Between a ROC and a hard place: Teaching prevalence plots to understand real world biomarker performance in the clinic

Lendrem, B. Clare, Lendrem, Dennis W., Pratt, Arthur G., Naamane, Najib, McMeekin, Peter, Ng, Wan-Fai, Allen, A. Joy, Power, Michael and Isaacs, John Dudley (2019) Between a ROC and a hard place: Teaching prevalence plots to understand real world biomarker performance in the clinic. Pharmaceutical Statistics. ISSN 1539-1604 (In Press)

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Official URL: https://doi.org/10.1002/pst.1963

Abstract

The Receiver Operating Characteristic (ROC) curve and the Area Under the Curve (AUC) of the ROC curve are widely used in discovery to compare the performance of diagnostic and prognostic assays. The ROC curve has the advantage that it is independent of disease prevalence. However, in this note, we remind scientists and clinicians that the performance of an assay upon translation to the clinic is critically dependent upon that very same prevalence. Without an understanding of prevalence in the test population, even robust bioassays with excellent ROC characteristics may perform poorly in the clinic. While the exact prevalence in the target population is not always known, simple plots of candidate assay performance as a function of prevalence rate give a better understanding of the likely real‐world performance and a greater understanding of the likely impact of variation in that prevalence on translation to the clinic.

Item Type: Article
Uncontrolled Keywords: assay performance, biomarker, prevalence, ROC AUC, sensitivity, specificity
Subjects: B200 Pharmacology, Toxicology and Pharmacy
G100 Mathematics
G300 Statistics
Department: Faculties > Health and Life Sciences > Nursing, Midwifery and Health
Depositing User: Elena Carlaw
Date Deposited: 10 Jul 2019 10:32
Last Modified: 30 Jul 2019 08:30
URI: http://nrl.northumbria.ac.uk/id/eprint/39939

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