Articles: sensitivity-specificity.
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Health Technol Assess · Jun 2009
ReviewSensitivity analysis in economic evaluation: an audit of NICE current practice and a review of its use and value in decision-making.
To determine how we define good practice in sensitivity analysis in general and probabilistic sensitivity analysis (PSA) in particular, and to what extent it has been adhered to in the independent economic evaluations undertaken for the National Institute for Health and Clinical Excellence (NICE) over recent years; to establish what policy impact sensitivity analysis has in the context of NICE, and policy-makers' views on sensitivity analysis and uncertainty, and what use is made of sensitivity analysis in policy decision-making. ⋯ The review and the policy impact assessment focused exclusively on documentary evidence, excluding other sources that might have revealed further insights on this issue. In seeking to address parameter uncertainty, both deterministic and probabilistic sensitivity analyses should be used. It is evident that some cost-effectiveness work, especially around the sensitivity analysis components, represents a challenge in making it accessible to those making decisions. This speaks to the training agenda for those sitting on such decision-making bodies, and to the importance of clear presentation of analyses by the academic community.
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Review
Diagnostic test accuracy may vary with prevalence: implications for evidence-based diagnosis.
Several studies and systematic reviews have reported results that indicate that sensitivity and specificity may vary with prevalence. ⋯ Sensitivity and specificity may vary in different clinical populations, and prevalence is a marker for such differences. Clinicians are advised to base their decisions on studies that most closely match their own clinical situation, using prevalence to guide the detection of differences in study population or study design.
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This study examined the efficacy of computed tomographic angiography (CTA) for detection of ruptured and unruptured aneurysms after adjustment for their size distributions under various conditions of aneurysm prevalence. ⋯ Small aneurysms detected on CTA should be investigated further unless there is a high pretest probability of a ruptured aneurysm. During screening for ruptured aneurysms, a negative CTA should be investigated further. During screening for unruptured aneurysms, a negative CTA results in a very low probability of a clinically important aneurysm.