title: Economic evaluations and diagnostic testing: an illustrative case study approach.
abstract: OBJECTIVE
  The aim of this study was to present a clear process of synthesizing test accuracy data when conducting economic evaluations of diagnostic tests for health technology assessment (HTA) assessors and health economists.
  
  
  METHODS
  We appraised the methods advocated for using diagnostic test accuracy data in economic evaluations. We used a case study of fetal anemia in which data from a screening test are used in combination with a confirmatory test.
  
  
  RESULTS
  We developed a step-by-step guide and consider two scenarios: when data on test accuracy from several studies are based on (i) the same test threshold for positivity and (ii) different test thresholds.
  
  
  CONCLUSIONS
  We conclude that each approach has its strengths and limitations. We show that the optimal operating point of the test should be identified to determine the true cost-effectiveness of the test. We advocate that these issues require a multidisciplinary team of health economists, decision modelers and statisticians.
authors.affiliation: Health Economics Unit, School of Health and Population Sciences, University of Birmingham, UK. sxs574@bham.ac.uk
authors.forename: Sabina
authors.initials: S
authors.lastname: Sanghera
authors.forename: Rosanna
authors.initials: R
authors.lastname: Orlando
authors.forename: Tracy
authors.initials: T
authors.lastname: Roberts
mesh_terms: D000740:Anemia / Q000175:diagnosis*; D003955:Diagnostic Tests, Routine / Q000191:economics*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis*; D006801:Humans; D011247:Pregnancy; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013673:Technology Assessment, Biomedical / Q000191:economics; D006113:United Kingdom