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abstract
Objective: There are multiple tests available that can help
diagnose ovarian cancer, and the cost-effective analysis of these
diagnostic interventions is essential for making well-informed decisions
regarding resource allocation. There are multiple factors that can
impact on the conclusions drawn from economic evaluations including test
accuracy, the impact of the testing pathway on patient costs and
outcomes, and delays along the ovarian cancer test-treat pathway. The
objective of this study was to evaluate how test accuracy, the choice of
perspective, and delays along the testing and diagnostic pathway have
been incorporated in economic evaluations of testing for ovarian cancer.
Methods: A systematic review of published literature was
undertaken to identify economic evaluations (eg, cost-effectiveness,
cost-utility analysis) focused on testing and diagnosis for ovarian
cancer.
Results: Seven studies met the inclusion criteria. Six
studies incorporated test accuracy and its impact on patients to some
extent. Four studies adopted a societal perspective, but only one
considered the costs incurred by patients on the testing and diagnosis
pathway. Where delays on the testing pathway were incorporated into the
analysis, these were frequently due to false-negative test results
leading to delays in patients accessing treatment. Any anxiety that
patients might experience as a result of a positive test was not
considered in these studies.
Conclusions: The impact on patients of receiving a
positive test in terms of anxiety and the costs incurred by patients
having to attend for testing and diagnosis are rarely considered. Delays
along the testing and diagnosis pathway can have a major effect on
patient outcomes, and it is important that these are acknowledged in
economic evaluations focused on testing. Future economic analysis should
incorporate these key determinants in order that diagnostic tests for
ovarian cancer can be robustly evaluated.
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