Semiparametric Inference of the Youden Index and the Optimal Cutoff Point under Density Ratio Models

The Youden index is a popular summary statistic for receiver operating characteristic curve. It gives the optimal cutoff point of a biomarker to distinguish the diseased and healthy individuals. In this paper, we propose to model the distributions of a biomarker for individuals in the healthy and diseased groups via a semiparametric density ratio model. Based on this model, we use the maximum empirical likelihood method to estimate the Youden index and the optimal cutoff point. We further establish the asymptotic normality of the proposed estimators and construct valid confidence intervals for the Youden index and the corresponding optimal cutoff point. The proposed method automatically covers both cases when there is no lower limit of detection (LLOD) and when there is a fixed and finite LLOD for the biomarker. Extensive simulation studies and a real data example are used to illustrate the effectiveness of the proposed method and its advantages over the existing methods.