Analysis of cut-off points for the CAGE Questionnaire for alcohol abuse

Physicians are in a key position to diagnose and treat patients with alcohol-related problems. Early interventions before the onset of these problems may decrease the costly health care as well as the psychological and social burden of alcoholism on the patient as well as the society. At this stage, the need for physicians to screen alcohol users systematically with a simple, effective and accurate instrument is becoming more critical. Being an easy-to-administer, low-cost, sensitive and specific screening tool, CAGE Questionnaire meets these criteria and offers the promise of raising the identification rate of alcoholic patients substantially. However, CAGE has still been reported to miss nearly half of at-risk drinkers because of the incorrect setting of the high likelihood criterion for the presence of alcoholism. Therefore, there is a need to determine a clinically significant cut-off point above which CAGE will be diagnostic. This article aims to identify these optimal work-points for three different clinical settings by employing a step-wise application of statistical indices such as the area under the ROC curve, leveling factor and Youden index. This method will enable health care providers to determine the optimal CAGE scores for different treatment settings and significantly decrease the number of unrecognised at-risk drinkers.