A modified Wald interval for the area under the ROC curve (AUC) in diagnostic case-control studies

TY - JOUR

T1 - A modified Wald interval for the area under the ROC curve (AUC) in diagnostic case-control studies

AU - Kottas, Martina

AU - Kuss, Oliver

AU - Zapf, Antonia

PY - 2014/2/19

Y1 - 2014/2/19

N2 - BACKGROUND: The area under the receiver operating characteristic (ROC) curve, referred to as the AUC, is an appropriate measure for describing the overall accuracy of a diagnostic test or a biomarker in early phase trials without having to choose a threshold. There are many approaches for estimating the confidence interval for the AUC. However, all are relatively complicated to implement. Furthermore, many approaches perform poorly for large AUC values or small sample sizes.METHODS: The AUC is actually a probability. So we propose a modified Wald interval for a single proportion, which can be calculated on a pocket calculator. We performed a simulation study to compare this modified Wald interval (without and with continuity correction) with other intervals regarding coverage probability and statistical power.RESULTS: The main result is that the proposed modified Wald intervals maintain and exploit the type I error much better than the intervals of Agresti-Coull, Wilson, and Clopper-Pearson. The interval suggested by Bamber, the Mann-Whitney interval without transformation and also the interval of the binormal AUC are very liberal. For small sample sizes the Wald interval with continuity has a comparable coverage probability as the LT interval and higher power. For large sample sizes the results of the LT interval and of the Wald interval without continuity correction are comparable.CONCLUSIONS: If individual patient data is not available, but only the estimated AUC and the total sample size, the modified Wald intervals can be recommended as confidence intervals for the AUC. For small sample sizes the continuity correction should be used.

AB - BACKGROUND: The area under the receiver operating characteristic (ROC) curve, referred to as the AUC, is an appropriate measure for describing the overall accuracy of a diagnostic test or a biomarker in early phase trials without having to choose a threshold. There are many approaches for estimating the confidence interval for the AUC. However, all are relatively complicated to implement. Furthermore, many approaches perform poorly for large AUC values or small sample sizes.METHODS: The AUC is actually a probability. So we propose a modified Wald interval for a single proportion, which can be calculated on a pocket calculator. We performed a simulation study to compare this modified Wald interval (without and with continuity correction) with other intervals regarding coverage probability and statistical power.RESULTS: The main result is that the proposed modified Wald intervals maintain and exploit the type I error much better than the intervals of Agresti-Coull, Wilson, and Clopper-Pearson. The interval suggested by Bamber, the Mann-Whitney interval without transformation and also the interval of the binormal AUC are very liberal. For small sample sizes the Wald interval with continuity has a comparable coverage probability as the LT interval and higher power. For large sample sizes the results of the LT interval and of the Wald interval without continuity correction are comparable.CONCLUSIONS: If individual patient data is not available, but only the estimated AUC and the total sample size, the modified Wald intervals can be recommended as confidence intervals for the AUC. For small sample sizes the continuity correction should be used.

KW - Area Under Curve

KW - Biomarkers

KW - Case-Control Studies

KW - Clinical Trials, Phase II as Topic

KW - Computer Simulation

KW - Confidence Intervals

KW - Diagnostic Tests, Routine

KW - Humans

KW - Models, Statistical

KW - ROC Curve

KW - Journal Article

U2 - 10.1186/1471-2288-14-26

DO - 10.1186/1471-2288-14-26

M3 - SCORING: Journal article

C2 - 24552686

VL - 14

SP - 26

JO - BMC MED RES METHODOL

JF - BMC MED RES METHODOL

SN - 1471-2288

ER -