Robust Bayesian prediction of subject disease status and population prevalence using several similar diagnostic tests.

Abstract

Sometimes several diagnostic tests are performed on the same population of subjects with the aim of assessing disease status of individuals and the prevalence of the disease in the population, but no test is a reference test. Although the diagnostic tests may have the same biological underpinnings, test results may disagree for some specific animals. In that case, it may be difficult to determine disease status for individual subjects, and consequently population prevalence estimation becomes difficult. In this paper, we propose a robust method of estimating disease status and prevalence that uses heavy-tailed sampling distributions in a hierarchical model to protect against the influence of conflicting observations on inferences. If a subject has a test outcome that is discordant with the other test results then it is downweighted in diagnosing a subject's disease status, and for estimating disease prevalence. The amount of downweighting depends on the degree of conflict among the test results for the subject.