Health economic evaluation of a serum-based blood test for brain tumour diagnosis: exploration of two clinical scenarios

Abstract

ObjectivesTo determine the potential costs and health benefits of a serum-based spectroscopic triage tool for brain tumours, which could be developed to reduce diagnostic delays in the current clinical pathway.DesignA 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.SettingExplored as a test in both primary and secondary care (neuroimaging) in the UK health service, as well as application to the USA.ParticipantsCalculations based on 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 measuresThe primary outcome measure was quality-adjusted life-years (QALY), which were employed to derive incremental cost-effectiveness ratios (ICER) in a cost-effectiveness analysis.ResultsResults indicate that using a blood-based spectroscopic test in both scenarios has the potential to be highly cost-effective in a health technology assessment agency decision-making process, as ICERs were well below standard threshold values of £20 000–£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).ConclusionUse 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.

Developing infrared spectroscopic detection for stratifying brain tumour patients: glioblastoma multiforme vs. lymphoma

“…Clearly this would not be very efficient for the clinic, as the excess brain scans would be costly to the health services, meanwhile putting healthy patients through needless stress and anxiety. However, these findings are still relatively promising, with a health economic study reporting statistics >80% would be cost-effective to the NHS [38]. The Gini impurity metric was examined to identify the most important features within the dataset.…”

“…A recently published health economic study has suggested a high-throughput alternative to the traditional IRE would be cost-effective to the UK's National Health Service (NHS). Gray et al highlight the clinical and economic benefits of implementing a quick diagnostic test for brain cancers into the current pathway [38]. They reported that a serum blood test at the primary care level could prioritise patients for neuroimaging, improving patient survival and quality of life, whilst also saving on the cost of unnecessary brain scans.…”

Optimised spectral pre-processing for discrimination of biofluids via ATR-FTIR spectroscopy

“…The analysis of biofluids, such as blood serum, using IR spectroscopy is a rapidly progressing field that is nearing ever closer to clinical translation (17,32,33). Due to its simplicity and robust methodology, the analysis of easily obtained bodily fluids using ATR-FTIR spectroscopy lends itself well to a rapid and cost-effective technology for clinical diagnostics (34,35).…”

“…Due to a combination of non-specific symptoms, pressure in the health service diagnostic pathway, expensive neuroimaging and highly invasive biopsiesthe diagnosis of brain tumours is often made in the case of an emergency, when the patient will likely have a well-developed tumour. A method of early detection would greatly benefit this patient pathway, allowing screening or triage into secondary healthcare (33). Recently, we have shown that glioblastoma (GBM) patients can be correctly identified at sensitivities and specificities of 91.5% and 83% respectively, using a feature-fed support vector machine (SVM) analysis (42).…”

Rapid analysis of disease state in liquid human serum combining infrared spectroscopy and “digital drying”

“…Only 3.7% of patients referred for medical imaging have been found to have major abnormal structural lesions indicative of cancer [3]. An early and accurate method of disease detection would aid health professionals in patient prioritization during the referral process, leading to a reduced demand on medical imaging resources and subsequent economic benefits to the health care system [4]. For patients, a diagnosis time improvement would potentially lead to higher life quality and expectancy [5].…”