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The value of diagnostic and prognostic tests

Thursday 12 March 2015, 12.30PM to 1.30pm

Speaker(s): Marta Soares, Centre for Health Economics, University of York

Diagnostic and prognostic tests are clinical investigations that provide information on the patient, the patient’s health, or on the (observed or expected) effects of treatment. With the increasing research and development efforts in the last few decades, many new tests are now being marketed. This means health systems are increasingly under pressure to not only decide which tests should be used in practice, but also what is the best way to proceed, clinically, from the information they provide. The assessment process informing such decisions is well established in the UK for medicinal products such as drugs, but is less mature for diagnostic and prognostic technologies.

The aim of health technology assessment (HTA) processes is to establish value, using health (benefits discounted of any harms) as metric, or also considering the health foregone by other patients due to the additional costs imposed by the new technology (cost effectiveness). The mechanism by which value is generated with clinical investigations is somehow different to that of drugs: rather than health being effected directly from the use of clinical investigations (which may occur but is not often the case), these technologies identify the level or magnitude of factors relating to the patient, disease or treatment that determine, or predict, health outcomes (with and/or without treatment).

The aim of this talk is to set out principles for HTA on diagnostic and prognostic information in a way that is consistent with methods used for the evaluation of other health care technologies. We initially contextualise aspects of value for diagnostics with the wider literature on heterogeneity, stratified decision making and personalised health care. We follow by identifying the basic components of value for clinical investigations (the triad: classification, choice, outcomes). These constitute the basis of a framework of valuation that will be initially presented by considering the simple case of diagnostic tests reporting dichotomous results (revisiting Phelps and Mushlim 1988). We then extend this framework to consider tests that report categorical and continuous results, and develop graphical representations to help inform decision making. Finally, we consider how such a framework would differ for prognostic procedures.

Location: ARRC Auditorium A/RC/014

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