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

Gray, Ewan and Butler, Holly J and Board, Ruth and Brennan, Paul M and Chalmers, Anthony J and Dawson, Timothy and Goodden, John and Hamilton, Willie and Hegarty, Mark G and James, Allan and Jenkinson, Michael D and Kernick, David and Lekka, Elvira and Livermore, Laurent J and Mills, Samantha J and O'Neill, Kevin and Palmer, David S and Vaqas, Babar and Baker, Matthew J (2018) Health economic evaluation of a serum based blood test for brain tumour diagnosis : exploration of two clinical scenarios. BMJ Open, 8 (5). e017593. ISSN 2044-6055 (

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Objectives To determine the potential costs and health benefits of a serum-based spectroscopic triage tool for brain tumours, that could be developed to reduce diagnostic delays in the current clinical pathway. Design A 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. Setting Explored as a test in both primary and secondary care (neuroimaging) in the UK health service, as well as application to the US. Participants Calculations based upon 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 Measures The primary outcome measure was quality adjusted life years (QALYs), which were employed to derive incremental cost-effectiveness ratios (ICERs) in a cost-effectiveness analysis. Results Results indicate that using a blood-based spectroscopic test in both scenarios has the potential to be highly cost-effective in a health technology assessment (HTA) agency decision making process, as ICERs were well below standard threshold values of £20,000 to £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). Conclusion Use 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.