Methods for Identifying the Cost-effective Case Definition Cut-off for Sequential Monitoring Tests: an Extension of Phelps and Mushlin
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.
|Date of creation:||2013|
|Date of revision:|
|Contact details of provider:|| Phone: Charles Thackrah Building, 101 Clarendon Road, LEEDS LS9 2LJ|
Fax: +44 (0) 113 343 3470
Web page: http://medhealth.leeds.ac.uk/auhe
More information through EDIRC
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- McCabe, C & Claxton, K & Culyer, AJ, 2008.
"The NICE Cost-Effectiveness Threshold: What it is and What that Means,"
26466, University Library of Munich, Germany.
- 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.
When requesting a correction, please mention this item's handle: RePEc:lee:wpaper:1303. See general information about how to correct material in RePEc.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Judy Wright)
If references are entirely missing, you can add them using this form.