Sarah J. Lord, MBBS, MS; Les Irwig, MBBCh, PhD; R. John Simes, MBBS, MS, MD
Potential Financial Conflicts of Interest: None disclosed.
Lord S., Irwig L., Simes R.; A Philosophical Approach to Diagnostic Test Evaluation. Ann Intern Med. 2007;146:757-758. doi: 10.7326/0003-4819-146-10-200705150-00016
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Published: Ann Intern Med. 2007;146(10):757-758.
We agree with Dr. Sonke and colleagues that one purpose of test accuracy studies is to determine whether the test provides accurate information about long-term clinical outcomes, that is, what is the prognostic value of the test information? We also agree that an ideal study to achieve this purpose is one in which the reference standard is a good proxy for patient outcome. In the absence of effective treatment, this information would be all that is required. However, if treatment is available, we also need to ask whether the test identifies patients whose outcomes would be improved by using this treatment, that is, what is the therapeutic value of testing? This is the issue we addressed in our article. Assessing the therapeutic value of a test does not just involve asking whether it provides accurate prognostic information. We also need to consider whether it identifies patients whose prognosis will improve with treatment (1).
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