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Monte Carlo decision curve analysis using aggregate data
Author(s) -
Hozo Iztok,
Tsalatsanis Athanasios,
Djulbegovic Benjamin
Publication year - 2017
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12723
Subject(s) - aggregate (composite) , monte carlo method , aggregate data , computer science , referral , prostate cancer , medicine , decision support system , statistics , intensive care medicine , data mining , mathematics , cancer , pathology , materials science , family medicine , composite material
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 . Materials and 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.