Nonparametric predictive inference for diagnostic test thresholds

Measuring the accuracy of diagnostic tests is crucial in many application areas including medicine, machine learning and credit scoring. The receiver operating characteristic (ROC) curve and surface are useful tools to assess the ability of diagnostic tests to discriminate between ordered classes or groups. To define these diagnostic tests, selecting the optimal thresholds that maximize the accuracy of these tests is required. One procedure that is commonly used to find the optimal thresholds is by maximizing what is known as Youden's index. This article presents nonparametric predictive inference (NPI) for selecting the optimal thresholds of a diagnostic test. NPI is a frequentist statistical method that is explicitly aimed at using few modeling assumptions, enabled through the use of lower and upper probabilities to quantify uncertainty. Based on multiple future observations, the NPI approach is presented for selecting the optimal thresholds for two-group and three-group scenarios. In addition, a pairwise approach has also been presented for the three-group scenario. The article ends with an example to illustrate the proposed methods and a simulation study of the predictive performance of the proposed methods along with some classical methods such as Youden index. The NPI-based methods show some interesting results that overcome some of the issues concerning the predictive performance of Youden's index.