Skip to main content
Log in

Outcomes research and cost-effectiveness analysis in radiology

  • European Health Policy
  • Review Article
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

The decision to implement a new medical technology requires that if not only increases survival or quality of life, but that it is also economically sound. The unique feature in the assessment of diagnostic tests is that the results of such tests are intermediate outcomes. Both randomized controlled clinical trials and decision analysis have an important role to play in the assessment of diagnostic tests. Important points to consider when performing a cost-effectiveness study are what perspective to take; comparing the technology with the next best strategy; including both effectiveness and costs; the distinction between describing and valuing the quality of life; intangibles such as the value of information; and the incremental cost-effectiveness ratio.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Weinstein MC, Fineberg HV (1980) Clinical decision analysis. WB Saunders, Philadelphia

    Google Scholar 

  2. Pauker SG, Kassirer JP (1987) Medical progress: decision analysis. N Engl J Med 316: 250–258

    Google Scholar 

  3. Drummond MF, Stoddart GL, Torrance GW (1987) Methods for the economic evaluation of health care programmes. Oxford Medical Publications, Oxford, pp 1–182

    Google Scholar 

  4. Weinstein MC, Stason WB (1977) Foundations of cost-effectiveness analysis for health and medical practices. N Engl J Med 296: 716–721

    Google Scholar 

  5. Detsky AS, Naglie IG (1990) A clinician's guide to cost-effectiveness analysis. Ann Intern Med 113: 147–154

    Google Scholar 

  6. Powe NR (1994) Economic and cost-effectiveness investigations of radiologic practices. Radiology 192: 11–18

    Google Scholar 

  7. Doubilet PM, Weinstein MC, McNeil BJ (1986) Use and misuse of the term “cost effective” in medicine. N Engl J Med 314: 253–256

    Google Scholar 

  8. Caro JJ, Trindade E, McGregor M (1992) The cost-effectiveness of replacing high-osmolality with low-osmolality contrast media. AJR 159: 869–874

    Google Scholar 

  9. Steinberg EP, Moore RD, Powe NR, Gopalan R, Davidoff AJ, Litt M, Graziano S, Brinker JA (1992) Safety and cost-effectiveness of high-osmolality as compared with low-osmolality contrast material in patients undergoing cardiac angiography. N Engl J Med 326: 425–430

    Google Scholar 

  10. Goel V, Deber RB, Detsky AS (1989) Nonionic contrast media: economic analysis and health policy development. Can Med Assoc J 140: 389–395

    Google Scholar 

  11. Jacobson PD, Rosenquist CJ (1988) The introduction of low-osmolar contrast agents in radiology: medical, economic, legal, and public policy issues. JAMA 260: 1586–1592

    Google Scholar 

  12. Sutherland JB, Huda W (1989) Costs and benefits of low-osmolality contrast agents in radiology. Can Assoc Radiol J 40: 18–21

    Google Scholar 

  13. Powe NR, Steinberg EP, Erickson JE, Moore RD, Smith CR, White RI Jr, Brinker JA, Fishman EK, Zinreich SJ, Kinnison ML (1988) Contrast medium-induced adverse reactions: economic outcome. Radiology 169: 163–168

    Google Scholar 

  14. Sonnenberg FA, Beck JR (1993) Markov models in medical decision making: a practical guide. Med Decis Making 13: 322–338

    Google Scholar 

  15. Metz CE (1986) ROC methodology in radiological imaging. Invest Radiol 21: 720–733

    Google Scholar 

  16. Hanley JA (1989) Receiver operating characteristic (ROC) methodology: the state of the art. Crit Rev Diagn Imaging 29: 307–335

    Google Scholar 

  17. Begg CB, McNeil BJ (1988) Assessment of radiologic tests: control of bias and other design considerations. Radiology 167: 565–569

    Google Scholar 

  18. Begg CB, Greenes A (1983) Assessment of diagnostic tests when disease verifications is subject to selection bias. Biometrics 39: 207–215

