A framework for quantifying net benefits of alternative prognostic models

Rapsomaniki, E., White, I.R., Wood, A.M., Thompson, S.G. and Ford, I. (2012) A framework for quantifying net benefits of alternative prognostic models. Statistics in Medicine, 31(2), pp. 114-130. (doi: 10.1002/sim.4362)

Abstract

New prognostic models are traditionally evaluated using measures of discrimination and risk reclassification, but these do not take full account of the clinical and health economic context. We propose a framework for comparing prognostic models by quantifying the public health impact (net benefit) of the treatment decisions they support, assuming a set of predetermined clinical treatment guidelines. The change in net benefit is more clinically interpretable than changes in traditional measures and can be used in full health economic evaluations of prognostic models used for screening and allocating risk reduction interventions. We extend previous work in this area by quantifying net benefits in life years, thus linking prognostic performance to health economic measures; by taking full account of the occurrence of events over time; and by considering estimation and cross-validation in a multiple-study setting. The method is illustrated in the context of cardiovascular disease risk prediction using an individual participant data meta-analysis. We estimate the number of cardiovascular-disease-free life years gained when statin treatment is allocated based on a risk prediction model with five established risk factors instead of a model with just age, gender and region. We explore methodological issues associated with the multistudy design and show that cost-effectiveness comparisons based on the proposed methodology are robust against a range of modelling assumptions, including adjusting for competing risks.

• Item Type: Articles
• Additional Information: <p>he definitive version is available at www3.interscience.wiley.com</p> <p>Professor Ian Ford is a member of the WOSCOPS group who are part of the Emerging Risk Factors Collaboration.</p>
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Ford, Professor Ian
• Authors: Rapsomaniki, E., White, I.R., Wood, A.M., Thompson, S.G., and Ford, I.
• Subjects: R Medicine > R Medicine (General)
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Statistics in Medicine
• Journal Abbr.: Stat Med
• Publisher: Wiley-Blackwell
• ISSN: 0277-6715
• ISSN (Online): 1097-0258
• Copyright Holders: Copyright © 2011 John Wiley and Sons, Ltd.
• First Published: First published in Statistics in Medicine 31(2):114-130
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher