Economic Analyses of a Novel Diagnostic Device in Endocrine Disease

Student thesis: Doctoral ThesisDoctor of Philosophy (PhD)

Abstract

Background
Diagnosing endocrine disorders with conventional methods is challenging and expensive. U-Rhythm is a novel device that collects 24-hour hormone profiles while users continue with daily activities. An early case-control study (ULTRADIAN) showed that U-Rhythm can play a role in differentiating endocrine conditions. The aim of this thesis was to assess U-Rhythm’s potential health economic value and explore the challenges of conducting an early economic evaluation.

Methods
A systematic review of economic evaluations of diagnostic tests for six selected endocrine disorders was performed. ULTRADIAN data on patients’ and healthy controls’ device satisfaction, recent healthcare usage and health-related quality of life were collected prospectively at four European centres. The burden of primary aldosteronism for the UK healthcare system was measured in a retrospective analysis of routinely collected healthcare data (CPRD-HES). A decision tree and Markov model was developed to conduct a cost-effectiveness, price threshold and value of information analysis to explore the potential cost-effectiveness of U-Rhythm in the diagnosis of primary aldosteronism and identify areas for further research.

Results
Only seven economic studies for three endocrine disorders were identified. ULTRADIAN data indicated patients’ general satisfaction with U-Rhythm, higher healthcare usage and lower health-related quality of life compared to healthy volunteers. The twenty-year healthcare costs associated with primary aldosteronism were double those of patients without the disease. U-Rhythm was found to be less cost-effective than existing tests for the confirmatory diagnosis of primary aldosteronism. Further investment in research and development was not worthwhile unless U-Rhythm’s costs are reduced and/or diagnostic accuracy increases as the technology evolves.

Conclusions
Early economic evaluation of diagnostics is hard due to limited and low-quality data, multiple potential uses in clinical practice, and efficiency depending on subsequent technologies. Decisions on further investment should be taken after their key parameters have been established and compared with currently available products.
Date of Award24 Jun 2021
Original languageEnglish
Awarding Institution
  • The University of Bristol
SupervisorWilliam Hollingworth (Supervisor) & Stafford L Lightman (Supervisor)

Keywords

  • Health Economics
  • Economic Evaluation
  • Early Economic Evaluation
  • Systematic Literature Review
  • Patient-Level Data Analysis
  • Healthcare Data Analysis
  • Decision-Analytic Modelling
  • Headroom Approach
  • Value of Information Analysis
  • Endocrine Disorders
  • Diagnostic Tests
  • Medical Devices
  • UK National Health Service
  • Health Technology Assessment

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