---
name: decision-curve-analysis
description: Use when evaluating the clinical utility of a binary prediction model from a single clinical CSV file by fitting a logistic decision-curve model, plotting decision and clinical-impact curves, and exporting summary outputs. NOT for: survival calibration, ROC-only discrimination analysis, nomogram construction, or time-to-event outcomes.
license: MIT
author: AIPOCH
---
> **Source**: [https://github.com/aipoch/medical-research-skills](https://github.com/aipoch/medical-research-skills)

# Decision Curve Analysis

## When to Use

Use this skill when you need to:
- evaluate whether a binary prediction model adds clinical net benefit across threshold probabilities;
- visualize decision curves and clinical-impact curves from a clinical cohort;
- export an auditable DCA model object together with summary text and PDFs.

Typical user requests:
- "Run decision-curve analysis on this binary outcome and risk-score dataset."
- "Generate DCA and clinical-impact plots for this prediction model."
- "Compare net benefit across thresholds for this case-control cohort."

## When Not to Use

Do not use this skill for:
- time-to-event or survival outcomes;
- ROC-only discrimination analysis without decision-curve outputs;
- nomogram construction or calibration-curve analysis;
- multiclass outcomes or non-binary endpoints.

## When to Read External Files

| Situation | File to Read | Purpose |
|-----------|--------------|---------|
| Need algorithm details | `references/algorithm.md` | Statistical methods and formulas |
| Need to run analysis | `scripts/main.R` | Get the complete command |
| Encounter errors | `references/troubleshooting.md` | Find solutions |
| Need CLI examples | `references/cli-guide.md` | Parameter usage examples |

---

## Usage

```bash
Rscript scripts/main.R \
  --data_file ./clinical_dca_data.csv \
  --outcome_col fustat \
  --predictor_col riskScore \
  --output_dir ./output/
```

---

## Arguments

| Short | Long | Type | Default | Description |
|-------|------|------|---------|-------------|
| `-d` | `--data_file` | character | **required** | Clinical CSV file with row names as sample IDs |
|  | `--outcome_col` | character | `fustat` | Binary outcome column encoded as `0/1` |
|  | `--predictor_col` | character | `riskScore` | Numeric predictor column used in the logistic DCA model |
|  | `--study_design` | character | `case-control` | Study design: `case-control` or `cohort` |
|  | `--population_prevalence` | double | `0.3` | Population prevalence for case-control DCA |
|  | `--threshold_by` | double | `0.01` | Threshold step size used to generate the threshold grid |
|  | `--confidence_level` | double | `0.95` | Confidence level passed to `rmda::decision_curve()` |
|  | `--population_size` | integer | `1000` | Population size used in the clinical-impact plot |
|  | `--n_cost_benefits` | integer | `8` | Number of cost-benefit labels in the clinical-impact plot |
|  | `--show_confidence_intervals` | flag | `FALSE` | Show confidence intervals on the decision curve |
|  | `--standardize_net_benefit` | flag | `FALSE` | Report standardized net benefit (`sNB`) instead of raw net benefit (`NB`) |
|  | `--decision_curve_color` | character | `#E64B35` | Decision-curve line color |
|  | `--impact_colors` | character | `#E64B35,#4DBBD5` | Two comma-separated colors for the clinical-impact plot |
|  | `--plot_width` | double | `6` | PDF width in inches |
|  | `--plot_height` | double | `5.5` | PDF height in inches |
|  | `--font_family` | character | `sans` | PDF font family |
|  | `--plot_title` | character | `Decision Curve Analysis` | Decision-curve plot title |
|  | `--base_cex` | double | `0.9` | Base text-size multiplier |
| `-o` | `--output_dir` | character | `./output/` | Output directory |
|  | `--overwrite` | flag | `FALSE` | Allow writing into a non-empty output directory |
| `-s` | `--seed` | integer | `42` | Random seed for reproducibility |
| `-T` | `--timeout_seconds` | integer | `0` | Elapsed time limit in seconds; `0` disables timeout |

---

## Input Format

### Clinical Data (`--data_file`)

CSV file with row names as sample IDs. The dataset must contain at least one binary outcome column and one numeric predictor column.

```csv
,fustat,riskScore,FOXP3,CD45
Patient_1,1,0.630147268229631,5.7783584300481,3.5407433709834
Patient_2,0,0.23007730941193,6.70308857663772,3.11795942819676
Patient_3,1,0.534809528754818,5.46860669585825,3.40086667402884
```

**Requirements**
- File extension must be `.csv`.
- Row names must be non-missing, unique sample IDs.
- `outcome_col` and `predictor_col` must exist.
- Outcome values must use `0/1` encoding.
- Predictor values must be finite numeric values.
- At least 20 rows, 5 positive outcomes, and 5 negative outcomes are required.

