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Estimating the cost effectiveness of screening tests

D J Torgerson1, D M Reid

  • 1National Primary Care Research & Development Centre, University of York, York, USA.

QJM : Monthly Journal of the Association of Physicians
|January 24, 1998
PubMed
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Evaluating screening tests requires understanding trade-offs, not just arbitrary criteria. Key considerations include balancing detection rates, false-positive rates, and costs for effective screening tool appraisal.

Area of Science:

  • Medical Screening
  • Diagnostic Test Evaluation
  • Health Technology Assessment

Background:

  • Numerous criteria have been proposed for ideal screening tests.
  • However, few, if any, tests meet all postulated criteria.
  • This necessitates a nuanced approach to test appraisal.

Purpose of the Study:

  • To explore the inherent trade-offs in screening test evaluation.
  • To argue against the utility of arbitrary criteria for appraising screening tools.
  • To highlight the importance of understanding the magnitude and nature of these trade-offs.

Main Methods:

  • The paper discusses common trade-offs encountered when evaluating screening tests.
  • It analyzes the relationship between detection rates, false-positive rates, and costs.

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  • A critical review of established screening test criteria is presented.

    • Main Results:

    • Screening tests rarely fulfill all ideal criteria.
    • Significant trade-offs exist between desirable test characteristics (e.g., sensitivity vs. specificity, cost).
    • The specific nature and magnitude of these trade-offs vary considerably between different screening tests.

    Conclusions:

    • Focusing on arbitrary criteria for screening tests is unhelpful.
    • Appraisal should prioritize understanding the specific trade-offs inherent to each test.
    • A pragmatic approach considering detection rates, false positives, and costs is crucial for effective screening.