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

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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.
Original languageEnglish
Article numbere017593
Number of pages9
JournalBMJ Open
Volume8
Issue number5
DOIs
Publication statusPublished - 24 May 2018

Keywords

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

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    Gray, E., Butler, H. J., Board, R., Brennan, P. M., Chalmers, A. J., Dawson, T., Goodden, J., Hamilton, W., Hegarty, M. G., James, A., Jenkinson, M. D., Kernick, D., Lekka, E., Livermore, L. J., Mills, S. J., O'Neill, K., Palmer, D. S., Vaqas, B., & Baker, M. J. (2018). Health economic evaluation of a serum based blood test for brain tumour diagnosis: exploration of two clinical scenarios. BMJ Open, 8(5), [e017593]. https://doi.org/10.1136/bmjopen-2017-017593