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Medical Decision Making
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Eualuation of Medical Technologies

A Generalized ROC Analysis

François Sainfort, PhD

The author describes a new methodology to solve medical decision problems involving a choice between alternatives under conditions of risk and uncertainty when imperfect empirical information from diagnostic technologies is available. The main new concept is the gener alized ROC (GROC) curve, which extends considerably the scope of analysis of the traditional ROC curve as well as the threshold approach to medical decision making. Both techniques become special cases of the new general approach. The author shows how to apply the technique and derive comprehensive clinical guidelines to solve the medical decision problem involving one patient in the most general situation. The larger problem of evaluating the performances of diagnostic technologies for a population of patients with varying prior prob abilities of disease is then addressed. A new measure of performance is proposed that goes beyond the well-accepted area under the ROC curve index. This measure is used to compare different technologies for a population of patients, and a new methodology is proposed to carry out such comparisons. Key words: technology assessment; decision theory; diagnostic information; ROC analysis. (Med Decis Making 1991;11:208-220)

Medical Decision Making, Vol. 11, No. 3, 208-220 (1991)
DOI: 10.1177/0272989X9101100312
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References
J. ICRU, April 1, 2008; 8(1): 57 - 62.
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 Med Decis MakingHome page
K. G.M. Moons, T. Stijnen, B. C. Michel, H. R. Buller, G.-A. Van Es, D. E. Grobbee, and J. D. F. Habbema
Application of Treatment Thresholds to Diagnostic-test Evaluation: An Alternative to the Comparison of Areas under Receiver Operating Characteristic Curves
Med Decis Making, October 1, 1997; 17(4): 447 - 454.
[Abstract] [PDF]