Confidence intervals for the difference in paired Youden indices

Comparison of accuracy between two diagnostic tests can be implemented by investigating the difference in paired Youden indices. However, few literature articles have discussed the inferences for the difference in paired Youden indices. In this paper, we propose an exact confidence interval for the difference in paired Youden indices based on the generalized pivotal quantities. For comparison, the maximum likelihood estimate-based interval and a bootstrap-based interval are also included in the study for the difference in paired Youden indices. Abundant simulation studies are conducted to compare the relative performance of these intervals by evaluating the coverage probability and average interval length. Our simulation results demonstrate that the exact confidence interval outperforms the other two intervals even with small sample size when the underlying distributions are normal. A real application is also used to illustrate the proposed intervals.