Health-Economic Analyses of Diagnostics: Guidance on Design and Reporting

Cost-effectiveness analyses (CEAs) can be used to assess the value of diagnostics in clinical practice. Due to the introduction of the European in vitro diagnostic and medical devices regulations, more clinical data on new diagnostics may become available, which may improve the interest and feasibility of performing CEAs. We present eight recommendations on the reporting and design of CEAs of diagnostics. The symptoms patients experience, the clinical setting, locations of test sampling and analysis, and diagnostic algorithms should be clearly reported. The used time horizon should reflect the time horizon used to model the treatment after the diagnostic pathway. Quality-adjusted life-years (QALYs) or disability-adjusted life-years (DALYs) should be used as the clinical outcomes but may be combined with other relevant outcomes, such as real options value. If the number of tests using the same equipment can vary, the economy of scale should be considered. An understandable graphical representation of the various diagnostic algorithms should be provided to understand the results, such as an efficiency frontier. Finally, the budget impact and affordability should be considered. These recommendations can be used in addition to other, more general, recommendations, such as the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) or the reference case for economic evaluation by the international decision support initiative.

Enterprises and challenges in diagnostics for precision medicine: an interview with Eddie Blair

Interview with Dr Eddie Blair, PhD, by Claire Raison (Commissioning Editor) Dr Eddie Blair is Managing Director of Integrated Medicines Ltd (Cambridge, UK), a company he formed in 2003 to enable precision medicine by combining diagnostic testing with new and existing medicines. Dr Blair has raised angel and private equity investments in excess of £12 million, has published over 40 primary peer-reviewed papers, including a series on companion diagnostic valuation, and is named inventor on at least 12 patents. Dr Blair is a member of the Editorial Advisory Board of Expert Review of Molecular Diagnostics and speaks to the Commissioning Editor here about entrepreneurship, obstacles and potential of introducing diagnostics innovations into routine clinical practice.

[An economic perspective on targeted treatments]

In the current context of crisis in the field of drug research and patients' increasing demand for greater involvement in the decision-making about their treatment, the possibility of a more personal tailored approach to medicine is emerging. This raises questions about the clinical benefits of targeted therapeutic approaches versus the cost of determining which patients are likely to benefit the most, and protecting the others from the toxicity of inappropriate treatments. Although cost-effectiveness studies shed light on this issue, the conclusions to which they point tend to be obscured by interdependence between the pricing of these tests and the cost of the treatments involved. Investigating the societal willingness-to-pay for gains in QALY (quality adjusted life year) should help to disentangle this interdependence and clarify the conclusions of cost-effectiveness studies.

Development and validation of risk models and molecular diagnostics to permit personalized management of cancer

Despite the advances made in cancer management over the past few decades, improvements in cancer diagnosis and prognosis are still poor, highlighting the need for individualized strategies. Toward this goal, risk prediction models and molecular diagnostic tools have been developed, tailoring each step of risk assessment from diagnosis to treatment and clinical outcomes based on the individual's clinical, epidemiological, and molecular profiles. These approaches hold increasing promise for delivering a new paradigm to maximize the efficiency of cancer surveillance and efficacy of treatment. However, they require stringent study design, methodology development, comprehensive assessment of biomarkers and risk factors, and extensive validation to ensure their overall usefulness for clinical translation. In the current study, the authors conducted a systematic review using breast cancer as an example and provide general guidelines for risk prediction models and molecular diagnostic tools, including development, assessment, and validation.