Assessing the performance of prediction models: a framework for traditional and novel measures

TY - JOUR

T1 - Assessing the performance of prediction models: a framework for traditional and novel measures

AU - Steyerberg, Ewout W

AU - Vickers, Andrew J

AU - Cook, Nancy R

AU - Gerds, Thomas

AU - Gonen, Mithat

AU - Obuchowski, Nancy

AU - Pencina, Michael J

AU - Kattan, Michael W

N1 - Keywords: Epidemiologic Studies; Models, Statistical; Prognosis; ROC Curve; Reproducibility of Results; Risk Assessment

PY - 2010/1

Y1 - 2010/1

N2 - The performance of prediction models can be assessed using a variety of methods and metrics. Traditional measures for binary and survival outcomes include the Brier score to indicate overall model performance, the concordance (or c) statistic for discriminative ability (or area under the receiver operating characteristic [ROC] curve), and goodness-of-fit statistics for calibration.Several new measures have recently been proposed that can be seen as refinements of discrimination measures, including variants of the c statistic for survival, reclassification tables, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Moreover, decision-analytic measures have been proposed, including decision curves to plot the net benefit achieved by making decisions based on model predictions.We aimed to define the role of these relatively novel approaches in the evaluation of the performance of prediction models. For illustration, we present a case study of predicting the presence of residual tumor versus benign tissue in patients with testicular cancer (n = 544 for model development, n = 273 for external validation).We suggest that reporting discrimination and calibration will always be important for a prediction model. Decision-analytic measures should be reported if the predictive model is to be used for clinical decisions. Other measures of performance may be warranted in specific applications, such as reclassification metrics to gain insight into the value of adding a novel predictor to an established model.

AB - The performance of prediction models can be assessed using a variety of methods and metrics. Traditional measures for binary and survival outcomes include the Brier score to indicate overall model performance, the concordance (or c) statistic for discriminative ability (or area under the receiver operating characteristic [ROC] curve), and goodness-of-fit statistics for calibration.Several new measures have recently been proposed that can be seen as refinements of discrimination measures, including variants of the c statistic for survival, reclassification tables, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Moreover, decision-analytic measures have been proposed, including decision curves to plot the net benefit achieved by making decisions based on model predictions.We aimed to define the role of these relatively novel approaches in the evaluation of the performance of prediction models. For illustration, we present a case study of predicting the presence of residual tumor versus benign tissue in patients with testicular cancer (n = 544 for model development, n = 273 for external validation).We suggest that reporting discrimination and calibration will always be important for a prediction model. Decision-analytic measures should be reported if the predictive model is to be used for clinical decisions. Other measures of performance may be warranted in specific applications, such as reclassification metrics to gain insight into the value of adding a novel predictor to an established model.

U2 - 10.1097/EDE.0b013e3181c30fb2

DO - 10.1097/EDE.0b013e3181c30fb2

M3 - Journal article

C2 - 20010215

SN - 1044-3983

VL - 21

SP - 128

EP - 138

JO - Epidemiology

JF - Epidemiology

IS - 1

ER -