How Is Evidence on Test Performance Synthesized for Economic Decision Models of Diagnostic Tests? A Systematic Appraisal of Health Technology Assessments in the UK Since 1997

AbstractObjectivesThe study aims to assess how evidence on diagnostic test accuracy is synthesized and used to inform economic decision modeling for HTA.MethodsAll reports evaluating diagnostic test via an economic decision model published by the NHS Research and Development Health Technology Assessment (HTA) program since 1997 were identified. The methods for evidence synthesis of diagnostic test accuracy data and its use in economic decision modeling in this sample were reviewed.ResultsForty-four HTA reports out of 474 concerned diagnostic accuracy, of which 11 did not do any economic evaluation. Of the remaining 33 HTAs, 14 conducted meta-analyses of diagnostic accuracy in the clinical review but only 8 used such pooled estimates to inform the decision model. A number of meta-analysis methods ranging in complexity were applied to estimate diagnostic accuracy. Nevertheless, when it came to informing the economic decision model, the majority of reviews used independent meta-analytic estimates of sensitivity and specificity.ConclusionsOften, very simplistic methods to estimate diagnostic test accuracy were used for purposes of informing an economic decision model. The assumptions made by the simplistic methods are usually invalid which may lead to suboptimal decisions being made. It is desirable that decision modelers become aware of the rapid evolution of meta-analysis methods in this area; however, further research is still required to identify how the pooled results obtained from the different meta-analysis models should best be used to inform economic decision models