Progression to the mean: A comparison of Bayesian clinical prediction models outputting the posterior mean versus conventional plug-in predictions

Abstract

Clinical prediction models provide predictions for individuals, typically expressed as point estimates derived from a deterministic function, such as a logistic regression equation. Such 'plug-in' predictions hide inherent uncertainty. In contrast, Bayesian methods offer a coherent mechanism for uncertainty propagation, and allow the computation of the posterior mean as the measure of centrality of choice for clinical decision-making. However, Bayesian methods are not widely utilised in predictive analytics for healthcare. We investigated the feasibility and performance of a Bayesian adaptation of the commonly used frequentist framework for risk prediction modelling. We assessed (i) the use of shrinkage priors with complementary features (simplicity, user input, and automatic shrinkage) that enable Laplace/normal approximation of the posterior, and (ii) exact and approximate methods for efficient computation of the posterior mean. Using examples and simulations, we demonstrate that this Bayesian approach is feasible and improves predictive performance, while enabling uncertainty quantification with suitable coverage. In small-to-medium sample sizes, the gain in clinical utility by using the posterior mean over plug-in predictions was equivalent to the gain from using a noticeably larger sample size. Adapting the widely used parametric regression methods to an approximate Bayesian framework for prediction modelling is both pragmatic and clinically advantageous.