scholarly journals Diagnostic accuracy, risk assessment, and cost-effectiveness of component-resolved diagnostics for food allergy: A systematic review

Allergy ◽  
2018 ◽  
Vol 73 (8) ◽  
pp. 1609-1621 ◽  
Author(s):  
J. Flores Kim ◽  
N. McCleary ◽  
B. I. Nwaru ◽  
A. Stoddart ◽  
A. Sheikh
Keyword(s):  
Systematic Review ◽  
Risk Assessment ◽  
Food Allergy ◽  
Cost Effectiveness ◽  
Diagnostic Accuracy

scholarly journals Systematic review, meta-analysis and economic modelling of molecular diagnostic tests for antibiotic resistance in tuberculosis

2015 ◽  
Vol 19 (34) ◽  
pp. 1-188 ◽  
Author(s):  
Francis Drobniewski ◽  
Mary Cooke ◽  
Jake Jordan ◽  
Nicola Casali ◽  
Tendai Mugwagwa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Economic ◽  
Drug Resistance ◽  
Cost Effectiveness ◽  
Diagnostic Accuracy ◽  
Care Pathway ◽  
Cost Effective ◽  
Rifampicin Resistance ◽  
Transmission Dynamic ◽  
Molecular Tests

BackgroundDrug-resistant tuberculosis (TB), especially multidrug-resistant (MDR, resistance to rifampicin and isoniazid) disease, is associated with a worse patient outcome. Drug resistance diagnosed using microbiological culture takes days to weeks, as TB bacteria grow slowly. Rapid molecular tests for drug resistance detection (1 day) are commercially available and may promote faster initiation of appropriate treatment.ObjectivesTo (1) conduct a systematic review of evidence regarding diagnostic accuracy of molecular genetic tests for drug resistance, (2) conduct a health-economic evaluation of screening and diagnostic strategies, including comparison of alternative models of service provision and assessment of the value of targeting rapid testing at high-risk subgroups, and (3) construct a transmission-dynamic mathematical model that translates the estimates of diagnostic accuracy into estimates of clinical impact.Review methods and data sourcesA standardised search strategy identified relevant studies from EMBASE, PubMed, MEDLINE, Bioscience Information Service (BIOSIS), System for Information on Grey Literature in Europe Social Policy & Practice (SIGLE) and Web of Science, published between 1 January 2000 and 15 August 2013. Additional ‘grey’ sources were included. Quality was assessed using quality assessment of diagnostic accuracy studies version 2 (QUADAS-2). For each diagnostic strategy and population subgroup, a care pathway was constructed to specify which medical treatments and health services that individuals would receive from presentation to the point where they either did or did not complete TB treatment successfully. A total cost was estimated from a health service perspective for each care pathway, and the health impact was estimated in terms of the mean discounted quality-adjusted life-years (QALYs) lost as a result of disease and treatment. Costs and QALYs were both discounted at 3.5% per year. An integrated transmission-dynamic and economic model was used to evaluate the cost-effectiveness of introducing rapid molecular testing (in addition to culture and drug sensitivity testing). Probabilistic sensitivity analysis was performed to evaluate the impact on cost-effectiveness of diagnostic and treatment time delays, diagnosis and treatment costs, and associated QALYs.ResultsA total of 8922 titles and abstracts were identified, with 557 papers being potentially eligible. Of these, 56 studies contained sufficient test information for analysis. All three commercial tests performed well when detecting drug resistance in clinical samples, although with evidence of heterogeneity between studies. Pooled sensitivity for GenoType®MTBDRplus (Hain Lifescience, Nehren, Germany) (isoniazid and rifampicin resistance), INNO-LiPA Rif.TB®(Fujirebio Europe, Ghent, Belgium) (rifampicin resistance) and Xpert®MTB/RIF (Cepheid Inc., Sunnyvale, CA, USA) (rifampicin resistance) was 83.4%, 94.6%, 95.4% and 96.8%, respectively; equivalent pooled specificity was 99.6%, 98.2%, 99.7% and 98.4%, respectively. Results of the transmission model suggest that all of the rapid assays considered here, if added to the current diagnostic pathway, would be cost-saving and achieve a reduction in expected QALY loss compared with current practice. GenoType MTBDRplus appeared to be the most cost-effective of the rapid tests in the South Asian population, although results were similar for GeneXpert. In all other scenarios GeneXpert appeared to be the most cost-effective strategy.ConclusionsRapid molecular tests for rifampicin and isoniazid resistance were sensitive and specific. They may also be cost-effective when added to culture drug susceptibility testing in the UK. There is global interest in point-of-care testing and further work is needed to review the performance of emerging tests and the wider health-economic impact of decentralised testing in clinics and primary care, as well as non-health-care settings, such as shelters and prisons.Study registrationThis study is registered as PROSPERO CRD42011001537.FundingThe National Institute for Health Research Health Technology Assessment programme.

