4.6 Article

Does McNemar's test compare the sensitivities and specificities of two diagnostic tests?

Journal

STATISTICAL METHODS IN MEDICAL RESEARCH
Volume 26, Issue 1, Pages 142-154

Publisher

SAGE PUBLICATIONS LTD
DOI: 10.1177/0962280214541852

Keywords

McNemar's test; diagnostic test; conditional dependence; sensitivity; specificity

Funding

  1. Basic Science Research Program through the National Research Foundation of Korea (NRF) - Ministry of Education, Science and Technology [NRF-2013R1A1A1061332]
  2. Inha University Research Grant
  3. National Research Foundation of Korea [2013R1A1A1061332] Funding Source: Korea Institute of Science & Technology Information (KISTI), National Science & Technology Information Service (NTIS)

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McNemar's test is often used in practice to compare the sensitivities and specificities for the evaluation of two diagnostic tests. For correct evaluation of accuracy, an intuitive recommendation is to test the diseased and the non-diseased groups separately so that the sensitivities can be compared among the diseased, and specificities can be compared among the healthy group of people. This paper provides a rigorous theoretical framework for this argument and study the validity of McNemar's test regardless of the conditional independence assumption. We derive McNemar's test statistic under the null hypothesis considering both assumptions of conditional independence and conditional dependence. We then perform power analyses to show how the result is affected by the amount of the conditional dependence under alternative hypothesis.

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