ArticleDiagnostic and prognostic research2023
Decision curve analysis: confidence intervals and hypothesis testing for net benefit.
Article in Diagnostic and prognostic research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 23 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Evaluating predictive performance, validity, and applicability of machine learning models for predicting HIV treatment interruption: a systematic review.BMC global and public health · 2025Pooled it
- Performance of cardiovascular disease risk prediction tools in chronic obstructive pulmonary disease.Annals of the American Thoracic Society · 2026Article
- Predicting the Need to Visit a Dentist in Young to Middle-Aged Adults: A Development and External Validation.Dentistry journal · 2026Article
- A general sample size framework for developing or updating a predictive algorithm: with application to clinical prediction models.BMC medical research methodology · 2026Article
- A Dynamic Online Nomogram for Predicting Postoperative Acute Kidney Injury After Sleeve Gastrectomy.Medical science monitor : international medical journal of experimental and clinical research · 2026Article
- Development and validation of a nomogram for overall survival in pancreatic solid pseudopapillary neoplasm: a population-based study.Scientific reports · 2026Article
- The continuous net benefit: assessing the clinical utility of prediction models when informing a continuum of decisions.Diagnostic and prognostic research · 2026Article
- Risk Prediction of Edentulism in Chinese Adults: Insights From the China Health and Retirement Longitudinal Study (CHARLS).International dental journal · 2026Article
- Predictive value of a preoperative computed tomography-derived perifracture soft-tissue envelope index for fracture-related infection after open reduction and internal fixation of tibial plateau fractures.Frontiers in medicine · 2026Article
- Shared molecular mechanisms between colorectal cancer and cardiovascular disease drive perioperative neurological vulnerability.Frontiers in genetics · 2026Article
- Applications of artificial intelligence in non-small cell lung cancer: from precision diagnosis to personalized prognosis and therapy.Journal of translational medicine · 2025Review
- A decomposition of Fisher's information to inform sample size for developing or updating fair and precise clinical prediction models - part 2: time-to-event outcomes.Diagnostic and prognostic research · 2025Article
- ESPWA: a deep learning-enabled tool for precision-based use of endocrine therapy in resource-limited settings.bioRxiv : the preprint server for biology · 2025Article
- A decomposition of Fisher's information to inform sample size for developing or updating fair and precise clinical prediction models for individual risk-part 1: binary outcomes.Diagnostic and prognostic research · 2025Article
- Hypothesis: Net benefit as an objective function during development of machine learning algorithms for medical applications.International journal of medical informatics · 2025Article
- Development and validation of a probability-assessment nomogram for non-suicidal self-injury in hospitalized adolescents and young adults with mental disorders.Scientific reports · 2025Article
- Expected Value of Sample Information Calculations for Risk Prediction Model Validation.Medical decision making : an international journal of the Society for Medical Decision Making · 2025Article
- Correction: Decision curve analysis: confidence intervals and hypothesis testing for net benefit.Diagnostic and prognostic research · 2025Article
- Measuring the Performance of Survival Models to Personalize Treatment Choices.Statistics in medicine · 2025Article
- Uncertainty of risk estimates from clinical prediction models: rationale, challenges, and approaches.BMJ (Clinical research ed.) · 2025Article
Corrections and comments
- Erratum issued
Authors and funding
4 authors.
Funding
Abstract
backgroundA number of recent papers have proposed methods to calculate confidence intervals and p values for net benefit used in decision curve analysis. These papers are sparse on the rationale for doing so. We aim to assess the relation between sampling variability, inference, and decision-analytic concepts. METHODS AND
resultsWe review the underlying theory of decision analysis. When we are forced into a decision, we should choose the option with the highest expected utility, irrespective of p values or uncertainty. This is in some distinction to traditional hypothesis testing, where a decision such as whether to reject a given hypothesis can be postponed. Application of inference for net benefit would generally be harmful. In particular, insisting that differences in net benefit be statistically significant would dramatically change the criteria by which we consider a prediction model to be of value. We argue instead that uncertainty related to sampling variation for net benefit should be thought of in terms of the value of further research. Decision analysis tells us which decision to make for now, but we may also want to know how much confidence we should have in that decision. If we are insufficiently confident that we are right, further research is warranted.
conclusionNull hypothesis testing or simple consideration of confidence intervals are of questionable value for decision curve analysis, and methods such as value of information analysis or approaches to assess the probability of benefit should be considered instead.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.