A comparison of C/B ratios from studies using receiver operating characteristic curve analysis

J Clin Epidemiol. 1999 Sep;52(9):885-92. doi: 10.1016/s0895-4356(99)00075-x.

Abstract

In receiver operating characteristic (ROC) curve analysis, the optimal cutoff value for a diagnostic test can be found on the ROC curve where the slope of the curve is equal to (C/B) x (1-p[D])/p[D], where p[D] is the disease prevalence and C/B is the ratio of net costs of treating nondiseased individuals to net benefits of treating diseased individuals. We conducted a structured review of the medical literature to examine C/B ratios found in ROC curve analysis. Only two studies were found in which a C/B ratio was explicitly calculated; in another 11 studies, a C/B ratio was based on a so-called holistic estimate, an all-encompassing educated estimate of the relative costs and benefits relevant to the clinical situation. The C/B ratios ranged from 0.0025 (tuberculosis screening) to 2.7 (teeth restoration for carious lesions). Clinical scenarios that are directly life threatening but curable had C/B ratios of less than 0.05. This analysis led us to construct a table of ordered C/B ratios that may be used by investigators to approximate C/B ratios for other clinical situations in order to establish cutpoints for new diagnostic tests.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Clinical Laboratory Techniques / standards*
  • Clinical Laboratory Techniques / statistics & numerical data
  • Costs and Cost Analysis
  • Decision Support Techniques
  • Diagnostic Tests, Routine / standards*
  • Diagnostic Tests, Routine / statistics & numerical data
  • Humans
  • Meta-Analysis as Topic
  • ROC Curve*
  • Sensitivity and Specificity