Economic evaluation of diagnostic tests - A review of published studies

Objectives: The purpose of this review was to examine whether studies from the medical literature focusing on efficiency of diagnostic facilities repo rted economic evaluation methods appropriately, following guidelines for co nducting and reporting economic evaluations. Methods: A MEDLINE search was conducted, and studies that concerned a diagn ostic technology and fulfilled the Drummond criteria were selected for meth odological review. The reliability of selection and methodological review b ased on the abstracts was determined by scoring a random sample of both abs tracts and full articles. Interrater reliability was determined by scoring a random sample of abstracts by both authors. Kappa values were calculated. Nine methodological aspects were reviewed: study design, the type of econo mic evaluation, the comparison made, the study's perspective, the cost-effe ctiveness ratio used, the definition of cost-effective, the types of costs analyzed, the cost calculation method, and the use of sensitivity analysis. Results: Two hundred fifty studies published between 1992 and 1997 were fou nd regarding efficiency of diagnostic facilities; 134 studies fulfilled the Drummond criteria and were selected for methodological review. Kappa value s showed reliability of selection and methodological review and interrater reliability. The existing literatue on the economic evaluation of diagnosti c facilities does not adhere well to guidelines for economic evaluation. In 95%, no perspective was mentioned, in 50% of the cases no ratio was given, in 82% the cost calculation method was not mentioned, and in 66% no sensit ivity analysis was reported. Conclusions: Our review suggests that to improve the quality of reporting e conomic evaluations, editorial boards could issue and enforce guidelines fo r standard reporting of such studies.