DECISION-MAKING ABOUT HEALTHCARE RELATED TESTS AND DIAGNOSTIC STRATEGIES

Abstract

While therapeutic interventions, especially pharmaceuticals, are increasingly subject to critical evaluation of the evidence supporting such interventions and decision-making processes to develop recommendations about them, such approaches and requirements either do not exist for healthcare related tests and diagnostic strategies (HCTDS) or there is a lack of clear regulation on how tests and strategies should be used. Scientists around the world, however, have made important progress on how such methods could be applied by public, policy makers and private funders in order to base decisions in favour or against their use on the best available evidence. These methods call for consideration of the always limited resources that are available to provide the best possible health care to the population. This thesis, based on a mixed-methods approach, provides a systematic evaluation of the available published and grey literature. In this thesis I describe the methodological approach used and the results from the work addressing the following topics: 1. Background about the challenges encountered in the field of diagnosis, 2. How to present evidence from test accuracy systematic reviews and our confidence in this evidence, 3. Summaries and syntheses of evidence about HCTDS. I also provide findings from in-depth interviews with experts and key informants’ experience and views about what is being done in major organizations and societies and how can this field move forward. I then conclude with recommendations on appropriate steps and a framework to support decision makers including guideline panels when making decisions about HCTDS. I also summarize additional products based on our work and future direction and projects of this research program.