Cost-Effectiveness of Food Allergy Interventions in Children: A Systematic Review of Economic Evaluations

2021 ◽  
Author(s):  
Laura Fanning ◽  
Ekaterina Woods ◽  
Catherine J. Hornung ◽  
Kirsten P. Perrett ◽  
Mimi L.K. Tang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Food Allergy ◽  
Cost Effectiveness ◽  
Economic Evaluations

Diagnostic accuracy of different caries risk assessment methods. A systematic review

2015 ◽  
Vol 43 (12) ◽  
pp. 1385-1393 ◽  
Author(s):  
Anna Senneby ◽  
Ingegerd Mejàre ◽  
Nils-Eric Sahlin ◽  
Gunnel Svensäter ◽  
Madeleine Rohlin
Keyword(s):  
Systematic Review ◽  
Risk Assessment ◽  
Diagnostic Accuracy ◽  
Assessment Methods ◽  
Caries Risk ◽  
Caries Risk Assessment

Accuracy of Automated Smartphone Applications for Detection of Melanomas in Adult Pigmented Lesions: A Systematic Review (Preprint)

2021 ◽  
Author(s):  
Justin Di Lu ◽  
Muskaan Sachdeva ◽  
Megan Lam ◽  
Ronald Vender
Keyword(s):  
Systematic Review ◽  
Risk Assessment ◽  
Diagnostic Accuracy ◽  
Expert Opinion ◽  
Histopathological Examination ◽  
Automated Analysis ◽  
Smartphone Applications ◽  
Benign Lesions ◽  
Pigmented Lesions ◽  
The Impact

BACKGROUND Automated smartphone applications are increasingly being developed to provide an immediate risk assessment of lesions. However, the accuracy of these smartphone applications are not well known. OBJECTIVE To systematically review and evaluate the diagnostic accuracy of automated smartphone applications in detecting melanoma in adults with pigmented lesions. METHODS We systematically searched for articles which evaluated automated smartphone applications for detecting melanomas in MEDLINE and Embase. Articles were included if they used smartphone applications with automated analysis for detecting melanomas and were compared to benign lesions that were confirmed through histopathological examination or expert opinion. RESULTS 12 automated smartphone conditions examined a total of 6635 lesions, comprising 269 melanomas. Sensitivities ranged from 7% (95% CI 2-16%) to 97% (95% CI 85-100%) and specificities from 27% (95% CI: 6-61%) to 100% (95% CI: 78-100%). However, none of these conditions were as accurate as the diagnostic evaluation by one dermatologist in one of the studies. CONCLUSIONS We do not recommend automated smartphone applications for detecting melanomas. In addition, research is needed on the impact of false interpretations from smartphone applications on patients with skin concerns.

scholarly journals Dermoscopy for melanoma detection and triage in primary care: a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e027529 ◽  
Author(s):  
OT Jones ◽  
LC Jurascheck ◽  
MA van Melle ◽  
S Hickman ◽  
NP Burrows ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Cost Effectiveness ◽  
Diagnostic Accuracy ◽  
Primary Care Physicians ◽  
Skin Lesions ◽  
Bibliographic Databases ◽  
Benign Lesions ◽  
Patient Acceptability ◽  
Training Requirements

