Confidence intervals for the Youden index and corresponding optimal cut-point

A global measure of biomarker effectiveness is the Youden index, the maximum difference between sensitivity, the probability of correctly classifying diseased individuals, and 1-specificity, the probability of incorrectly classifying healthy individuals. The cut-point leading to the index is the optimal cut-point when equal weight is given to sensitivity and specificity. Using the delta method, we present approaches for estimating confidence intervals for the Youden index and corresponding optimal cut-point for normally distributed biomarkers and also those following gamma distributions. We also provide confidence intervals using various bootstrapping methods. A comparison of interval width and coverage probability is conducted through simulation over a variety of parametric situations. Confidence intervals via delta method are shown to have both closer to nominal coverage and shorter interval widths than confidence intervals from the bootstrapping methods.