---

## Output Files

| File | Format | Description |
|------|--------|-------------|
| `data/dca_model.rds` | R serialized object (`.rds`) | Saved `rmda::decision_curve()` result object |
| `table/dca_summary.txt` | Plain text (`.txt`) | Text summary of decision-curve net benefit statistics |
| `plot/decision_curve.pdf` | PDF (`.pdf`) | Decision-curve plot |
| `plot/clinical_impact_curve.pdf` | PDF (`.pdf`) | Clinical-impact plot |
| `session_info.txt` | Plain text (`.txt`) | Session information and run parameters |

### `dca_summary.txt`

Summary fields include:
- threshold-specific net benefit statistics from `summary(dca_model)`;
- the selected measure (`NB` or `sNB`);
- the fitted formula and study-design context recorded in `session_info.txt`.

---

## Workflow

### Step 1: Validate Input
- Confirm the clinical CSV exists and is readable.
- Check that the requested outcome and predictor columns are present.
- Validate sample IDs, binary outcome coding, and numeric predictor values.

### Step 2: Prepare Analysis Dataset
- Keep only the outcome and predictor columns required for DCA.
- Coerce outcome and predictor values to numeric.
- Reject cohorts with too few rows or too few events/non-events.

### Step 3: Fit Decision-Curve Model
- Fit a logistic decision-curve model with `rmda::decision_curve()`.
- Build a threshold grid from `0` to `1` using `threshold_by`.
- Apply `population_prevalence` when `study_design` is `case-control`.

### Step 4: Save Outputs
- Save the fitted DCA object as `.rds`.
- Export the text summary as `.txt`.
- Render the decision curve and clinical-impact curve as PDFs.
- Record session metadata for reproducibility.

---

## Examples

### Basic Usage

```bash
Rscript scripts/main.R \
  --data_file clinical_dca_data.csv \
  --outcome_col fustat \
  --predictor_col riskScore \
  --output_dir ./output/
```

### Cohort Design With Custom Plotting

```bash
Rscript scripts/main.R \
  --data_file clinical_dca_data.csv \
  --study_design cohort \
  --outcome_col fustat \
  --predictor_col riskScore \
  --plot_title "Cohort DCA" \
  --decision_curve_color "#3C5488" \
  --impact_colors "#3C5488,#00A087" \
  --show_confidence_intervals \
  --output_dir ./cohort_output/
```

### With Bundled Test Data

```bash
Rscript scripts/main.R \
  --data_file tests/data/dca_data.csv \
  --outcome_col fustat \
  --predictor_col riskScore \
  --output_dir tests/output/ \
  --overwrite
```

---

## Error Handling

| Error | Cause | Solution |
|-------|-------|----------|
| `SKILL_INVALID_PARAMETER` | Invalid design, invalid numeric range, invalid outcome coding, insufficient rows, insufficient class counts, or failed model fitting | Check arguments, data ranges, and binary outcome coding |
| `SKILL_FILE_NOT_FOUND` | Input CSV does not exist | Verify the input path |
| `SKILL_MISSING_COLUMNS` | Required columns are absent | Check `outcome_col` and `predictor_col` names |
| `SKILL_EMPTY_DATA` | Input file is empty or contains no usable rows/columns | Check the CSV content |
| `SKILL_SAMPLE_MISMATCH` | Reserved for cross-file sample mismatch scenarios | Not expected for this single-file workflow |
| `SKILL_PACKAGE_NOT_FOUND` | Required R package is missing | Install the listed CRAN package(s) |

**IF error persists**, READ: `references/troubleshooting.md`

---

## Testing

### Smoke Test With Included Data

```bash
Rscript scripts/main.R --help

Rscript scripts/main.R \
  --data_file tests/data/dca_data.csv \
  --outcome_col fustat \
  --predictor_col riskScore \
  --output_dir tests/output/ \
  --overwrite
```

### Automated Smoke Test Script

```bash
Rscript tests/run_smoke_test.R
```

Optional shell wrapper:

```bash
bash tests/run_smoke_test.sh
```

### Expected Output

```text
tests/output/
|-- data/dca_model.rds
|-- plot/clinical_impact_curve.pdf
|-- plot/decision_curve.pdf
|-- session_info.txt
`-- table/dca_summary.txt
```

---

## References

1. Vickers AJ, Elkin EB. Decision curve analysis: a novel method for evaluating prediction models.
2. rmda package documentation for clinical decision-curve analysis.

**For detailed algorithm**, READ: `references/algorithm.md`

---

## Implementation Checklist

- [x] CLI parsing with `optparse`
- [x] `set.seed()` for reproducibility
- [x] Top-level CRAN dependency checks
- [x] Session info recording
- [x] Timeout parameter exposed as CLI option
- [x] Relative-path `source()` usage via `get_script_dir()`
- [x] Modular script structure in `scripts/`
- [x] Test data provided in `tests/data/`
- [x] Error handling with `SKILL_*` codes
- [x] Reference docs provided in `references/`