Cost-effectiveness analyses of diagnostic strategies: a literature survey using the NHS Economic Evaluation Database

The aim of this study was to examine the methods used in published cost-effectiveness analyses of diagnostic strategies and to explore possible changes in methodology over time. A literature survey was conducted by identifying cost-effectiveness analyses found in the UK NHS Economic Evaluation Database. Only full economic evaluations involving diagnostic strategies as the type of intervention were included. Various study characteristics were examined and temporary changes in methodology were tested. In total, 612 cost-effectiveness analyses involving various diseases were identified, including neoplasms (27%), digestive diseases (16%) and bacterial infections/mycoses (13%). In the 391 studies that focused only on diagnostic strategies, benefit was based primarily on diagnostic accuracy or clinical measures. Slight temporal increases in cost-utility analyses and use of modelling were observed. The methodological diversity seen in this review of previous studies is expected to continue. However, better quality clinical studies and systematic reviews are expected in the future as a result of concurrent developments such as the Standards for Reporting of Diagnostic Accuracy initiative. Taken together with initiatives to appraise and improve the quality of cost-effectiveness analyses, these developments can be expected to result in better quality cost-effectiveness analyses. However, a reader beware policy will always exist, since the reader needs to assess the relevance and transferability of the cost-effectiveness analysis.