Letter by Pepe et al regarding article, "Use and misuse of the receiver operating characteristic curve in risk prediction".

To the Editor: Current statistical approaches for evaluation of risk prediction markers are unsatisfactory. We applaud Cook’s criticisms of the c-index, or area under the receiver operating characteristic curve. This index is based on the notion of pairing subjects, one with poor outcome (eg, cardiovascular event within 10 years) and one without, and determination of whether the risk for the former (ie, the case) is larger than the risk for the latter (ie, the control). This probability of correct ordering of risks is not a relevant measure of …