The early bird catches the worm: Early cost-effectiveness analysis of new medical tests

Buisman, L. R., Rutten-van Moelkn, M. P. M. H., Postmus, D., Luime, J. J., Uyl-de Groot, C. A. & Redekop, W. K., 2016, In : International Journal of Technology Assessment in Health Care. 32, 1-2, p. 46-53 8 p.

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  • Leander R. Buisman
  • Maureen P. M. H. Rutten-van Moelkn
  • Douwe Postmus
  • Jolanda J. Luime
  • Carin A. Uyl-de Groot
  • William K. Redekop

Objectives: There is little specific guidance on performing an early cost-effectiveness analysis (CEA) of medical tests. We developed a framework with general steps and applied it to two cases.

Methods: Step 1 is to narrow down the scope of analysis by defining the test's application, target population, outcome measures, and investigating current test strategies and test strategies if the new test were available. Step 2 is to collect evidence on the current test strategy. Step 3 is to develop a conceptual model of the current and new test strategies. Step 4 is to conduct the early-CEA by evaluating the potential (cost-)effectiveness of the new test in clinical practice. Step 5 involves a decision about the further development of the test.

Results: The first case illustrated the impact of varying the test performance on the headroom (maximum possible price) of an add-on test for patients with an intermediate-risk of having rheumatoid arthritis. Analyses showed that the headroom is particularly dependent on test performance. The second case estimated the minimum performance of a confirmatory imaging test to predict individual stroke risk. Different combinations of sensitivity and specificity were found to be cost-effective; if these combinations are attainable, the medical test developer can feel more confident about the value of further development of the test.

Conclusions: A well-designed early-CEA methodology can improve the ability to develop (cost-)effective medical tests in an efficient manner. Early-CEAs should continuously integrate insights and evidence that arise through feedback, which may convince developers to return to earlier steps.

Original languageEnglish
Pages (from-to)46-53
Number of pages8
JournalInternational Journal of Technology Assessment in Health Care
Issue number1-2
Publication statusPublished - 2016


  • Early cost-effectiveness analysis, Medical test, Decision support, Research and development, Manufacturer, Test developer, MINOR ISCHEMIC-STROKE, RHEUMATOID-ARTHRITIS, ECONOMIC-EVALUATION, TECHNOLOGY-ASSESSMENT, DECISION-MAKING, DEVICES, METHOTREXATE, UNCERTAINTY, THERAPY, DRUGS

ID: 31135382