Decision analysis to complete diagnostic research by closing the gap between test characteristics and cost-effectiveness.
OBJECTIVE
The lack of a standard methodology in diagnostic research impedes adequate evaluation before implementation of constantly developing diagnostic techniques. We discuss the methodology of diagnostic research and underscore the relevance of decision analysis in the process of evaluation of diagnostic tests.


METHODS
Overview and conceptual discussion.


RESULTS
Diagnostic research requires a stepwise approach comprising assessment of test characteristics followed by evaluation of added value, clinical outcome, and cost-effectiveness. These multiple goals are generally incompatible with a randomized design. Decision-analytic models provide an important alternative through integration of the best available evidence. Thus, critical assessment of clinical value and efficient use of resources can be achieved.


CONCLUSIONS
Decision-analytic models should be considered part of the standard methodology in diagnostic research. They can serve as a valid alternative to diagnostic randomized clinical trials (RCTs).
Schaafsma
Joanna D
JD
Department of Neurology, University Medical Center Utrecht, The Netherlands. j.d.schaafsma@umcutrecht.nl
van der Graaf
Yolanda
Y
Rinkel
Gabriel J E
GJ
Buskens
Erik
E
D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D019937:Diagnostic Techniques and Procedures / Q000191:economics; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012107:Research Design