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Table 2 Five-year cost-effectiveness of new test strategies versus current test strategy

From: A five-year model to assess the early cost-effectiveness of new diagnostic tests in the early diagnosis of rheumatoid arthritis

Test strategy New test Sea Spa Test costsa TP n (%) FP n (%) TN n (%) FN n (%) Costs QALYs ∆Costs ∆QALYs ICER Headroomb
ACR/EULAR 2010 RA   0.62 0.77 €1,593d 185 (34) 58 (11) 195 (35) 114 (21) €16,784 3.430     
Add-on all patients B-cell 0.60 0.90 €150 254 (46) 77 (14) 175 (32) 46 (8) €16,807 3.454 €23 0.024 €969 €602
IL-6 0.70 0.53 €50 265 (48) 149 (27) 103 (19) 34 (6) €17,387 3.451 €603 0.021 €28,171 -€125e
MRI 0.90 0.60 €756 288 (52) 135 (24) 117 (21) 11 (2) €17,848 3.461 €1,063 0.031 €34,318 €312
Genetic 0.40 0.85 €750 231 (42) 87 (16) 166 (30) 69 (13) €17,611 3.444 €827 0.014 €57,606 €210
Add-on intermediate-risk patients B-cell 0.60 0.90 €150 244 (44) 74 (13) 178 (32) 56 (10) €16,748 3.450 -€37 0.020 Dominantc €511
IL-6 0.70 0.53 €50 254 (46) 135 (24) 117 (21) 46 (8) €17,271 3.448 €487 0.018 €26,696 -€72e
MRI 0.90 0.60 €756 273 (49) 124 (22) 128 (23) 27 (5) €17,404 3.456 €620 0.026 €23,457 €269
Genetic 0.40 0.85 €750 224 (41) 82 (15) 170 (31) 75 (14) €17,211 3.442 €427 0.012 €35,233 €173
Example of what would happen if one would replace the RA classification criteria
Replacement all B-cell 0.60 0.90 €150 180 (33) 25 (5) 227 (41) 120 (22) €15,983 3.432 -€801 0.002 Dominantc €984
IL-6 0.70 0.53 €50 210 (38) 119 (22) 134 (24) 90 (16) €16,849 3.434 €64 0.004 €17,526 €59
MRI 0.90 0.60 €756 270 (49) 101 (18) 151 (27) 30 (5) €17,139 3.458 €355 0.027 €12,906 €951
Genetic 0.40 0.85 €750 120 (22) 38 (7) 214 (39) 180 (33) €16,675 3.414 € -110 -0.016 €6,914 €543
  1. Se sensitivity, Sp specificity, TP true positive, FP false positive, TN true negative, FN false negative, QALY quality-adjusted life year, ICER incremental cost-effectiveness ratio (€ per QALY gained), ACR/EULAR American College of Rheumatology/European League Against Rheumatism, RA rheumatoid arthritis, MRI magnetic resonance imaging. aThese are the Se, Sp and costs of the new test; the Se and Sp of the combination of the new test plus the ACR/EULAR criteria are reported in the text. bWillingness to pay threshold is €20,000 per QALY gained. cDominant = better health outcomes and lower costs. dCosts of visits and diagnostic tests during first year. eMainly due to the low specificity, an IL-6 test as an add-on can never be cost-effective compared to the current test strategy