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The Role of Diagnostic Spectrum Bias in Cost-effectiveness Analysis

出版	University of California, San Diego, 1999
URL	http://books.google.com.hk/books?id=CPz2nJRrpfsC&hl=&source=gbs_api

註釋The sensitivity and specificity of diagnostic tests are known to vary with the spectrum of disease in patients studied. Failure to account for diagnostic spectrum bias in a technology assessment may lead to poorly targeted clinical use and cost-effectiveness policy. Two models of diagnostic spectrum bias (co-morbidity and work-up) were examined in a clinical trial series consisting of patients likely to be evaluated for active tuberculosis in U.S. inpatient and specialized outpatient facilities. The sensitivity and specificity of a nucleic acid amplification test and an existing test for acid fast bacilli were characterized in tuberculosis suspects with and without known HIV infection and by physician's risk assessment. Second-order Monte Carlo simulations compared incremental costs of a 30-day evaluation and cases detected in these clinically-defined subgroups. Effect modification, defined as a "cross-over" or quantitative change in the joint distribution of incremental costs and effects in a two-dimensional policy space, was assessed nonparametrically. For HIV-positive patients, and patients classified by physicians during work-up as at intermediate risk for tuberculosis, the costlier test was likely to represent a superior economic and clinical preference 88% and 65% of the time respectively, versus