The feasibility of economic evaluation of diagnostic procedures

This paper reviews the principles of cost-benefit and cost-effectiveness analysis as they are applied to diagnostic procedures. These medical procedures present particularly thorny problems to those who would subject them to economic evaluation. Five specific problem areas encountered in attempting to apply economic evaluation to diagnostic procedures are discussed in detail. They are: defining homogeneous patient groups for analysis; specifying the relevant diagnostic alternatives; measuring diagnostic accuracy; measuring diagnostic costs; and specifying the measured outcomes of the diagnostic process. The economic evaluation literature on two diagnostic procedures--the skull X-ray and computed tomographic (CT) scanning is reviewed within the context of a model of economic evaluation. Two studies were found to successfully apply the principles of economic evaluation to CT scanning; none were found for skull X-rays. The most common approaches to evaluating the usefulness of these procedures, and the limitations of these approaches, are summarized.