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Health economic evaluation of a serum-based blood test for brain tumour diagnosis: exploration of two clinical scenarios
  1. Ewan Gray1,
  2. Holly J Butler2,3,
  3. Ruth Board4,
  4. Paul M Brennan5,
  5. Anthony J Chalmers6,7,
  6. Timothy Dawson8,
  7. John Goodden9,
  8. Willie Hamilton10,
  9. Mark G Hegarty2,3,
  10. Allan James11,
  11. Michael D Jenkinson12,13,
  12. David Kernick14,
  13. Elvira Lekka8,
  14. Laurent J Livermore15,
  15. Samantha J Mills12,
  16. Kevin O’Neill16,
  17. David S Palmer3,17,
  18. Babar Vaqas16,
  19. Matthew J Baker2,3
  1. 1Health Improvement Scotland, Glasgow, UK
  2. 2Department of Pure and Applied Chemistry, University of Strathclyde Technology and Innovation Centre, Glasgow, UK
  3. 3ClinSpec Diagnostics Limited, University of Strathlcyde, Technology and Innovation Centre, Glasgow, UK
  4. 4Rosemere Cancer Centre, Lancashire Teaching Hospitals NHS Trust, Royal Preston Hospital, Preston, UK
  5. 5Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
  6. 6Beatson West of Scotland Cancer Centre, Glasgow, UK
  7. 7Institute of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, UK
  8. 8Neurosurgery Department, Lancashire Teaching Hospitals NHS Trust, Royal Preston Hospital, Preston, UK
  9. 9Neurosurgery Department, Leeds General Infirmary, Leeds, UK
  10. 10Primary Care Diagnostics, University of Exeter Medical School, College House, University of Exeter, Exeter, UK
  11. 11Institute of Molecular Cell and Systems Biology, Glasgow, UK
  12. 12Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
  13. 13Institute of Translational Medicine, Clinical Science Centre, University of Liverpool, Liverpool, UK
  14. 14St Thomas’ Medical Group, Exeter, UK
  15. 15Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
  16. 16John Fulcher Neuro-Oncology Laboratory, Imperial College, London, UK
  17. 17WestCHEM, Department of Pure and Applied Chemistry, University of Strathclyde, Glasgow, UK
  1. Correspondence to Dr Matthew J Baker; matthew.baker{at}strath.ac.uk

Abstract

Objectives To determine the potential costs and health benefits of a serum-based spectroscopic triage tool for brain tumours, which could be developed to reduce diagnostic delays in the current clinical pathway.

Design A model-based health pre-trial economic assessment. Decision tree models were constructed based on simplified diagnostic pathways. Models were populated with parameters identified from rapid reviews of the literature and clinical expert opinion.

Setting Explored as a test in both primary and secondary care (neuroimaging) in the UK health service, as well as application to the USA.

Participants Calculations based on an initial cohort of 10 000 patients. In primary care, it is estimated that the volume of tests would approach 75 000 per annum. The volume of tests in secondary care is estimated at 53 000 per annum.

Main outcome measures The primary outcome measure was quality-adjusted life-years (QALY), which were employed to derive incremental cost-effectiveness ratios (ICER) in a cost-effectiveness analysis.

Results Results indicate that using a blood-based spectroscopic test in both scenarios has the potential to be highly cost-effective in a health technology assessment agency decision-making process, as ICERs were well below standard threshold values of £20 000–£30 000 per QALY. This test may be cost-effective in both scenarios with test sensitivities and specificities as low as 80%; however, the price of the test would need to be lower (less than approximately £40).

Conclusion Use of this test as triage tool in primary care has the potential to be both more effective and cost saving for the health service. In secondary care, this test would also be deemed more effective than the current diagnostic pathway.

  • biophysics
  • health economics
  • neurology
  • neurological oncology
  • adult oncology

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/

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Footnotes

  • EG and HJB contributed equally.

  • Contributors EG conducted the health economic assessment including data analysis, data interpretation and writing. HJB contributed to data interpretation, writing and providing details regarding clinical spectroscopy. MJB is the principal investigator of this research, and initiated this interdisciplinary project and team. RB, PMB, AJC, TD, JG, WH, AJ, MDJ, DK, EL, LJL, SJM, KO and BV are members of the clinical focus group involved in spearheading translation, all of whom provided feedback on the manuscript. MGH, DSP, HJB and MJB are involved in the ClinSpec Diagnostics project.

  • Funding Scottish Enterprise is Scotland’s main economic development agency and non-departmental public body of the Scottish Government. They work with partners in both the private and public sectors to exploit the best opportunities to deliver a significant, lasting effect on the Scottish economy. The High-Growth Spinout Programme helps researchers take their ideas and inventions from the lab to the global marketplace. (UKCG 12448)

  • Competing interests MJB, MGH, HJB and DSP are all involved in ClinSpec Diagnostics, a prospective spin-out company from the University of Strathclyde focusing on the translation of serum spectroscopic diagnostics (Company No SC535447).

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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