title: Risk prediction models: I. Development, internal validation, and assessing the incremental value of a new (bio)marker.
abstract: Prediction models are increasingly used to complement clinical reasoning and decision making in modern medicine in general, and in the cardiovascular domain in particular. Developed models first and foremost need to provide accurate and (internally and externally) validated estimates of probabilities of specific health conditions or outcomes in targeted patients. The adoption of such models must guide physician's decision making and an individual's behaviour, and consequently improve individual outcomes and the cost-effectiveness of care. In a series of two articles we review the consecutive steps generally advocated for risk prediction model research. This first article focuses on the different aspects of model development studies, from design to reporting, how to estimate a model's predictive performance and the potential optimism in these estimates using internal validation techniques, and how to quantify the added or incremental value of new predictors or biomarkers (of whatever type) to existing predictors. Each step is illustrated with empirical examples from the cardiovascular field.
authors.affiliation: Julius Center for Health Sciences and Primary Care, UMC Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. k.g.m.moons@umcutrecht.nl
authors.forename: Karel G M
authors.initials: KG
authors.lastname: Moons
authors.forename: Andre Pascal
authors.initials: AP
authors.lastname: Kengne
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: Patrick
authors.initials: P
authors.lastname: Royston
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Vergouwe
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Altman
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
mesh_terms: D015415:Biomarkers / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000378:metabolism; D003362:Cost-Benefit Analysis; D003657:Decision Making; D003661:Decision Support Techniques; D006801:Humans; D008962:Models, Theoretical; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012306:Risk
chemical_list: D015415:Biomarkers