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Cost-effectiveness Analysis in the Assessment of Diagnostic Imaging Technologies¹

¹ From the Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, 10th Floor, Boston, MA 02114-4724 (G.S.G., P.M.M., U.S., M.T.B.); Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass (G.S.G., U.S.); and PhD Program in Health Policy, Harvard University, Boston, Mass (P.M.M.). Received February 19, 2004; revision requested April 27; revision received May 4; accepted May 24. Address correspondence to G.S.G. (e-mail: scott@mgh-ita.org).

In many ways, diagnostic technologies differ from therapeutic medical technologies. Perhaps most important, diagnostic technologies do not generally directly affect long-term patient outcomes. Instead, the results of diagnostic tests can influence the care of patients; in that way, diagnostic tests may affect long-term outcomes. Because of this, the benefits associated with the use of a specific diagnostic technology will depend on the performance characteristics (eg, sensitivity and specificity) of the test, as well as other factors, such as prevalence of disease and effectiveness of available treatments for the disease in question. The fact that diagnostic tests affect short-term, or "surrogate," outcomes, rather than long-term patient outcomes makes evaluation of these tests more complicated than the evaluation of therapeutic technologies. This article will trace the history of technology assessment in medicine, address the role of cost-effectiveness and decision analysis in health technology assessment, and describe unique features and approaches to assessing diagnostic technologies. The article will then conclude with a consideration of the limits of medical technology assessment.

© RSNA, 2005

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