A cost effective approach to the investigation of syncope: relative merit of different diagnostic strategies.
OBJECTIVE
To compare the cost effectiveness of a conventional diagnostic work-up with that of several different diagnostic cascades for the investigation of undifferentiated syncope.


METHODS
A MEDLINE search established a weighted estimate of diagnostic yield for several diagnostic investigations. 'High-end' and 'low-end' cost estimates were calculated for these investigations based on figures from four representative Canadian tertiary care centres in four different provinces. Several diagnostic models were applied to a hypothetical cohort of 100 patients with undifferentiated syncope.


RESULTS
The conventional diagnostic cascade resulted in a diagnosis in 85% of patients, at a cost per diagnosis of $467 to $959. The optimal model increased the diagnostic yield to 98.9%, at a cost of $460 to $1043 per diagnosed patient.


CONCLUSIONS
A combination of new technology and selective use of investigations has the potential to raise diagnostic yield without appreciably increasing cost per diagnosis.
Simpson
C S
CS
University of Western Ontario, London, Canada.
Krahn
A D
AD
Klein
G J
GJ
Yee
R
R
Skanes
A C
AC
Manda
V
V
Norris
C
C
D000465:Algorithms; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D003363:Cost Control; D003362:Cost-Benefit Analysis; D004452:Echocardiography / Q000191:economics; D004562:Electrocardiography / Q000191:economics; D015716:Electrocardiography, Ambulatory / Q000191:economics; D005251:Fees, Medical; D006801:Humans; D016239:MEDLINE; D013575:Syncope / Q000175:diagnosis* / Q000191:economics