ObjectiveMost skin lesions first present in primary care, where distinguishing rare melanomas from benign lesions can be challenging. Dermoscopy improves diagnostic accuracy among specialists and is promoted for use by primary care physicians (PCPs). However, when used by untrained clinicians, accuracy may be no better than visual inspection. This study aimed to undertake a systematic review of literature reporting use of dermoscopy to triage suspicious skin lesions in primary care settings, and challenges for implementation.DesignA systematic literature review and narrative synthesis.Data sourcesWe searched MEDLINE, Cochrane Central, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and SCOPUS bibliographic databases from 1 January 1990 to 31 December 2017, without language restrictions.Inclusion criteriaStudies including assessment of dermoscopy accuracy, acceptability to patients and PCPs, training requirements, and cost-effectiveness of dermoscopy modes in primary care, including trials, diagnostic accuracy and acceptability studies.Results23 studies met the review criteria, representing 49 769 lesions and 3708 PCPs, all from high-income countries. There was a paucity of studies set truly in primary care and the outcomes measured were diverse. The heterogeneity therefore made meta-analysis unfeasible; the data were synthesised through narrative review. Dermoscopy, with appropriate training, was associated with improved diagnostic accuracy for melanoma and benign lesions, and reduced unnecessary excisions and referrals. Teledermoscopy-based referral systems improved triage accuracy. Only three studies examined cost-effectiveness; hence, there was insufficient evidence to draw conclusions. Costs, training and time requirements were considered important implementation barriers. Patient satisfaction was seldom assessed. Computer-aided dermoscopy and other technological advances have not yet been tested in primary care.ConclusionsDermoscopy could help PCPs triage suspicious lesions for biopsy, urgent referral or reassurance. However, it will be important to establish further evidence on minimum training requirements to reach competence, as well as the cost-effectiveness and patient acceptability of implementing dermoscopy in primary care.Trial registration numberCRD42018091395.

scholarly journals LO74: Cost-effectiveness of pathways for diagnosing pulmonary embolism in Canada

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S33-S33
Author(s):  
S.E. Garland ◽  
B. Tsoi ◽  
A. Sinclair ◽  
K. Peprah ◽  
K. Lee
Keyword(s):  
Risk Assessment ◽  
Pulmonary Embolism ◽  
Cost Effectiveness ◽  
Diagnostic Imaging ◽  
Diagnostic Accuracy ◽  
Cost Effective ◽  
Diagnostic Strategy ◽  
Diagnostic Strategies ◽  
Clinical Risk Assessment ◽  
Rule Out

Introduction: Pulmonary embolism (PE) is a common cardiovascular condition with high mortality rates if left untreated. Given the non-specific and varied symptoms of PE, its diagnosis remains challenging and approaches can lend themselves to inefficiencies through over-testing and over-diagnosis. Clinicians rely on a multi-component and sequential approach, including clinical risk assessment, rule-out biomarkers, and diagnostic imaging. This study assessed the potential cost-effectiveness of different diagnostic algorithms. Methods: A cost-utility model was developed with an upfront decision tree capturing the diagnostic accuracy and a Markov cohort model reflecting the lifetime disease progression and clinical utility of each diagnostic strategy. 57 diagnostic strategies were evaluated that were permutations of various clinical risk assessment, rule-out biomarkers and diagnostic imaging modalities. Diagnostic test accuracy was informed by systematic reviews and meta-analyses, and costs (2016 CAD) were obtained from Canadian costing databases to reflect a health-care payer perspective. Separate scenario analyses were conducted on patients contra-indicated for computed tomography (CT) or who are pregnant as this entails a comparison of a different set of diagnostic strategies. Results: Six diagnostic strategies formed the efficiency frontier. Diagnosing patients with PE was generally cost-effective if willingness-to-pay was greater than $1,481 per quality-adjusted-life year (QALY). CT dominated other imaging modality given its greater diagnostic accuracy, lower rates of non-diagnostic findings and lowest overall costs. The use of clinical prediction rules to determine clinical pre-test probability of PE and the application of rule-out test for patients with low-to-moderate risk of PE may be cost-effective while reducing the proportion of patients requiring CT and lowering radiation exposure. At a willingness-to-pay of $50,000 per QALY, the strategy of Wells (2 tier) --> d-dimer --> CT --> CT was the most likely cost-effective diagnostic strategy. However, different diagnostic strategies were considered cost-effective for pregnant patients and those contra-indicated for CT. Conclusion: This study highlighted the value of economic modelling to inform judicious use of resources in achieving a diagnosis for PE. These findings, in conjunction with a recent health technology assessment, may help to inform clinical practice and guidelines. Which strategy would be considered cost-effective reflected ones willingness to trade-off between misdiagnosis and over-diagnosis.

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