A note on Youden's J and its cost ratio.

N. Smits

Research output: Contribution to JournalArticleAcademicpeer-review

180 Downloads (Pure)


Background. The Youden index, the sum of sensitivity and specificity minus one, is an index used for setting optimal thresholds on medical tests. Discussion. When using this index, one implicitly uses decision theory with a ratio of misclassification costs which is equal to one minus the prevalence proportion of the disease. It is doubtful whether this cost ratio truly represents the decision maker's preferences. Moreover, in populations with a different prevalence, a selected threshold is optimal with reference to a different cost ratio. Summary. The Youden index is not a truly optimal decision rule for setting thresholds because its cost ratio varies with prevalence. Researchers should look into their cost ratio and employ it in a decision theoretic framework to obtain genuinely optimal thresholds. © 2010 Smits; licensee BioMed Central Ltd.
Original languageEnglish
Pages (from-to)89
Number of pages4
JournalBMC Medical Research Methodology
Publication statusPublished - 2010


Dive into the research topics of 'A note on Youden's J and its cost ratio.'. Together they form a unique fingerprint.

Cite this