Making Informed Decisions: the Value of Testing Strategies in Healthcare

In this thesis, I cover many aspects related to the economics of testing strategies in healthcare, from the organization of screening tests to the use of diagnostics to combat antimicrobial resistance. It is important to consider the testing infrastructure: where should testing take place, close to the patient or in specialized laboratories; who should perform the test and how are these health professionals organized; and what value do the test results have for public health and how are these data shared? These are some of the issues to be considered when deciding when to implement or reimburse tests. From a cost-effectiveness perspective, the underlying clinical data should be sufficient to compare the testing strategy to other health technologies, by using generalizable health outcomes, such as quality-adjusted life years, and by using sufficiently long time hori¬zons. In a cost-effectiveness analysis, the costs for society are related to the clinical benefits for patients, but for microbiological tests, the clinical value is broader than that, especially if tests can identify specific pathogens. The collected data can be used to make public health decisions, for example by updating treatment guidelines for infectious disease and by responding to antimicrobial resistance and potentially pandemic pathogens.