Integrating economic considerations into cutpoint selection may help align clinical decision support toward value-based healthcare.
Clinical prediction models providing binary categorizations for clinical decision support require the selection of a probability threshold, or "cutpoint," to classify individuals. Existing cutpoint selection approaches typically optimize test-specific metrics, including sensitivity and specificity, but overlook the consequences of correct or incorrect classification. We introduce a new cutpoint selection approach considering downstream consequences using net monetary benefit (NMB) and through simulations compared it with alternative approaches in 2 use-cases: (i) [...]
Author(s): Parsons, Rex, Blythe, Robin, Cramb, Susanna M, McPhail, Steven M
DOI: 10.1093/jamia/ocad042