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THE EARLY BIRD CATCHES THE WORM: EARLY COST-EFFECTIVENESS ANALYSIS OF NEW MEDICAL TESTS

Part of: Special Collection - Methods

Published online by Cambridge University Press:  22 March 2016

Leander R. Buisman ,
Maureen P.M.H. Rutten-van Mölken ,
Douwe Postmus ,
Jolanda J. Luime ,
Carin A. Uyl-de Groot  and
William K. Redekop
Leander R. Buisman
Affiliation:
Institute of Health Policy and Management, Erasmus University Rotterdam; Institute for Medical Technology Assessment, Erasmus University Rotterdambuisman@bmg.eur.nl
Maureen P.M.H. Rutten-van Mölken
Affiliation:
Institute of Health Policy and Management, Erasmus University Rotterdam; Institute for Medical Technology Assessment, Erasmus University Rotterdam
Douwe Postmus
Affiliation:
Department of Epidemiology, University of Groningen, University Medical Center Groningen
Jolanda J. Luime
Affiliation:
Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam
Carin A. Uyl-de Groot
Affiliation:
Institute of Health Policy and Management, Erasmus University Rotterdam; Institute for Medical Technology Assessment, Erasmus University Rotterdam
William K. Redekop
Affiliation:
Institute of Health Policy and Management, Erasmus University Rotterdam; Institute for Medical Technology Assessment, Erasmus University Rotterdam
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Abstract

Objectives: There is little specific guidance on performing an early cost-effectiveness analysis (CEA) of medical tests. We developed a framework with general steps and applied it to two cases.

Methods: Step 1 is to narrow down the scope of analysis by defining the test's application, target population, outcome measures, and investigating current test strategies and test strategies if the new test were available. Step 2 is to collect evidence on the current test strategy. Step 3 is to develop a conceptual model of the current and new test strategies. Step 4 is to conduct the early-CEA by evaluating the potential (cost-)effectiveness of the new test in clinical practice. Step 5 involves a decision about the further development of the test.

Results: The first case illustrated the impact of varying the test performance on the headroom (maximum possible price) of an add-on test for patients with an intermediate-risk of having rheumatoid arthritis. Analyses showed that the headroom is particularly dependent on test performance. The second case estimated the minimum performance of a confirmatory imaging test to predict individual stroke risk. Different combinations of sensitivity and specificity were found to be cost-effective; if these combinations are attainable, the medical test developer can feel more confident about the value of further development of the test.

Conclusions: A well-designed early-CEA methodology can improve the ability to develop (cost-)effective medical tests in an efficient manner. Early-CEAs should continuously integrate insights and evidence that arise through feedback, which may convince developers to return to earlier steps.

Keywords

Early cost-effectiveness analysisMedical testDecision supportResearch and developmentManufacturerTest developer
Type
Methods
Information
International Journal of Technology Assessment in Health Care , Volume 32 , Issue 1-2 , 2016 , pp. 46 - 53
Copyright
Copyright © Cambridge University Press 2016 

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