Confidence Interval Estimation for the Bland-Altman Limits of Agreement with Multiple Observations Per Individual

The limits of agreement (LoA) method proposed by Bland and Altman has become a standard for assessing agreement between different methods measuring the same quantity. Virtually, all method comparison studies have reported only point estimates of LoA due largely to the lack of simple confidence interval procedures. In this article, we address confidence interval estimation for LoA when multiple measurements per individual are available. Separate procedures are proposed for situations when the underlying true value of the measured quantity is assumed changing and when it is perceived as stable. A fixed number of replicates per individual is not needed for the procedures to work. As shown by the worked examples, the construction of these confidence intervals requires only quantiles from the standard normal and chi-square distributions. Simulation results show the proposed procedures perform well. A SAS macro implementing the methods is available on the publisher's website.