TY - JOUR
T1 - The indication area of a diagnostic test. Part I--discounting gain and loss in diagnostic certainty
AU - Stalpers, Lukas J. A.
AU - Nelemans, Patty J.
AU - Geurts, Sandra M. E.
AU - Jansen, Erik
AU - de Boer, Peter
AU - Verbeek, André L. M.
PY - 2015
Y1 - 2015
N2 - Test performance is conventionally expressed by gain in diagnostic certainty. We propose net diagnostic gain and indication area as more appropriate measures of test performance; then, the loss in certainty due to misclassification and the information of "no test" would be performed are taken into account. A decision analytical model was developed in which two alternative strategies were compared: testing and no testing. Correct diagnostic test results received a positive value; undesired test results received a negative value. Within the "no test" scenario, it was assumed that physicians are more prone to treat as the probability of disease is higher. Discounting gain and loss in diagnostic certainty results in a concave function of the prior. The indication area is the range of priors with a net diagnostic gain; testing is deleterious beyond this range. The net diagnostic gain reaches a maximum at a specific prior. A freely available Web site-based calculator was developed for easy calculation of the indication area and the maximum diagnostic gain for each combination of sensitivity and specificity. Medical testing is not indicated when the prior disease probabilities are low (as to screening for a condition) or high (for diagnostic confirmation)
AB - Test performance is conventionally expressed by gain in diagnostic certainty. We propose net diagnostic gain and indication area as more appropriate measures of test performance; then, the loss in certainty due to misclassification and the information of "no test" would be performed are taken into account. A decision analytical model was developed in which two alternative strategies were compared: testing and no testing. Correct diagnostic test results received a positive value; undesired test results received a negative value. Within the "no test" scenario, it was assumed that physicians are more prone to treat as the probability of disease is higher. Discounting gain and loss in diagnostic certainty results in a concave function of the prior. The indication area is the range of priors with a net diagnostic gain; testing is deleterious beyond this range. The net diagnostic gain reaches a maximum at a specific prior. A freely available Web site-based calculator was developed for easy calculation of the indication area and the maximum diagnostic gain for each combination of sensitivity and specificity. Medical testing is not indicated when the prior disease probabilities are low (as to screening for a condition) or high (for diagnostic confirmation)
U2 - https://doi.org/10.1016/j.jclinepi.2015.05.016
DO - https://doi.org/10.1016/j.jclinepi.2015.05.016
M3 - Article
C2 - 26139436
SN - 0895-4356
VL - 68
SP - 1120
EP - 1128
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
IS - 10
ER -