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 w ork-up with that of several different diagnostic cascades for the investiga tion of undifferentiated syncope. DESIGN: A MEDLINE search established a weighted estimate of diagnostic yiel d for several diagnostic investigations. 'High-end' and 'low-end' cost esti mates were calculated for these investigations based on figures from four r epresentative Canadian tertiary care centres in four different provinces. S everal diagnostic models were applied to a hypothetical cohort of 100 patie nts 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 in creased the diagnostic yield to 98.9%, at a cost of $460 to $1043 per diagn osed patient. CONCLUSION: A combination of new technology and selective use of investigat ions has the potential to raise diagnostic yield without appreciably increa sing cost per diagnosis.