title: Monte Carlo decision curve analysis using aggregate data.
abstract: BACKGROUND
  Decision curve analysis (DCA) is an increasingly used method for evaluating diagnostic tests and predictive models, but its application requires individual patient data. The Monte Carlo (MC) method can be used to simulate probabilities and outcomes of individual patients and offers an attractive option for application of DCA.
  
  
  METHODS
  We constructed a MC decision model to simulate individual probabilities of outcomes of interest. These probabilities were contrasted against the threshold probability at which a decision-maker is indifferent between key management strategies: treat all, treat none or use predictive model to guide treatment. We compared the results of DCA with MC simulated data against the results of DCA based on actual individual patient data for three decision models published in the literature: (i) statins for primary prevention of cardiovascular disease, (ii) hospice referral for terminally ill patients and (iii) prostate cancer surgery.
  
  
  RESULTS
  The results of MC DCA and patient data DCA were identical. To the extent that patient data DCA were used to inform decisions about statin use, referral to hospice or prostate surgery, the results indicate that MC DCA could have also been used. As long as the aggregate parameters on distribution of the probability of outcomes and treatment effects are accurately described in the published reports, the MC DCA will generate indistinguishable results from individual patient data DCA.
  
  
  CONCLUSIONS
  We provide a simple, easy-to-use model, which can facilitate wider use of DCA and better evaluation of diagnostic tests and predictive models that rely only on aggregate data reported in the literature.
authors.affiliation: Department of Mathematics, Indiana University, Gary, IN, USA.
authors.forename: Iztok
authors.initials: I
authors.lastname: Hozo
authors.affiliation: USF Health Program for Comparative Effectiveness Research, Division for Evidence-based Medicine, Department of Internal Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tsalatsanis
authors.affiliation: USF Health Program for Comparative Effectiveness Research, Division for Evidence-based Medicine, Department of Internal Medicine, University of South Florida, Tampa, FL, USA.|Departments of Hematology and Health Outcome Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.|Tampa General Hospital, Tampa, FL, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Djulbegovic
mesh_terms: D002318:Cardiovascular Diseases / Q000188:drug therapy; D003661:Decision Support Techniques; D003663:Decision Trees; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D017051:Hospice Care; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D009010:Monte Carlo Method; D011471:Prostatic Neoplasms / Q000601:surgery; D012017:Referral and Consultation; D019452:Terminally Ill
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Decision curve analysis; Monte Carlo simulation; medical decision making