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The Optimal Cutoff of a Diagnostic Test

In: Medical Decision Making

Author

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  • Stefan Felder

    (University of Basel)

  • Thomas Mayrhofer

    (Stralsund University of Applied Sciences)

Abstract

We introduce a scenario in which there are an infinite number of available tests. This is the case if the test outcome must be determined by the decision maker by setting a cut-off value. A good example is the prostate-specific antigen (PSA) test for the detection of prostate cancer in men. The analysis of a blood sample results in a PSA value, which the physician assesses as either positive or negative depending on the chosen cut-off value. We demonstrate how the optimal cut-off value depends on the prior probability of the disease as well as on the utility and potential harm from testing and treatment. This chapter also introduces the use of the receiver operating characteristic (ROC) curve, which is well known in clinical epidemiology.

Suggested Citation

  • Stefan Felder & Thomas Mayrhofer, 2022. "The Optimal Cutoff of a Diagnostic Test," Springer Books, in: Medical Decision Making, edition 3, chapter 0, pages 173-192, Springer.
    • Handle: RePEc:spr:sprchp:978-3-662-64654-0_8
    DOI: 10.1007/978-3-662-64654-0_8
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