{
  "abstract": "Background Decision curve analysis (DCA) evaluates prediction model usefulness using net benefit (NB). Population-level NB is often interpreted as a proxy for population-level expected utility, but this assumes comparability of utility across subgroups. We aimed to characterize when subgroup utility heterogeneity may invalidate population-level DCA conclusions. Methods We compared prediction-driven treatment with default strategies in populations containing subgroups with different utility values. We derived an inconsistency region: combinations of subgroup-specific ΔNB values for which population-level NB and utility favor different strategies. We also developed a practical robustness framework. Results Opposite signs of subgroup-specific ΔNB provide a warning signal for possible inconsistency. The inconsistency region is larger when subgroup sizes are more similar and subgroup-specific \\(a-c\\) values are more different, where \\(a-c\\) is the incremental utility of a true positive relative to a false negative. When \\(a-c\\) differs across subgroups, population-level NB combines quantities on different implicit utility scales and may conflict with population utility. A real-world case study illustrates the problem. Conclusions Using population-level NB as a proxy for population utility implicitly assumes homogeneous \\(a-c\\) across subgroups. Subgroup DCA and our framework can identify and assess when utility heterogeneity may invalidate population-level conclusions.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": "2609.34521",
  "author_total": 6,
  "authors": [
    {
      "name": "Junfeng Wang"
    },
    {
      "name": "Kim Zhipei Wang"
    },
    {
      "name": "Ben Van Calster"
    },
    {
      "name": "Nan van Geloven"
    },
    {
      "name": "Ewout Steyerberg"
    },
    {
      "name": "Laure Wynants"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3ac08n5b32ff1.bib",
  "cited_by": 0,
  "doi": "10.48550/arxiv.2609.34521",
  "fulltext_url": null,
  "id": "3ac08n5b32ff1",
  "issns": [],
  "landing_url": "https://arxiv.org/abs/2609.34521",
  "language": null,
  "licence": "LicenseRef-arXiv-nonexclusive-1.0",
  "licence_label": "arXiv licence",
  "licence_source": "article",
  "licence_url": "http://arxiv.org/licenses/nonexclusive-distrib/1.0/",
  "metadata_licence": "CC0-1.0",
  "native_subjects": [
    [
      "arxiv",
      "stat.ME"
    ],
    [
      "openalex",
      "2613|Statistical Methods in Epidemiology"
    ]
  ],
  "openalex": "W7214714162",
  "pdf_url": "https://arxiv.org/pdf/2609.34521",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-28",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/3ac08n5b32ff1.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:25:26Z",
      "native_id": "2609.34521",
      "source": "arxiv",
      "url": "https://arxiv.org/abs/2609.34521"
    }
  ],
  "subjects": [
    {
      "field": "mathematics",
      "origin": "arxiv:stat.ME",
      "subfield": "statistics"
    }
  ],
  "title": "Population-Level Decision Curve Analysis May Mislead the Evaluation of Prediction Model Usefulness under Subgroup Utility Heterogeneity",
  "title_text": "Population-Level Decision Curve Analysis May Mislead the Evaluation of Prediction Model Usefulness under Subgroup Utility Heterogeneity",
  "type": "preprint",
  "updated_at": "2026-10-30T12:25:26Z",
  "url": "https://research.draconitic.com/paper/3ac08n5b32ff1",
  "venue": "arXiv",
  "versions": []
}