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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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				E. Hypponen, S. Turner, P. Cumberland, C. Power, and I. Gibb Serum 25-Hydroxyvitamin D Measurement in a Large Population Survey with Statistical Harmonization of Assay Variation to an International Standard J. Clin. Endocrinol. Metab., December 1, 2007; 92(12): 4615 - 4622. [Abstract] [Full Text] [PDF]

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				M. Causse, A. D. Garcia-Mayorgas, J. B. Gutierrez, and M. Casal Preliminary Evaluation of a Multiplex Reverse Transcription-PCR Assay Combined with a New DNA Chip Hybridization Assay for Detecting Respiratory Syncytial Virus J. Clin. Microbiol., November 1, 2007; 45(11): 3811 - 3813. [Abstract] [Full Text] [PDF]

				R. S. Parekh, W.H. L. Kao, L. A. Meoni, E. Ipp, P. L. Kimmel, J. La Page, C. Fondran, W. C. Knowler, M. J. Klag, and and the Family Investigation of Nephropathy and Di Reliability of Urinary Albumin, Total Protein, and Creatinine Assays after Prolonged Storage: The Family Investigation of Nephropathy and Diabetes Clin. J. Am. Soc. Nephrol., November 1, 2007; 2(6): 1156 - 1162. [Abstract] [Full Text] [PDF]

				C. Lefoll-Masson, C. Fermanian, I. Aime, N. Verroust, G. Taylor, P.-A. Laloe, N. Liu, P. Aegerter, and M. Fischler The Comparability of Bispectral Index and State Entropy Index During Maintenance of Sufentanil-Sevoflurane-Nitrous Oxide Anesthesia Anesth. Analg., November 1, 2007; 105(5): 1319 - 1325. [Abstract] [Full Text] [PDF]

				E. C. Uong, M. Epperson, S. A. Bathon, and D. B. Jeffe Adherence to Nasal Positive Airway Pressure Therapy Among School-aged Children and Adolescents With Obstructive Sleep Apnea Syndrome Pediatrics, November 1, 2007; 120(5): e1203 - e1211. [Abstract] [Full Text] [PDF]

				R. M. Determann, E. K. Wolthuis, P. E. Spronk, M. A. Kuiper, J. C. Korevaar, M. B. Vroom, and M. J. Schultz Reliability of Height and Weight Estimates in Patients Acutely Admitted to Intensive Care Units Crit. Care Nurse, October 1, 2007; 27(5): 48 - 55. [Full Text] [PDF]

				M. E. Johnson and P. J. Murphy Measurement of Ocular Surface Irritation on a Linear Interval Scale with the Ocular Comfort Index Invest. Ophthalmol. Vis. Sci., October 1, 2007; 48(10): 4451 - 4458. [Abstract] [Full Text] [PDF]

				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]