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Oxford University Press (OUP), American Journal of Epidemiology, 3(170), p. 369-378

DOI: 10.1093/aje/kwp122

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Designing 2-phase prevalence studies in the absence of a "gold standard" test

Journal article published in 2009 by Agus Salim ORCID, Alan H. Welsh
This paper was not found in any repository, but could be made available legally by the author.
This paper was not found in any repository, but could be made available legally by the author.

Full text: Unavailable

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Abstract

A population survey for estimating prevalence is challenging when a disease or condition is difficult to diagnose. If clinical diagnosis is expensive, a 2-phase study, in which less expensive but less accurate tests are administered to all study subjects in the first phase (screening phase) and a more accurate but expensive or time-consuming test is administered to only a subset of the subjects in the second phase, is an attractive approach. Published research has discussed ways of maximizing precision of the prevalence estimate from a 2-phase study with a "gold standard" second-phase test. For many psychiatric disorders, even the best diagnostic tests are not of gold standard quality. In this paper, the authors propose a quasi-optimal design for 2-phase prevalence studies without a gold standard test; random-effects latent class analysis facilitates the estimation of prevalence and appropriately addresses the issue of dependent errors among the diagnostic tests. The authors show that the quasi-optimal design is efficient compared with the balanced and random designs when there is strong inter-test dependence caused by additional factors, apart from disease status, and highlight the importance of collecting data on those subjects testing negative in the first phase.