A GEE approach to estimating sensitivity and specificity and coverage properties of the confidence intervals

A generalized estimating equation (GEE) approach is used to estimate the se nsitivity and specificity of five non-culture screening tests for detecting Chlamydia trachomatis in endocervical specimens from women attending famil y planning clinics. Since the estimates of these parameters can be very clo se to the upper limit of one, confidence interval construction based on the traditional approaches, such as the delta method or a back-transformation approach, may not have the stated coverage. We compare different approaches to calculating confidence intervals for the sensitivity and specificity fr om the results of the GEE approach. These methods include the delta method, a back-transformation approach, and a bootstrap approach. In addition, we use simulations to investigate the estimated coverage rates of the delta me thod and the back-transformation approach. Published in 2001 by John Wiley & Sons, Ltd.