Result card

  • ETH10: Are the accuracy measures decided and balanced on a transparent and acceptable way?
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Are the accuracy measures decided and balanced on a transparent and acceptable way?

Authors: Gottfried Endel

Internal reviewers: Wilhelm Donner, Scott Goulden, Grace Jennings, Paolo Giorgi Rossi, Ingrid Wilbacher, Claudia Wild

At the moment a clear rule for prioritising screening procedures is not available. The decision process is mainly driven by scientific organisations of care providers. This expert opinion is based (hopefully) on clinical studies, clinical experience and a broad knowledge of the natural course of the disease. The definition of cut-off values for tests should be based on scientific evidence.

  • Respect for autonomy: organised population screening is a recommendation and provides information to support decision making on the individual level. As well as the potential benefits and harms, the uncertainty associated with tests and prognoses also have to be addressed.
  • Non-maleficence: comprehensive information is needed to deal with uncertainty.
  • Beneficence: balancing risks and cost with potential benefits can only be done at the local level (information on cost and organisational issues is local). Uncertainty is part of every prognosis. So it must be stated that “more is not automatically better” and that is a key point when balancing different scales.
  • Justice: In this question the domain of justice addresses potential restrictions deriving from the setting of cut-offs. Accuracy measures determine inclusion or exclusion of individuals or in a rule for prioritizing screening methods for healthy individuals according to age and /or gender need a clear rational.

Decisions about cut-off values need a valid scientific basis. The uncertainty associated with all decisions and prognoses has to be communicated. The degree of uncertainty acceptable in a healthcare system should be made explicit and is the subject of a value judgement.

The general approach on the EU level has to be put into operation at the local level. This could be done using an interactive participatory approach to HTA.

  • Respect for autonomy: organised population screening is a recommendation and provides information to support decision making on the individual level. As well as potential benefits and harms, the uncertainty associated with tests and prognoses also have to be addressed.
  • Non-maleficence: comprehensive information is needed to deal with uncertainty.
  • Beneficence: balancing risks and cost with potential benefits can only be done at the local level (information on cost and organisational issues is local). Uncertainty is part of every prognosis. So it must be stated that “more is not automatically better “and that is a key point when balancing different scales.
  • Justice: In this question the domain of justice addresses potential restrictions deriving from the setting of cut-offs. Accuracy measures determine inclusion or exclusion of individuals or in a rule for prioritizing screening methods for groups.
Critical
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Endel G Result Card ETH10 In: Endel G Ethical analysis In: Jefferson T, Vicari N, Frønsdal K [eds.]. Abdominal Aorta Aneurysm Screening [Core HTA], Agenzia nationale per i servizi sanitari regionali (age.na.s), Italy; 2013. [cited 5 July 2022]. Available from: http://corehta.info/ViewCover.aspx?id=106