[Discriminative ability, reclassification and net benefit: the predictive value of biomarkers].
More and more biomarkers are becoming available to predict the risk of disease. Several performance measures are used to express the predictive value of a biomarker. In this article we use as an example the Framingham risk score with and without the HDL cholesterol concentration as a risk factor for the prediction of the occurrence of cardiovascular disease. We consider 3 performance measures for diagnostic or prognostic quality: (a) the area under the Receiver Operating Characteristic (ROC) curve (AUC), a traditional measure to indicate discriminative ability; (b) the Net Reclassification Improvement (NRI), a popular measure based on the improvements in the high- and low-risk classification of patients by adding the HDL value as a risk factor; (c) Net Benefit, a measure based on decision sciences. Net benefit is a better measure for the value of a biomarker, since it takes more of the clinical context into account and is easier to interpret than the AUC and the NRI.
Erasmus MC, afd. Maatschappelijke Gezondheidszorg, Rotterdam, the Netherlands. e.steyerberg@erasmusmc.nl
Ewout W
EW
Steyerberg
Michael J
MJ
Pencina
Ben
B
Van Calster
D015415:Biomarkers / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D003937:Diagnosis, Differential; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000145:classification* / Q000706:statistics & numerical data*; D012307:Risk Factors
D015415:Biomarkers; D008076:Cholesterol, HDL