title: A comparison of C/B ratios from studies using receiver operating characteristic curve analysis.
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.
authors.affiliation: Department of Internal Medicine Specialties, The University of Texas M.D. Anderson Cancer Center, Houston 77030-4095, USA.
authors.forename: S B
authors.initials: SB
authors.lastname: Cantor
authors.forename: C C
authors.initials: CC
authors.lastname: Sun
authors.forename: G
authors.initials: G
authors.lastname: Tortolero-Luna
authors.forename: R
authors.initials: R
authors.lastname: Richards-Kortum
authors.forename: M
authors.initials: M
authors.lastname: Follen
mesh_terms: D019411:Clinical Laboratory Techniques / Q000592:standards* / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D003955:Diagnostic Tests, Routine / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D015201:Meta-Analysis as Topic; D012372:ROC Curve; D012680:Sensitivity and Specificity