Cost-effectiveness of new technologies for staging endometrial cancer.

Abstract

To ensure the dissemination of new imaging technology, radiologists must demonstrate that diagnostic information is worth more than the cost of the test. Methodology of cost-effectiveness is complex and new to the radiological community. In this review an evaluation of diagnostic imaging for patients with endometrial cancer is used to illustrate numerous methods to define value of imaging. Receiver operating characteristics (ROC) analysis determines value of test efficacy while Bayesian analysis determines value in the context of disease prevalence. The value of imaging tests for clinical practice, however, depends on the patient’s specific circumstance. This value can be defined by cost-effectiveness analysis which can assist in developing imaging guidelines that are patient specific. Technology development vs dissemination During the twentieth century, the remarkable evolution of diagnostic radiology has depended on the development and dissemination of new technologies. New technology was rapidly adapted into clinical practice, and the pace of evolution was largely governed by the product development cycle. However, health care reform introduced by managed care and cost containment has constrained the dissemination of new technology. Indeed, in many circumstances technology dissemination is now the “choke point” for the advancement of medical imaging. To ensure the dissemination of new technology, radiologists must demonstrate to the medical community including clinical colleagues and health administrators that the diagnostic information provided by the technology is worth the costs of obtaining the information. For most radiologists, technology assessment and health care are an unfamiliar and difficult endeavor. This paper evaluates the use of modern imaging in the management of endometrial cancer to illustrate how radiologists can analyze the value of new technology in clinical practice.