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Reducing cost in sequential testing: a limit of indifference approach.

Anwar E Ahmed1, Christine M Schubert, Donna K McClish

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This study introduces the minimum cost maximum ROC (MCMROC) curve to evaluate sequential diagnostic tests. It demonstrates how a limit of indifference impacts test accuracy and cost, offering insights for clinical decision-making.

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Area of Science:

  • Medical Diagnostics
  • Biostatistics
  • Health Economics

Background:

  • Noninferiority studies use a limit of indifference to define acceptable results.
  • Receiver Operating Characteristic (ROC) curves are standard for assessing diagnostic test accuracy.

Purpose of the Study:

  • To apply the limit of indifference concept to ROC curves for sequential testing.
  • To develop the minimum cost maximum ROC (MCMROC) curve and analyze its cost implications.

Main Methods:

  • Defined a limit of indifference for acceptable sensitivity values in sequential testing.
  • Generated MCMROC curves and associated cost curves for varying limits of indifference (0.999, 0.95, 1).
  • Applied the methodology to sequential diabetes diagnosis in the Pima Indian population.

Main Results:

  • The limit of indifference had a greater impact on cost curves than on MCMROC curves.
  • Cost reduction was observed at high false positive rates (FPRs) with a higher limit of indifference (0.999).
  • Cost reduction occurred at low FPRs with a lower limit of indifference (0.95).

Conclusions:

  • The MCMROC curve effectively visualizes the trade-off between diagnostic accuracy and testing cost.
  • The limit of indifference is a crucial factor in optimizing sequential diagnostic strategies for cost-effectiveness.