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Methods for Identifying the Cost-effective Case Definition Cut-off for Sequential Monitoring Tests: an Extension of Phelps and Mushlin


Author Info

  • Christopher McCabe

    (Department of Emergency Medicine, University of Alberta, Canada)

  • Paul Baxter

    (Centre for Epidemiology & Biostatistics, University of Leeds)

  • Roberta Longo

    (Leeds Institute of Health Sciences, University of Leeds)

  • Peter Hall

    (Leeds Institute of Health Sciences, University of Leeds)

  • Jenny Hewison

    (Leeds Institute of Health Sciences, University of Leeds)

  • Mehran Afshar

    (Leeds Teaching Hospitals Trust, Leeds)

  • Geoff Hall

    (Leeds Teaching Hospitals Trust, Leeds)


The arrival of personalized medicine in the clinic means that treatment decisions will increasingly rely on test results. The challenge of limited health care resources means that the dissemination of these technologies will be dependent on their value in relation to their cost; i.e. their cost effectiveness. Phelps and Mushlin have described how to optimize tests to meet cost effectiveness target. However, when tests are applied repeatedly the case mix of the patients tested changes with each administration, and this impacts upon the value of each subsequent test administration. In this paper we present a modification of Phelps and Mushlin’s framework for diagnostic tests; to identify the cost effective cut-off for monitoring tests. Using the use of Ca125 test monitoring for relapse in Ovarian Cancer, we show how the repeated use of the diagnostic cut-off can lead to a substantially increased false negative rate compared to the monitoring cut-off – over 20% higher than in this example – with the associated harms for individual and population health.

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Bibliographic Info

Paper provided by Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds in its series Working Papers with number 1303.

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Length: 16 pages
Date of creation: 2013
Date of revision:
Handle: RePEc:lee:wpaper:1303

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  1. Christopher McCabe & Karl Claxton & Anthony J. Culyer, 2008. "The NICE Cost-Effectiveness Threshold: What it is and What that Means," PharmacoEconomics, Springer Healthcare | Adis, vol. 26(9), pages 733-744.
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