Facilitating validation of prediction models: A comparison of manual and semi-automated validation using registry-based data of breast cancer patients in the Netherlands

Background: Clinical prediction models are not routinely validated. To facilitate validation procedures, the online Evidencio platform (https://www.evidencio.com) has developed a tool partly automating this process. This study aims to determine whether semi-automated validation can reliably substitute manual validation. Methods: Four different models used in breast cancer care were selected: CancerMath, INFLUENCE, Predicted Probability of Axillary Metastasis, and PREDICT v.2.0. Data were obtained from the Netherlands Cancer Registry according to the inclusion criteria of the original development population. Calibration (intercepts and slopes) and discrimination (area under the curve (AUC)) were compared between semi-automated and manual validation. Results: Differences between intercepts and slopes of all models using semi-automated validation ranged from 0 to 0.03 from manual validation, which was not clinically relevant. AUCs were identical for both validation methods. Conclusions: This easy to use semi-automated validation option is a good substitute for manual validation and might increase the number of validations of prediction models used in clinical practice. In addition, the validation tool was considered to be user-friendly and to save a lot of time compared to manual validation. Semi-automated validation will contribute to more accurate outcome predictions and treatment recommendations in the target population.