Optimal two-phase sampling for comparing correlated areas under the ROC curves of two screening tests in the presence of verification bias.

ABSTRACT

The accuracy of a screening test is often measured by the area under the receiver characteristic (ROC) curve (AUC) of a screening test. Two-phase designs have been widely used in diagnostic studies for estimating one single AUC and comparing two AUCs where the screening test results are measured for a large sample (Phase one sample) while the disease status is only verified for a subset of Phase one sample (Phase two sample) by a gold standard. In this paper, we consider the optimal two-phase sampling design for comparing the performance of two ordinal screening tests in classifying disease status. Specifically, we derive an analytical variance formula for the AUC difference estimator and use it to find the optimal sampling probabilities that minimize the variance formula for the AUC difference estimator. According to the proposed optimal two-phase design, the strata with the levels of two tests far apart from each other should be over-sampled while the strata with the levels of two tests close to each other should be under-sampled. Simulation results indicate that two-phase sampling under optimal allocation (OA) achieves a substantial amount of variance reduction, compared with two-phase sampling under proportional allocation (PA). Furthermore, in comparison with a one-phase random sampling, two-phase sampling under OA or PA has a clear advantage in reducing the variance of AUC difference estimator when the variances of the two screening test results in the disease population differ greatly from their counterparts in non-disease population.