What does it take to perform an optimal cost-effectiveness analysis in radiology? https://www.radiologybusiness.com/topics/healthcare-economics/cost-effectiveness-analysis-radiology-imaging-jacr

1. July 30, 2018 | Michael Walter | Healthcare Economics & Policy
Performing a cost-effectiveness analysis (CEA) is a crucial part of the decision-making
process for any imaging provider. The industry lacks consistency when it comes to
exactly how CEAs are carried out, however, which can make their conclusions less
reliable.
Looking to determine strategies for performing the best CEAs possible in radiology,
researchers performed a systematic review of 80 different examples carried out from
2013 to 2017 and shared their findings in the Journal of the American College of
Radiology.
What does it take to perform an optimal cost-
effectiveness analysis in radiology?
    

2. Overall, more than 41 percent of the studies examined imaging related to different kinds
of cancer. Another 15 percent examined cardiovascular disease, more than 11 percent
examined intracranial hemorrhage and more than 8 percent examined bone imaging.
While more than 56 percent focused on CT, 35 percent focused on MRI. Ultrasound,
nuclear medicine and x-rays were also the subject of numerous CEAs.
The authors also noted that 70 percent of the studies were completed from the payer
perspective, 18.8 percent from the societal perspective and 5 percent from the hospital
perspective. Meanwhile, 17.5 percent of CEAs did not report a perspective at all.
“A CEA’s perspective identifies its intended user and indicates what type of policy
decision it should inform,” wrote Alice Zhou, BS, Johns Hopkins School of Medicine in
Baltimore, Maryland, and colleagues. “The perspective also guides which components
of cost must be included in the analysis; a societal analysis includes indirect costs,
whereas other perspectives do not. Therefore, analyses performed from different
perspectives are not comparable, and clear reporting of perspective is essential for
readers to properly interpret and compare results. When conducting a CEA, researchers
must align their perspective with their intended user, correctly perform the analysis from
that perspective, and finally, state the perspective for readers.”
Zhou and colleagues also emphasized that it is important to measure patient outcomes
using quality-adjusted life years (QALYs).
“Measuring patient outcomes in radiology is uniquely difficult because downstream
disease management is influenced by factors beyond diagnosis,” they wrote. “Use of
intermediate outcomes may mitigate some of this downstream uncertainty, but positive
intermediate outcomes may not correlate with positive final outcomes. In radiology,
QALYs can still be measured if the probability of downstream disease states based on
standard clinical practice is considered.”
The authors also said all CEAs should compare results with a range of willingness-to-
pay (WTP) thresholds, which estimate what consumers are willing to pay to gain specific
health benefits. In addition, they added, CEAs should always state all direct and indirect
costs in their calculations.

3. “We emphasize that all CEAs should publish thorough cost inventory tables to promote
transparency and comparability between studies,” the authors wrote. “In addition, cost
inventory tables should be accompanied by a description of cost calculation methods
and sourcing in the body of the text.”
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