falciparum/Plasmodium spp P.f/pan) versus microscopic tests for the diagnosis and treatment of gestational malaria in Colombia. Methods Cost-effectiveness analyses of gestational malaria diagnosis from an institutional perspective using a decision tree. Standard costing was performed for the identification, measurement and assessment phases, with data from Colombian tariff manuals. The data was collected from Health Situation Analysis, SIVIGILA and meta-analysis. Average and incremental cost-effectiveness ratio were estimated. The uncertainty was assessed through probabilistic sensitivity analysis. Results The cost of rapid diagnostic tests in 3,000 pregnant women with malaria was US$66,936 and 1,182 disability adjusted life years (DALYs) were estimated. The cost using thick blood smear tests was US$50,838 and 1,023 DALYs, for an incremental cost-effectiveness of US$ 101.2. The probabilistic sensitivity analysis of rapid diagnostic tests determined that they are highly cost-effective in 70% of the cases, even below the US$1,200 threshold; also, they showed an incremental net monetary benefit of $150,000 when payer’s willingness is US$1,000. Conclusion The use of rapid diagnostic tests for timely diagnosis and treatment of gestational malaria is a highly cost-effective strategy in Colombia, with uncertainty analyses supporting the robustness of this conclusion and the increased net monetary benefit that the health system would obtain. This strategy may help in preventing the negative effects on maternal health and the neonate at a low cost.

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