    Google Scholar 

  19. Hunink MGM, Richardson D, Doubilet PM, Begg CB (1990) Testing for fetal pulmonary maturity: an ROC analysis involving covariates, verification bias and combination testing. Med Decis Making 10: 201–211

    Google Scholar 

  20. Hunink MGM, Polak JF, Barlan MM, O'Leary DH (1993) Detection and quantification of carotid artery stenosis: efficacy of various Doppler velocity parameters. AJR 160: 619–625

    Google Scholar 

  21. Phelps CE, Mushlin AI (1988) Focusing technology assessment using medical decision therapy. Med Decis Making 8: 279–289

    Google Scholar 

  22. Mushlin AI, Mooney C, Grow V, Phelps CE (1994) The value of diagnostic information to patients with suspected multiple sclerosis. Rochester-Toronto MRI Study Group. Arch Neurol 51: 67–72

    Google Scholar 

  23. Appel LJ, Steinberg EP, Powe NR, Anderson GF, Dwyer SA, Faden RR (1990) Risk reduction from low osmolality contrast media. Med Care 28: 324–337

    Google Scholar 

  24. Der Simonian R, Laird N (1986) Meta-analysis in clinical trials. Controlled Clin Trials 7: 177–188

    Google Scholar 

  25. Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22: 719–748

    Google Scholar 

  26. Hunink MG, Wong JB (1994) Meta-analysis of failure-time data with adjustment for covariates. Med Decis Making 14: 59–70

    Google Scholar 

  27. Eddy DM, Hasselblad V, Shachter RD (1992) Meta-analysis by the confidence profile method: the statistical synthesis of evidence. Academic Press, Boston

    Google Scholar 

  28. Littenberg B, Moses LE (1993) Estimating diagnostic accuracy from multiple conflicting reports: a new meta-analytic method. Med Decis Making 13: 313–321

    Google Scholar 

  29. Caro JJ, Trindade E, McGregor M (1991) The risks of death and of severe nonfatal reactions with high- vs low-osmolality contrast media: a meta-analysis. AJR 156: 825–832

    Google Scholar 

  30. Hunink MG, Wong JB, Donaldson MC, Meyerovitz MF, Harrington DP (1994) Patency results of percutaneous and surgical revascularization for femoropopliteal arterial disease. Med Decis Making 14: 71–81

    Google Scholar 

  31. Hinink MG, Wong JB, Donaldson MC, Meyerovitz MF, Vries JA de, Harrington DP (1995) Revascularization for femoropopliteal disease: a decision and cost-effectiveness analysis. JAMA 274: 165–171

    Google Scholar 

  32. Koopmanschap MA, Ineveld BM van (1992) Towards a new approach for estimating indirect costs of disease. Soc Sci Med 34: 1005–110

    Google Scholar 

  33. Koopmanschap MA, Rutten FFH, Inenveld, BM van, Roijen L van (1995) The friction cost method for measuring indirect costs of disease. J Health Econ 14(2): 171–189

    Google Scholar 

  34. Hillner BE, Philbrick JT, Becker DM (1992) Optimal management of suspected lower-extremity deep vein thrombosis: an evaluation with cost assessment of 24 management strategies. Arch Intern Med 152: 165–175

    Google Scholar 

  35. Hunink MG, Bos JJ (1995) Triage of patients to angiography for detection of aortic rupture after blunt chest trauma: cost-effectiveness analysis of using CT. AJR 165: 27–36

    Google Scholar 

  36. Yin D, Baum RA, Carpenter JP, Langlotz CP, Pentecost MJ (1995) Cost-effectiveness of MR angiography in cases of limb-threatening peripheral vascular disease. Radiology 194: 757–764

    Google Scholar 

  37. Eddy DM, Hasselblad V, McGivney W, Hendee W (1988) The value of mammography screening in women under age 50 years. JAMA 259: 1512–1519

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Adjunct appointments: University Hospital Groningen, The Netherlands and Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA

Correspondence to: M. G. M. Hunink

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hunink, M.G.M. Outcomes research and cost-effectiveness analysis in radiology. Eur. Radiol. 6, 615–620 (1996). https://doi.org/10.1007/BF00187659

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00187659

Key words

Navigation