Health economic evaluation of a serum based blood test for brain tumour diagnosis: exploration of two clinical scenarios

Ewan Gray, Holly J Butler, Ruth Board, Paul M Brennan, Anthony J Chalmers, Timothy Dawson, John Goodden, Willie Hamilton, Mark G Hegarty, Allan James, Michael D Jenkinson, David Kernick, Elvira Lekka, Laurent J Livermore, Samantha J Mills, Kevin O'Neill, David S Palmer, Babar Vaqas, Matthew J Baker

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives
To determine the potential costs and health benefits of a serum-based spectroscopic triage tool for brain tumours, that could be developed to reduce diagnostic delays in the current clinical pathway.
Design
A model-based health pre-trial economic assessment. Decision tree models were constructed based on simplified diagnostic pathways. Models were populated with parameters identified from rapid reviews of the literature and clinical expert opinion.
Setting
Explored as a test in both primary and secondary care (neuroimaging) in the UK health service, as well as application to the US.
Participants
Calculations based upon an initial cohort of 10,000 patients. In primary care, it is estimated that the volume of tests would approach 75,000 per annum. The volume of tests in secondary care is estimated at 53,000 per annum.
Main Outcome Measures
The primary outcome measure was quality adjusted life years (QALYs), which were employed to derive incremental cost-effectiveness ratios (ICERs) in a cost-effectiveness analysis.
Results
Results indicate that using a blood-based spectroscopic test in both scenarios has the potential to be highly cost-effective in a health technology assessment (HTA) agency decision making process, as ICERs were well below standard threshold values of £20,000 to £30,000 per QALY. This test may be cost-effective in both scenarios with test sensitivities and specificities as low as 80%; however, the price of the test would need to be lower (less than approximately £40).
Conclusion
Use of this test as triage tool in primary care has the potential to be both more effective and cost saving for the health service. In secondary care, this test would also be deemed more effective than the current diagnostic pathway.
LanguageEnglish
Article numbere017593
Number of pages9
JournalBMJ Open
Volume8
Issue number5
DOIs
Publication statusPublished - 24 May 2018

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Hematologic Tests
Brain Neoplasms
Secondary Care
Cost-Benefit Analysis
Tumors
Brain
Blood
Health
Primary Health Care
Cost effectiveness
Economics
Quality-Adjusted Life Years
Triage
Serum
Costs and Cost Analysis
Health Services
Costs
Biomedical Technology Assessment
Decision Trees
Critical Pathways

Keywords

  • brain tumour
  • serum-based spectroscopic triage tool
  • diagnosis

Cite this

Gray, Ewan ; Butler, Holly J ; Board, Ruth ; Brennan, Paul M ; Chalmers, Anthony J ; Dawson, Timothy ; Goodden, John ; Hamilton, Willie ; Hegarty, Mark G ; James, Allan ; Jenkinson, Michael D ; Kernick, David ; Lekka, Elvira ; Livermore, Laurent J ; Mills, Samantha J ; O'Neill, Kevin ; Palmer, David S ; Vaqas, Babar ; Baker, Matthew J. / Health economic evaluation of a serum based blood test for brain tumour diagnosis : exploration of two clinical scenarios. In: BMJ Open. 2018 ; Vol. 8, No. 5.
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abstract = "ObjectivesTo determine the potential costs and health benefits of a serum-based spectroscopic triage tool for brain tumours, that could be developed to reduce diagnostic delays in the current clinical pathway.DesignA model-based health pre-trial economic assessment. Decision tree models were constructed based on simplified diagnostic pathways. Models were populated with parameters identified from rapid reviews of the literature and clinical expert opinion.SettingExplored as a test in both primary and secondary care (neuroimaging) in the UK health service, as well as application to the US. ParticipantsCalculations based upon an initial cohort of 10,000 patients. In primary care, it is estimated that the volume of tests would approach 75,000 per annum. The volume of tests in secondary care is estimated at 53,000 per annum. Main Outcome MeasuresThe primary outcome measure was quality adjusted life years (QALYs), which were employed to derive incremental cost-effectiveness ratios (ICERs) in a cost-effectiveness analysis. ResultsResults indicate that using a blood-based spectroscopic test in both scenarios has the potential to be highly cost-effective in a health technology assessment (HTA) agency decision making process, as ICERs were well below standard threshold values of £20,000 to £30,000 per QALY. This test may be cost-effective in both scenarios with test sensitivities and specificities as low as 80{\%}; however, the price of the test would need to be lower (less than approximately £40).ConclusionUse of this test as triage tool in primary care has the potential to be both more effective and cost saving for the health service. In secondary care, this test would also be deemed more effective than the current diagnostic pathway.",
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author = "Ewan Gray and Butler, {Holly J} and Ruth Board and Brennan, {Paul M} and Chalmers, {Anthony J} and Timothy Dawson and John Goodden and Willie Hamilton and Hegarty, {Mark G} and Allan James and Jenkinson, {Michael D} and David Kernick and Elvira Lekka and Livermore, {Laurent J} and Mills, {Samantha J} and Kevin O'Neill and Palmer, {David S} and Babar Vaqas and Baker, {Matthew J}",
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Gray, E, Butler, HJ, Board, R, Brennan, PM, Chalmers, AJ, Dawson, T, Goodden, J, Hamilton, W, Hegarty, MG, James, A, Jenkinson, MD, Kernick, D, Lekka, E, Livermore, LJ, Mills, SJ, O'Neill, K, Palmer, DS, Vaqas, B & Baker, MJ 2018, 'Health economic evaluation of a serum based blood test for brain tumour diagnosis: exploration of two clinical scenarios' BMJ Open, vol. 8, no. 5, e017593. https://doi.org/10.1136/bmjopen-2017-017593

