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Two tests, a threshold, and the rate they are read against

A predictive value is computed from a sensitivity, a specificity and a prevalence, and each of the three is softer than it is quoted as being. Two positives from a 90/95 test on a one-in-a-thousand condition are worth 24.49% if the tests' errors are independent, 10.16% at a correlation of 0.1, and 3.16% at 0.5 — barely more than the 1.77% one positive was worth. The sensitivity and specificity are not two properties of a test but one property read at a threshold somebody chose, and the threshold that minimises harm moves by three standard deviations of the score across the prevalences such a test is used at. The prevalence itself is usually estimated from the same test's positive rate, which at one in a thousand reads 5.09%.

What a second positive is worth, prevalence 0.10%. A 90% sensitive, 95% specific test. One positive gives 1.77%. Two independent positives give 24.49%, which is what multiplying the likelihood ratios says. At a correlation of 0.1 between the tests' errors it is 10.16%, and at 0.5 it is 3.16%.

The second test that is not a second opinion

Two positives from a 90/95 test on a one-in-a-thousand condition give a 24.49% chance of disease if the tests are independent. At a correlation of 0.1 between their errors it is 10.16%, and at 0.5 it is 3.16% — barely more than the 1.77% one positive was worth.

The operating characteristic, and the point that minimises harm at 0.10% prevalence. The published pair — 90% sensitive, 95% specific — is the open mark. With a miss costing 100 times a false alarm and a prevalence of 0.10%, the threshold that minimises expected cost sits at 74.7% sensitivity and 98.81% specificity, with a predictive value of 5.9%.

The test is a point somebody chose

A test reported as 90% sensitive and 95% specific is not two properties of a test. It is one property read at a threshold, and the threshold that minimises harm runs from 3.05 standard deviations of the score at a prevalence of one in ten thousand to −0.12 at one in two — 45% of cases detected at one end and 99.9% at the other.

Estimating a prevalence of 0.10% from 1,000 tests. The positive rate reads 5.09%, which is 50.9 times the truth. The Rogan-Gladen correction averages 0.100% — unbiased — with a standard deviation of 0.820 points against the positive rate's 0.695, and it comes out negative on 48.6% of samples.

The prevalence the test has to estimate

Every predictive value takes a prevalence as given, and the prevalence is usually estimated from the same test's positive rate. At a true prevalence of one in a thousand that rate reads 5.09% — fifty times the truth — and the correction that inverts it is unbiased, 18% more variable, and negative on 48.6% of samples of a thousand.

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