title: A modified Wald interval for the area under the ROC curve (AUC) in diagnostic case-control studies.
abstract: 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.
authors.forename: Martina
authors.initials: M
authors.lastname: Kottas
authors.forename: Oliver
authors.initials: O
authors.lastname: Kuss
authors.affiliation: Institute for Biostatistics, Hannover Medical School, Carl-Neuberg-Str, 1, 30625 Hannover, Germany. antonia.zapf@med.uni-goettingen.de.
authors.forename: Antonia
authors.initials: A
authors.lastname: Zapf
mesh_terms: D019540:Area Under Curve; D015415:Biomarkers; D016022:Case-Control Studies; D017322:Clinical Trials, Phase II as Topic / Q000379:methods / Q000706:statistics & numerical data*; D003198:Computer Simulation; D016001:Confidence Intervals; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D006801:Humans; D015233:Models, Statistical; D012372:ROC Curve
chemical_list: D015415:Biomarkers