Evaluating the accuracy and economic value of a new test in the absence of a perfect reference test
- 23 May 2017
- journal article
- research article
- Published by Wiley in Research Synthesis Methods
- Vol. 8 (3), 321-332
- https://doi.org/10.1002/jrsm.1243
Abstract
Streptococcus pneumoniae (SP) pneumonia is often treated empirically as diagnosis is challenging because of the lack of a perfect test. Using BinaxNOW-SP, a urinary antigen test, as an add-on to standard cultures may not only increase diagnostic yield but also increase costs. To estimate the sensitivity and specificity of BinaxNOW-SP and subsequently estimate the cost-effectiveness of adding BinaxNOW-SP to the diagnostic work-up. We fit a Bayesian latent-class meta-analysis model to obtain estimates of BinaxNOW-SP accuracy that adjust for the imperfect accuracy of culture. Meta-analysis results were combined with information on prevalence of SP pneumonia to estimate the number of patients who are correctly classified under competing diagnostic strategies. Taking into consideration the cost of antibiotics, we determined the incremental cost of adding BinaxNOW-SP to the work-up per case correctly diagnosed. The BinaxNOW-SP test had a pooled sensitivity of 0.74 (95% credible interval [CrI], 0.67-0.83) and a pooled specificity of 0.96 (95% CrI, 0.92-0.99). An overall increase in diagnostic accuracy of 6.2% due to the addition of BinaxNOW-SP corresponded to an incremental cost per case correctly classified of $582 Canadian dollars. The methods we have described allow us to evaluate the accuracy and economic value of a new test in the absence of a perfect reference test using an evidence-based approach.Keywords
This publication has 24 references indexed in Scilit:
- From accuracy to patient outcome and cost-effectiveness evaluations of diagnostic tests and biomarkers: an exemplary modelling studyBMC Medical Research Methodology, 2013
- Target practice: choosing target conditions for test accuracy studies that are relevant to clinical practiceBMJ, 2011
- Performance measure of urinary antigen in patients with Streptococcus pneumoniae bacteremiaDiagnostic Microbiology and Infectious Disease, 2010
- A statistical method was used for the meta-analysis of tests for latent TB in the absence of a gold standard, combining random-effect and latent-class methods to estimate test accuracyJournal of Clinical Epidemiology, 2010
- Random Effects Models in a Meta-Analysis of the Accuracy of Two Diagnostic Tests Without a Gold StandardJournal of the American Statistical Association, 2009
- Integration of Meta-analysis and Economic Decision Modeling for Evaluating Diagnostic TestsMedical Decision Making, 2008
- Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in AdultsClinical Infectious Diseases, 2007
- Evaluation of Nucleic Acid Amplification Tests in the Absence of a Perfect Gold-Standard TestEpidemiology, 2005
- Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviewsJournal of Clinical Epidemiology, 2005
- Bayesian Measures of Model Complexity and FitJournal of the Royal Statistical Society Series B: Statistical Methodology, 2002