The evaluation of a treatment is often difficult, but at least there is a clear outcome--either the patient gets better or does not.
When assessing a new diagnostic test, however, the situation may not be so simple. The successful "outcome" for a test may be either a positive or a negative result, depending upon whether a doctor wishes to confirm or exclude a diagnosis. Another possible way of assessing outcome is by whether the test affects the management of the patient: some test results, both positive and negative, will lead to a change in management, whereas in other circumstances a positive or negative result will lead the doctor to continue with the same management plan.
Diagnoses as drivers
The development of a new treatment is often seen as a very important driver of health service direction and costs. The development of new diagnostic tests is equally important. When a new diagnostic test is developed, for example the ability to identify an enzyme deficiency, then a new group of people will be identified as having a positive test result and this will initiate further diagnostic effort or treatment, even though there is not always good evidence that the …
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