Negative predictive value

The negative predictive value is the proportion of patients with negative test results who are correctly diagnosed.

Worked example

In the following example, the terms predictive value positive and predictive value negative are valid as shown assuming the data come from a cross-sectional study, or more generally, any study from which valid prevalence estimates may be obtained.

A worked example

A diagnostic test with sensitivity 67% and specificity 91% is applied to 2030 people to look for a disorder with a population prevalence of 1.48%

		Fecal occult blood screen test outcome
	Total population (pop.) = 2030	Test outcome positive	Test outcome negative	Accuracy (ACC) = (TP + TN) / pop. = (20 + 1820) / 2030 ≈ 90.64%	F1 score = 2 × ⁠precision × recall/precision + recall⁠ ≈ 0.174
Patients with bowel cancer (as confirmed on endoscopy)	Actual condition positive (AP) = 30 (2030 × 1.48%)	True positive (TP) = 20 (2030 × 1.48% × 67%)	False negative (FN) = 10 (2030 × 1.48% × (100% − 67%))	True positive rate (TPR), recall, sensitivity = TP / AP = 20 / 30 ≈ 66.7%	False negative rate (FNR), miss rate = FN / AP = 10 / 30 ≈ 33.3%
	Actual condition negative (AN) = 2000 (2030 × (100% − 1.48%))	False positive (FP) = 180 (2030 × (100% − 1.48%) × (100% − 91%))	True negative (TN) = 1820 (2030 × (100% − 1.48%) × 91%)	False positive rate (FPR), fall-out, probability of false alarm = FP / AN = 180 / 2000 = 9.0%	Specificity, selectivity, true negative rate (TNR) = TN / AN = 1820 / 2000 = 91%
	Prevalence = AP / pop. = 30 / 2030 ≈ 1.48%	Positive predictive value (PPV), precision = TP / (TP + FP) = 20 / (20 + 180) = 10%	False omission rate (FOR) = FN / (FN + TN) = 10 / (10 + 1820) ≈ 0.55%	Positive likelihood ratio (LR+) = ⁠TPR/FPR⁠ = (20 / 30) / (180 / 2000) ≈ 7.41	Negative likelihood ratio (LR−) = ⁠FNR/TNR⁠ = (10 / 30) / (1820 / 2000) ≈ 0.366
		False discovery rate (FDR) = FP / (TP + FP) = 180 / (20 + 180) = 90.0%	Negative predictive value (NPV) = TN / (FN + TN) = 1820 / (10 + 1820) ≈ 99.45%	Diagnostic odds ratio (DOR) = ⁠LR+/LR−⁠ ≈ 20.2

Related calculations

• False positive rate (α) = type I error = 1 − specificity = FP / (FP + TN) = 180 / (180 + 1820) = 9%
• False negative rate (β) = type II error = 1 − sensitivity = FN / (TP + FN) = 10 / (20 + 10) ≈ 33%
• Power = sensitivity = 1 − β
• Positive likelihood ratio = sensitivity / (1 − specificity) ≈ 0.67 / (1 − 0.91) ≈ 7.4
• Negative likelihood ratio = (1 − sensitivity) / specificity ≈ (1 − 0.67) / 0.91 ≈ 0.37
• Prevalence threshold = $PT={\frac {{\sqrt {TPR(-TNR+1)}}+TNR-1}{(TPR+TNR-1)}}$ ≈ 0.2686 ≈ 26.9%

This hypothetical screening test (fecal occult blood test) correctly identified two-thirds (66.7%) of patients with colorectal cancer. Unfortunately, factoring in prevalence rates reveals that this hypothetical test has a high false positive rate, and it does not reliably identify colorectal cancer in the overall population of asymptomatic people (PPV = 10%).

On the other hand, this hypothetical test demonstrates very accurate detection of cancer-free individuals (NPV ≈ 99.5%). Therefore, when used for routine colorectal cancer screening with asymptomatic adults, a negative result supplies important data for the patient and doctor, such as reassuring patients worried about developing colorectal cancer.

Definition

If the data arise from a cross-sectional study (or any study from which valid prevalence estimates can obtained), then the Negative Predictive Value can be defined as:

$NPV={\frac {\rm {number\ of\ True\ Negatives}}{{\rm {number\ of\ True\ Negatives}}+{\rm {number\ of\ False\ Negatives}}}}$

For any type study, a more general formula will work:

$NPV={\frac {({\rm {specificity}})({\rm {1-prevalence}})}{({\rm {specificity}})({\rm {1-prevalence}})+(1-{\rm {sensitivity}})({\rm {prevalence}})}}$

Relation to negative post-test probability

Although sometimes used synonymously, a negative predictive value generally refers to what is established by control groups, while a negative post-test probability rather refers to a probability for an individual. Still, if the individual's pre-test probability of the target condition is the same as the prevalence in the control group used to establish the negative predictive value, then the two are numerically equal.

See also

• Positive predictive value
• Sensitivity and specificity
• Binary classification

References

• Altman DG, Bland JM (1994). "Diagnostic tests 2: Predictive values". BMJ. 309 (6947): 102. PMC 2540558. PMID 8038641. {{cite journal}}: Unknown parameter |month= ignored (help)