Health economic evaluation of a serum based blood test for brain tumour diagnosis : exploration of two clinical scenarios. / Gray, Ewan; Butler, Holly J; Board, Ruth; Brennan, Paul M; Chalmers, Anthony J; Dawson, Timothy; Goodden, John; Hamilton, Willie ; Hegarty, Mark G; James, Allan; Jenkinson, Michael D; Kernick, David; Lekka, Elvira ; Livermore, Laurent J; Mills, Samantha J; O'Neill, Kevin; Palmer, David S; Vaqas, Babar; Baker, Matthew J.

In: BMJ Open, Vol. 8, No. 5, e017593, 24.05.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Health economic evaluation of a serum based blood test for brain tumour diagnosis

T2 - BMJ Open

AU - Gray, Ewan

AU - Butler, Holly J

AU - Board, Ruth

AU - Brennan, Paul M

AU - Chalmers, Anthony J

AU - Dawson, Timothy

AU - Goodden, John

AU - Hamilton, Willie

AU - Hegarty, Mark G

AU - James, Allan

AU - Jenkinson, Michael D

AU - Kernick, David

AU - Lekka, Elvira

AU - Livermore, Laurent J

AU - Mills, Samantha J

AU - O'Neill, Kevin

AU - Palmer, David S

AU - Vaqas, Babar

AU - Baker, Matthew J

PY - 2018/5/24

Y1 - 2018/5/24

N2 - ObjectivesTo determine the potential costs and health benefits of a serum-based spectroscopic triage tool for brain tumours, that could be developed to reduce diagnostic delays in the current clinical pathway.DesignA model-based health pre-trial economic assessment. Decision tree models were constructed based on simplified diagnostic pathways. Models were populated with parameters identified from rapid reviews of the literature and clinical expert opinion.SettingExplored as a test in both primary and secondary care (neuroimaging) in the UK health service, as well as application to the US. ParticipantsCalculations based upon an initial cohort of 10,000 patients. In primary care, it is estimated that the volume of tests would approach 75,000 per annum. The volume of tests in secondary care is estimated at 53,000 per annum. Main Outcome MeasuresThe primary outcome measure was quality adjusted life years (QALYs), which were employed to derive incremental cost-effectiveness ratios (ICERs) in a cost-effectiveness analysis. ResultsResults indicate that using a blood-based spectroscopic test in both scenarios has the potential to be highly cost-effective in a health technology assessment (HTA) agency decision making process, as ICERs were well below standard threshold values of £20,000 to £30,000 per QALY. This test may be cost-effective in both scenarios with test sensitivities and specificities as low as 80%; however, the price of the test would need to be lower (less than approximately £40).ConclusionUse of this test as triage tool in primary care has the potential to be both more effective and cost saving for the health service. In secondary care, this test would also be deemed more effective than the current diagnostic pathway.

AB - ObjectivesTo determine the potential costs and health benefits of a serum-based spectroscopic triage tool for brain tumours, that could be developed to reduce diagnostic delays in the current clinical pathway.DesignA model-based health pre-trial economic assessment. Decision tree models were constructed based on simplified diagnostic pathways. Models were populated with parameters identified from rapid reviews of the literature and clinical expert opinion.SettingExplored as a test in both primary and secondary care (neuroimaging) in the UK health service, as well as application to the US. ParticipantsCalculations based upon an initial cohort of 10,000 patients. In primary care, it is estimated that the volume of tests would approach 75,000 per annum. The volume of tests in secondary care is estimated at 53,000 per annum. Main Outcome MeasuresThe primary outcome measure was quality adjusted life years (QALYs), which were employed to derive incremental cost-effectiveness ratios (ICERs) in a cost-effectiveness analysis. ResultsResults indicate that using a blood-based spectroscopic test in both scenarios has the potential to be highly cost-effective in a health technology assessment (HTA) agency decision making process, as ICERs were well below standard threshold values of £20,000 to £30,000 per QALY. This test may be cost-effective in both scenarios with test sensitivities and specificities as low as 80%; however, the price of the test would need to be lower (less than approximately £40).ConclusionUse of this test as triage tool in primary care has the potential to be both more effective and cost saving for the health service. In secondary care, this test would also be deemed more effective than the current diagnostic pathway.

KW - brain tumour

KW - serum-based spectroscopic triage tool

KW - diagnosis

UR - http://bmjopen.bmj.com/

U2 - 10.1136/bmjopen-2017-017593

DO - 10.1136/bmjopen-2017-017593

M3 - Article

VL - 8

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 5

M1 - e017593

ER -