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Computational Statistics & Data Analysis
Volume 51, Issue 2, 15 November 2006, Pages 601-611
 
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doi:10.1016/j.csda.2005.12.021    How to Cite or Link Using DOI (Opens New Window)
Copyright © 2006 Elsevier B.V. All rights reserved.

Estimators of sensitivity and specificity in the presence of verification bias: A Bayesian approach

Edson Zangiacomi Martineza, Corresponding Author Contact Information, E-mail The Corresponding Author, Jorge Alberto Achcara, b and Francisco Louzada-Netob, E-mail The Corresponding Author

aDepartamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP/USP). Av. Bandeirantes, 3900 - Ribeirão Preto CEP 14049-900, SP, Brazil bDepartamento de Estatística, Universidade Federal de São Carlos (UFSCar). Caixa Postal 676 - São Carlos CEP 13565-905, SP, Brazil

Received 8 April 2005; 
revised 22 December 2005; 
accepted 31 December 2005. 
Available online 20 January 2006.

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Abstract

Verification bias can occur if some of the patients with test results are not selected to receive the gold standard procedure. Unverified cases frequently are not suggestive to be positives. Consequently, the set of verified cases overestimates the number of true positives and underestimates the number of true negatives. The sensitivity and specificity estimates based only on the patients with verified disease are often biased. In this article we derive estimators for sensitivity and specificity not subject to verification bias using a Bayesian approach. Marginal posterior densities of all parameters are estimated using the Gibbs sampler algorithm. An application to the study of accuracy of Hybrid Capture II in the diagnosis of cervical intraepithelial neoplasia grades 2 and 3 illustrates the proposed methodology.

Keywords: Verification bias; Work-up bias; Diagnostic tests; Sensitivity; Specificity; Gibbs sampling

Article Outline

1. Introduction
2. Model formulation
3. A Bayesian analysis
4. A Bayesian analysis in the presence of covariates
5. An example
6. Concluding remarks
References

 
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