title: A cost effective approach to the investigation of syncope: relative merit of different diagnostic strategies.
abstract: 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.
authors.affiliation: University of Western Ontario, London, Canada.
authors.forename: C S
authors.initials: CS
authors.lastname: Simpson
authors.forename: A D
authors.initials: AD
authors.lastname: Krahn
authors.forename: G J
authors.initials: GJ
authors.lastname: Klein
authors.forename: R
authors.initials: R
authors.lastname: Yee
authors.forename: A C
authors.initials: AC
authors.lastname: Skanes
authors.forename: V
authors.initials: V
authors.lastname: Manda
authors.forename: C
authors.initials: C
authors.lastname: Norris
mesh_terms: 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