Figure 1

Theoretical example of a full study population and a nested case-control sample. The index test result and the outcome are obtained for all patients of the study population. The case-control ratio was 1:4 (sampling fraction (SF) = 160/400 = 0.40). Valid diagnostic accuracy measures can be obtained from the nested case-control sample, by multiplying the controls with 1/sampling fraction. For example, the positive predictive value (PPV) of a full study population can be calculated with a/(a + b), in this example 30/(30 + 100) = 0.23. In a nested case-control sample the PPV is calculated with a/(a + (1/SF)*b), in this example: 30/(30 + 2.5*40) = 0.23. In a case-control sample however, the controls are sampled from a source population with unknown size. Therefore, the sample fraction is unknown and valid estimate of the PPV cannot be calculated.