NR 714 Discussion Full Economic Evaluation
NR 714 Discussion Full Economic Evaluation
DQ1 Partial Economic Evaluation
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Derived from your healthcare experience, determine the
components of partial economic evaluation from an advanced nursing practice
perspective.
DQ2 Full Economic Evaluation
Derived from your healthcare experience, determine the
components of full economic evaluation from an advanced nursing practice
perspective.
Economic evaluations of diagnostic imaging address a range of different issues and involve a variety of assessment approaches. These analyses study: (1) diagnostic test utilization patterns, referral patterns and imaging, (2) impacts on use after introduction of decision support systems, (3) trends for specific conditions, and (4) the cost-effectiveness of particular diagnostic strategies in defined subpopulations. The data sources include observational studies, retrospective reviews, prospective studies, and secondary database analyses. As noted, imaging studies may result in findings that require further testing to more conclusively determine if patients have a condition or not. Clinical studies may not capture these comprehensive sets of events that occur due to diagnostic imaging, and retrospective analyses are suboptimal due to a limited availability of health status data or clinical information. For a variety of reasons, medical record data and resource use data are often not connected electronically.
Cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) are important tools to assess the potential appropriateness of imaging interventions. Their growth has paralleled the growth in imaging spending and payer requirements to demonstrate value for expenditures. Cost-utility studies generally estimate cost per quality-adjusted life-years (QALYs) gained (a combined time and quality-of-time metric). In 2008, Otero and colleagues evaluated 20 years of cost-effectiveness studies for radiology (1985–2005), providing an assessment of 111 published CUAs. During this period, there was an increase from a few CUAs each year to approximately 10 per year. Nearly 80% of the CUAs they identified pertained to diagnostic radiology. They summarized studies by modality and disease/condition. Ultrasound and angiography were the most frequently studied imaging tests, followed by MRI and CT. The five most frequently assessed disease areas were peripheral vascular disease, cerebrovascular disease, ischemic heart disease, musculoskeletal and rheumatologic disease, and lung cancer. Importantly, approximately 80% of studies used secondary data from the literature to estimate quality of life ‘utility scores’ for the QALY estimation rather than primary data collection. This highlights the need for more comprehensive prospective studies to assess the economic impact of imaging on patient outcomes.
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NR 714 Discussion Full Economic Evaluation
Most economic evaluations of diagnostic imaging have estimated the marginal effects of imaging interventions on particular types of patients by comparison with alternative testing strategies. The incremental costs and consequences associated with using health resources for one condition or type of medical test can be compared with those costs and outcomes from using other tests, and potentially compared among conditions. To date, the number of well-designed imaging evaluation studies is still very limited. The clinical scientific imaging literature has predominantly focused on diagnostic accuracy characteristics and comparisons. Recently, more incremental cost-effectiveness studies of imaging are being conducted and published. But these studies face considerable challenges in sorting out the heterogeneity associated with estimating cross-population or cross-indication effects associated with implementing diagnostic testing guidelines.
Economic assessments can be conducted at a health system level as well as for a typical patient with a health condition. Consider a policy that tries to encourage adherence to findings from a diagnostic test that indicates a low likelihood that a surgery would improve a patient’s morbidity or mortality status. This could result in fewer surgeries of that type being performed, thereby reducing the aggregate number of surgeries expected to have suboptimal outcomes and lower cost. Likewise, a diagnostic test that leads to additional testing, treatments, or procedures may result in other patients not receiving specific procedures or care, particularly in systems with a fixed health budget. Therefore, a comprehensive assessment of the economic impact on the health system of using a diagnostic test should include these direct and indirect effects. Practically speaking, however, few, if any, economic assessments of diagnostic imaging interventions have taken a comprehensive societal perspective.
NR 714 Discussion Full Economic Evaluation ESSAY
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