Yes, Jim Walker is absolutely correct that not all diagnostic issues devolve
into financial questions. Thus, we are talking about the "costs" in a
broader sense that may not be reducible to financial measures.
David L. Doggett, Ph.D.
Senior Medical Research Analyst
Technology Assessment Group
ECRI, a non-profit health services research organization
5200 Butler Pike
Plymouth Meeting, PA 19462-1298, USA
Phone: +1 (610) 825-6000 ext.5509
Fax: +1(610) 834-1275
E-mail: [log in to unmask]
> -----Original Message-----
> From: Jim Walker [SMTP:[log in to unmask]]
> Sent: Monday, April 03, 2000 2:31 PM
> To: [log in to unmask]; [log in to unmask]; [log in to unmask]
> Cc: [log in to unmask]
> Subject: Re: RE: Levels of evidence and guideline recommendations for
> diagnostic tests
>
> David,
> Many testing issues may devolve into cost-effectiveness questions; that
> most do requires demonstration. Test ineffectiveness or inappropriateness
> for a given patient, physical risk, time wasted, potential false-positives
> and the attend additional tests with their risks, worry, and the risk of
> creating a sense that there is an organic cause and the next test will
> reveal it (for which see Balint, M. (1964). The doctor, his patient and
> the illness. Madison, Conn., International Universities.) are all more
> important in many physicians' decision making than cost--granted its real
> significance.
>
> Jim
>
>
> Optimized biomedical information in the nick of time.
>
> James M. Walker, MD
> Assistant Professor, Medicine
> Senior Clinical Information Architect
> Penn State Geisinger Health System
> Penn State College of Medicine
> ********
> [log in to unmask]
> P.O. Box 850, H-136
> Hershey, PA 17033
> *********
> phone: 717 531-1594
> fax: 717 531-6785
>
> >>> "Doggett, David" <[log in to unmask]> 04/03 12:29 PM >>>
> You should be aware of the Fryback and Thornbury hierarchy of diagnostic
> efficacy (Fryback, DG and Thornbury, JR, The efficacy of diagnostic
> imaging,
> Med Decis Making 1991, 11:88-94). Interestingly, the typical
> sensitivity/specificity or PPV/NPV studies are at a very low level in this
> hierarchy. Above these come the ability of the test to change diagnostic
> thinking, the ability to change therapeutic practice, patient efficacy
> (ability to improve disease measures and/or quality of life measures), and
> the top level is cost-benefit studies from the societal perspective. This
> top level is important because essentially all diagnostic test issues
> devolve into cost-effectiveness questions.
>
> David L. Doggett, Ph.D.
> Senior Medical Research Analyst
> Technology Assessment Group
> ECRI, a non-profit health services research organization
> 5200 Butler Pike
> Plymouth Meeting, PA 19462-1298, USA
> Phone: +1 (610) 825-6000 ext.5509
> Fax: +1(610) 834-1275
> E-mail: [log in to unmask]
>
>
> > -----Original Message-----
> > From: Nino Cartabellotta [SMTP:[log in to unmask]]
> > Sent: Friday, March 31, 2000 10:10 AM
> > To: Farquhar, Cynthia
> > Cc: [log in to unmask]
> > Subject: Re: Levels of evidence and guideline recommendations for
> > diagnostic tests
> >
> > At 09.54 31/03/00 -0500, you wrote:
> > >Dear All,
> > >
> > >I am writing to enquire if any one know of a system for grading
> evidence
> > >and making guideline recommendations for comparative tests for
> > diagnostics.
> > >Most of the systems that I have seen have really only referred to MA,
> > >systematic reviews and RCTS for therapeutics.
> >
> > You can find it at:
> > http://cebm.jr2.ox.ac.uk/eboc/eboclevels.html
> >
> > Bests
> > Dott. Nino Cartabellotta
> > 0339 6443819
> > [log in to unmask]
> >
> >
> --------------------------------------------------------------------------
> > ----
> > G I M B E
> > Gruppo Italiano per la Medicina Basata sulle Evidenze
> >
> --------------------------------------------------------------------------
> > ----
> > Passaggio L. da Vinci, 16 - 90145 Palermo
> > Telefax 091 407153
> > [log in to unmask]
> >
> --------------------------------------------------------------------------
> > ----
> > www.gimbe.org
> >
> --------------------------------------------------------------------------
> > ----
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