Análisis coste-efectivo de la punción aspiración transbronquial de lesiones pulmonares sin afectación endobronquial

A Systematic Review of Health Economic Evaluations of Diagnostic Biomarkers

“…Genetic testing was employed for treatment selection in patients ( N = 7) [ 40 – 46 ] or to test for a familial disease in patients and their relatives ( N = 6) [ 47 – 52 ]. Biomarkers were applied to diagnose several types of cancer ( N = 23) [ 20 , 21 , 24 – 30 , 32 – 40 , 44 – 48 ], cardiovascular/circulatory diseases ( N = 9) [ 22 , 23 , 31 , 41 , 43 , 49 – 52 ], and respiratory disease ( N = 1) [ 42 ]. Economic evaluations were most often performed in colorectal cancer and evaluated genetic testing strategies like testing of BRAF and KRAS genetic mutations.…”

“…The number of strategies that were assessed differed between studies and ranged from two to 17 strategies (median: three strategies). Fourteen studies reported a single comparison of two strategies ( N = 14) [ 21 , 23 , 26 , 27 , 30 – 32 , 34 , 36 – 39 , 42 , 44 ], i.e., an evaluation of a biomarker strategy compared with no biomarker ( N = 6) [ 21 , 30 , 31 , 34 , 36 , 42 ] or a head to-head comparison of two specific biomarkers ( N = 8) [ 23 , 26 , 27 , 32 , 37 – 39 , 44 ].…”

“…Verry et al [ 39 ] reported the incremental costs and incremental QALYs, but not the incremental cost-utility ratio, and Steinfort et al [ 32 ] reported incremental costs per QALY and cost savings. Nine studies performed a CEA, of which two were trial based [ 25 , 30 ], and reported the incremental costs per life-year gained ( N = 5) [ 29 , 33 , 40 , 47 , 52 ], the incremental costs per additional case detected ( N = 3) [ 25 , 30 , 34 ], or the incremental costs per extra patient surviving at 5 years ( N = 1) [ 20 ]. Eight trial-based studies were identified, containing two CUAs [ 23 , 42 ] and two CEAs [ 25 , 30 ].…”

“…Cost effectiveness was mostly assessed from a healthcare system perspective ( N = 15) [ 20 , 22 , 23 , 25 , 31 , 33 , 38 – 40 , 42 – 44 , 48 , 49 , 51 ], while some other studies adopted a hospital perspective ( N = 7) [ 21 , 24 , 30 , 32 , 34 , 36 , 52 ], a third party payer perspective ( N = 5) [ 26 , 27 , 41 , 46 , 47 ], or limited the perspective to that of the operating room ( N = 1) [ 37 ]. Five studies adopted a societal perspective [ 28 , 29 , 35 , 45 , 50 ], of which three studies presented the productivity losses that were included [ 28 , 35 , 45 ].…”

“…Looking at CEAs, the time horizon varied substantially. Three studies used a time horizon capturing the duration of the diagnostic process or the duration of hospital stay [ 25 , 30 , 34 ], whilst there were also four studies that incorporated a lifetime horizon [ 29 , 33 , 34 , 47 ]. The majority of CUAs used a lifetime horizon ( N = 10) [ 22 , 26 – 28 , 31 , 35 , 43 , 48 , 49 , 51 ] and adopted a healthcare system perspective ( N = 11) [ 22 , 23 , 31 , 38 , 39 , 42 – 44 , 48 , 49 , 51 ].…”