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Measuring agreement in method comparison studies

Department of Public Health Sciences, St George's Hospital Medical School, London, UK

Douglas G Altman

ICRF Medical Statistics Group, Centre for Statistics in Medicine, Institute of Health Sciences, Oxford, UK

Agreement between two methods of clinical measurement can be quantified using the differences between observations made using the two methods on the same subjects. The 95% limits of agreement, estimated by mean difference 1.96 standard deviation of the differences, provide an interval within which 95% of differences between measurements by the two methods are expected to lie. We describe how graphical methods can be used to investigate the assumptions of the method and we also give confidence intervals. We extend the basic approach to data where there is a relationship between difference and magnitude, both with a simple logarithmic transformation approach and a new, more general, regression approach. We discuss the importance of the repeatability of each method separately and compare an estimate of this to the limits of agreement. We extend the limits of agreement approach to data with repeated measurements, proposing new estimates for equal numbers of replicates by each method on each subject, for unequal numbers of replicates, and for replicated data collected in pairs, where the underlying value of the quantity being measured is changing. Finally, we describe a nonparametric approach to comparing methods.

Statistical Methods in Medical Research, Vol. 8, No. 2, 135-160 (1999)
DOI: 10.1177/096228029900800204


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				L. S. Kim, J. J. McAnany, K. R. Alexander, and G. A. Fishman Intersession Repeatability of Humphrey Perimetry Measurements in Patients with Retinitis Pigmentosa Invest. Ophthalmol. Vis. Sci., October 1, 2007; 48(10): 4720 - 4724. [Abstract] [Full Text] [PDF]

				P. S. Myles and J. Cui I. Using the Bland Altman method to measure agreement with repeated measures Br. J. Anaesth., September 1, 2007; 99(3): 309 - 311. [Full Text] [PDF]

				M. Friden, A. Gupta, M. Antonsson, U. Bredberg, and M. Hammarlund-Udenaes In Vitro Methods for Estimating Unbound Drug Concentrations in the Brain Interstitial and Intracellular Fluids Drug Metab. Dispos., September 1, 2007; 35(9): 1711 - 1719. [Abstract] [Full Text] [PDF]

				A. Ruggeri, E. Grisan, and J. Schroeter Evaluation of repeatability for the automatic estimation of endothelial cell density in donor corneas Br. J. Ophthalmol., September 1, 2007; 91(9): 1213 - 1215. [Abstract] [Full Text] [PDF]

				M. Crilly, C. Coch, M. Bruce, H. Clark, and D. Williams Indices of cardiovascular function derived from peripheral pulse wave analysis using radial applanation tonometry: a measurement repeatability study Vascular Medicine, August 1, 2007; 12(3): 189 - 197. [Abstract] [PDF]

				R. Cortes, M. Rivera, A. Salvador, V. Bertomeu, F. G. de Burgos, E. Rosello-Lleti, M. Portoles, R. Paya, L. Martinez-Dolz, and V. Climent Variability of NT-proBNP plasma and urine levels in patients with stable heart failure: a 2-year follow-up study Heart, August 1, 2007; 93(8): 957 - 962. [Abstract] [Full Text] [PDF]

				R. Lavanya, L. Teo, D. S Friedman, H. T Aung, M. Baskaran, H. Gao, T. Alfred, S. K Seah, K. Kashiwagi, P. J Foster, et al. Comparison of anterior chamber depth measurements using the IOLMaster, scanning peripheral anterior chamber depth analyser, and anterior segment optical coherence tomography Br. J. Ophthalmol., August 1, 2007; 91(8): 1023 - 1026. [Abstract] [Full Text] [PDF]

				E. Selvin, C. M. Crainiceanu, F. L. Brancati, and J. Coresh Short-term Variability in Measures of Glycemia and Implications for the Classification of Diabetes Arch Intern Med, July 23, 2007; 167(14): 1545 - 1551. [Abstract] [Full Text] [PDF]

				N. M. Kayes, K. M. McPherson, D. Taylor, P. J. Schluter, B.-J. K. Wilson, and G. S. Kolt The Physical Activity and Disability Survey (PADS): reliability, validity and acceptability in people with multiple sclerosis Clinical Rehabilitation, July 1, 2007; 21(7): 628 - 639. [Abstract] [PDF]

				H.-M. Chen, C.-L. Hsieh, Sing Kai Lo, L.-J. Liaw, S.-M. Chen, and J.-H. Lin The Test-Retest Reliability of 2 Mobility Performance Tests in Patients With Chronic Stroke Neurorehabil Neural Repair, July 1, 2007; 21(4): 347 - 352. [Abstract] [PDF]

				N. Janzen, M. Peter, S. Sander, U. Steuerwald, M. Terhardt, U. Holtkamp, and J. Sander Newborn Screening for Congenital Adrenal Hyperplasia: Additional Steroid Profile using Liquid Chromatography-Tandem Mass Spectrometry J. Clin. Endocrinol. Metab., July 1, 2007; 92(7): 2581 - 2589. [Abstract] [Full Text] [PDF]

				M. Rynning, T. Wentzel-Larsen, and B. J. Bolann A Model for an Uncertainty Budget for Preanalytical Variables in Clinical Chemistry Analyses Clin. Chem., July 1, 2007; 53(7): 1343 - 1348. [Abstract] [Full Text] [PDF]

				J. M. Nielsen, S. B. Kristiansen, S. Ringgaard, T. T. Nielsen, A. Flyvbjerg, A. N. Redington, and H. E. Botker Left ventricular volume measurement in mice by conductance catheter: evaluation and optimization of calibration Am J Physiol Heart Circ Physiol, July 1, 2007; 293(1): H534 - H540. [Abstract] [Full Text] [PDF]

				A. Boonen, D. van der Heijde, R. Landewe, A. van Tubergen, H. Mielants, M. Dougados, and S. van der Linden How do the EQ-5D, SF-6D and the well-being rating scale compare in patients with ankylosing spondylitis? Ann Rheum Dis, June 1, 2007; 66(6): 771 - 777. [Abstract] [Full Text] [PDF]

				M. Kverka, J. Burianova, R. Lodinova-Zadnikova, I. Kocourkova, J. Cinova, L. Tuckova, and H. Tlaskalova-Hogenova Cytokine Profiling in Human Colostrum and Milk by Protein Array Clin. Chem., May 1, 2007; 53(5): 955 - 962. [Abstract] [Full Text] [PDF]

				C. Arzola, S. Davies, A. Rofaeel, and J. C. A. Carvalho Ultrasound Using the Transverse Approach to the Lumbar Spine Provides Reliable Landmarks for Labor Epidurals Anesth. Analg., May 1, 2007; 104(5): 1188 - 1192. [Abstract] [Full Text] [PDF]

				D. J. C. Alders, R. N. Cornelussen, F. W. Prinzen, P. A. C. Specht, M. I. M. Noble, A. J. Drake-Holland, F. J. J. de Kanter, and J. H. G. M. van Beek Heart/Cardiac Muscle: Regional sympathetic denervation affects the relation between canine local myocardial blood flow and oxygen consumption Exp Physiol, May 1, 2007; 92(3): 541 - 548. [Abstract] [Full Text] [PDF]