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A New Logistic Regression Approach for the Evaluation of Diagnostic Test Results

Author

Listed:
  • A. Cecile J. W. Janssens

    (Center for Clinical Decision Sciences, Department of Public Health, Erasmus MC, the Netherlands, a.janssens@erasmusmc.nl)

  • Yazhong Deng

    (Center for Clinical Decision Sciences, Department of Public Health, Erasmus MC, the Netherlands)

  • Gerard J. J. M. Borsboom

    (Center for Clinical Decision Sciences, Department of Public Health, Erasmus MC, the Netherlands)

  • Marinus J. C. Eijkemans

    (Center for Clinical Decision Sciences, Department of Public Health, Erasmus MC, the Netherlands)

  • J. Dik. F. Habbema

    (Center for Clinical Decision Sciences, Department of Public Health, Erasmus MC, the Netherlands)

  • Ewout W. Steyerberg

    (Center for Clinical Decision Sciences, Department of Public Health, Erasmus MC, the Netherlands)

Abstract

The value of a dichotomous diagnostic test is often described in terms of sensitivity, specificity, and likelihood ratios (LRs). Although it is known that these test characteristics vary between subgroups of patients, they are generally interpreted, on average, without considering information on patient characteristics, such as clinical signs and symptoms, or on previous test results. This article presents a reformulation of the logistic regression model that allows to calculate the LRs of diagnostic test results conditional on these covariates. The proposed method starts with estimating logistic regression models for the prior and posterior odds of disease. The regression model for the prior odds is based on patient characteristics, whereas the regression model for the posterior odds also includes the diagnostic test of interest. Following the Bayes theorem, the authors demontsrate that the regression model for the LR can be derived from taking the differences between the regression coefficients of the 2 models. In a clinical example, they demonstrate that the LRs of positive and negative test results and the sensitivity and specificity of the diagnostic test varied considerably between patients with different risk profiles, even when a constant odds ratio was assumed. The proposed logistic regression approach proves an efficient method to determine the performance of tests at the level of the individual patient risk profile and to examine the effect of patient characteristics on diagnostic test characteristics.

Suggested Citation

  • A. Cecile J. W. Janssens & Yazhong Deng & Gerard J. J. M. Borsboom & Marinus J. C. Eijkemans & J. Dik. F. Habbema & Ewout W. Steyerberg, 2005. "A New Logistic Regression Approach for the Evaluation of Diagnostic Test Results," Medical Decision Making, , vol. 25(2), pages 168-177, March.
  • Handle: RePEc:sae:medema:v:25:y:2005:i:2:p:168-177
    DOI: 10.1177/0272989X05275154
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    Citations

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    Cited by:

    1. Dwivedi Alok Kumar & Mallawaarachchi Indika & Figueroa-Casas Juan B. & Morales Angel M. & Tarwater Patrick, 2015. "Multinomial Logistic Regression Approach for the Evaluation of Binary Diagnostic Test in Medical Research," Statistics in Transition New Series, Polish Statistical Association, vol. 16(2), pages 203-222, June.
    2. Angel M. Morales & Patrick Tarwater & Indika Mallawaarachchi & Alok Kumar Dwivedi & Juan B. Figueroa-Casas, 2015. "Multinomial logistic regression approach for the evaluation of binary diagnostic test in medical research," Statistics in Transition new series, Główny Urząd Statystyczny (Polska), vol. 16(2), pages 203-222, June.
    3. Ying Huang & Eric Laber, 2016. "Personalized Evaluation of Biomarker Value: A Cost-Benefit Perspective," Statistics in Biosciences, Springer;International Chinese Statistical Association, vol. 8(1), pages 43-65, June.
    4. Alok Kumar Dwivedi & Indika Mallawaarachchi & Juan B. Figueroa-Casas & Angel M. Morales & Patrick Tarwater, 2015. "Multinomial Logistic Regression Approach For The Evaluation Of Binary Diagnostic Test In Medical Research," Statistics in Transition New Series, Polish Statistical Association, vol. 16(2), pages 203-222, June.

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