difference in cost sequential testing nt

Cost was reduced at high false positive rates (FPRs) at higher limit of indifference (0.999) and at small FPRs as the limit of indifference decreased (0.95). The limit of indifference tended to have less of an effect on the MCMROC curves than on the associated cost curves that were greatly affected. We compared the MCMROC and its associated cost curve between limits of indifference set to 0.999, 0.95 (a 5% reduction in TPR), and 1 (no reduction in TPR). In doing so, we generated the minimum cost maximum ROC (MCMROC) curve, which reflects the reduced sensitivity and cost of testing.

We expressed a limit of indifference for the range of acceptable sensitivity values and examined the associated cost of testing within this range. This corresponded to a yearly cost reduction of approximately 2-5 million per million inhabitants in these counties. Results: The estimated costs for NT-proBNP tests and echocardiographies per county were reduced by 33-36 with the 400 pg/mL cut-off and by 28-29 with the 300 pg/mL cut-off. We applied this concept to a measure of accuracy, the Receiver Operating Characteristic (ROC) curve, for a sequence of tests. The cost-effectiveness of the testing strategy was estimated through the short-term cost avoidance and reduction in demand for echocardiographies. In noninferiority studies, a limit of indifference is used to express a tolerance in results such that the clinician would regard such results as being acceptable or ‘not worse’.

Difference in cost sequential testing nt