|
Abstract:
|
This research provides guidance to choosing between the Believe the Positive (BP) and Believe the Negative (BN) sequential testing strategies or a single test, using accuracy (as measured by Youden Index) as the primary determinant. Approximately 75% of the parameter combinations examined in the simulation resulted in either BP or BN being recommended over a single test based on higher accuracy at the optimal point. About half the time, BP was preferred, and the other half BN, with the choice often a function of the ratio of standard deviations of those without and with disease (b). Large values of b for the first test of the sequence tended to be associated with BN as opposed to BP, while small values of b appear to favor BP. When there was initially no preference between sequences and/or single tests based on Youden Index, cost of the sequence was considered. We found that in such case, disease prevalence plays a large role in the selection of strategies, with lower values favoring BN, and sometimes higher values favoring BP. The cost threshold for the sequential strategy to be preferred over a single, more accurate test, was often quite high.
|
