A simple, step-by-step guide to interpreting decision curve analysis

BACKGROUND: Decision curve analysis is a method to evaluate prediction models and diagnostic tests that was introduced in a 2006 publication. Decision curves are now commonly reported in the literature, but there remains widespread misunderstanding of and confusion about what they mean. SUMMARY OF COMMENTARY: In this paper, we present a didactic, step-by-step introduction to interpreting a decision curve analysis and answer some common questions about the method. We argue that many of the difficulties with interpreting decision curves can be solved by relabeling the y-axis as “benefit” and the x-axis as “preference.” A model or test can be recommended for clinical use if it has the highest level of benefit across a range of clinically reasonable preferences. CONCLUSION: Decision curves are readily interpretable if readers and authors follow a few simple guidelines.