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Optimal allocation strategies in platform trials with continuous endpoints. 连续终点平台试验的最佳分配策略。
IF 2.3 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-05-01 Epub Date: 2024-03-20 DOI: 10.1177/09622802241239008
Marta Bofill Roig, Ekkehard Glimm, Tobias Mielke, Martin Posch

Platform trials are randomized clinical trials that allow simultaneous comparison of multiple interventions, usually against a common control. Arms to test experimental interventions may enter and leave the platform over time. This implies that the number of experimental intervention arms in the trial may change as the trial progresses. Determining optimal allocation rates to allocate patients to the treatment and control arms in platform trials is challenging because the optimal allocation depends on the number of arms in the platform and the latter typically varies over time. In addition, the optimal allocation depends on the analysis strategy used and the optimality criteria considered. In this article, we derive optimal treatment allocation rates for platform trials with shared controls, assuming that a stratified estimation and a testing procedure based on a regression model are used to adjust for time trends. We consider both, analysis using concurrent controls only as well as analysis methods using concurrent and non-concurrent controls and assume that the total sample size is fixed. The objective function to be minimized is the maximum of the variances of the effect estimators. We show that the optimal solution depends on the entry time of the arms in the trial and, in general, does not correspond to the square root of k allocation rule used in classical multi-arm trials. We illustrate the optimal allocation and evaluate the power and type 1 error rate compared to trials using one-to-one and square root of k allocations by means of a case study.

平台试验是一种随机临床试验,可同时比较多种干预措施,通常是与一种共同对照进行比较。测试实验干预措施的臂可能会随着时间的推移进入或离开平台。这意味着试验中实验干预臂的数量可能会随着试验的进展而发生变化。在平台试验中,确定将患者分配到治疗臂和对照臂的最佳分配率具有挑战性,因为最佳分配率取决于平台中的臂数,而后者通常会随着时间的推移而变化。此外,最佳分配率还取决于所使用的分析策略和所考虑的优化标准。在本文中,我们假定使用分层估计和基于回归模型的测试程序来调整时间趋势,从而推导出共享对照的平台试验的最佳治疗分配率。我们既考虑了仅使用同期对照的分析方法,也考虑了使用同期和非同期对照的分析方法,并假设总样本量是固定的。需要最小化的目标函数是效应估计值方差的最大值。我们的研究表明,最优解取决于试验中各臂的进入时间,一般来说,最优解与经典多臂试验中使用的 k 的平方根分配规则并不一致。我们通过案例研究说明了最优分配,并评估了与使用一对一和 k 的平方根分配的试验相比的功率和 1 类错误率。
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引用次数: 0
Bayesian analysis of joint quantile regression for multi-response longitudinal data with application to primary biliary cirrhosis sequential cohort study 应用于原发性胆汁性肝硬化序列队列研究的多反应纵向数据联合量子回归贝叶斯分析
IF 2.3 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-27 DOI: 10.1177/09622802241247725
Yu-Zhu Tian, Man-Lai Tang, Catherine Wong, Mao-Zai Tian
This article proposes a Bayesian approach for jointly estimating marginal conditional quantiles of multi-response longitudinal data with multivariate mixed effects model. The multivariate asymmetric Laplace distribution is employed to construct the working likelihood of the considered model. Penalization priors on regression parameters are incorporated into the working likelihood to conduct Bayesian high-dimensional inference. Markov chain Monte Carlo algorithm is used to obtain the fully conditional posterior distributions of all parameters and latent variables. Monte Carlo simulations are conducted to evaluate the sample performance of the proposed joint quantile regression approach. Finally, we analyze a longitudinal medical dataset of the primary biliary cirrhosis sequential cohort study to illustrate the real application of the proposed modeling method.
本文提出了一种利用多变量混合效应模型联合估计多响应纵向数据边际条件量值的贝叶斯方法。本文采用多变量非对称拉普拉斯分布来构建所考虑模型的工作似然。将回归参数的惩罚先验纳入工作似然,以进行贝叶斯高维推断。使用马尔科夫链蒙特卡罗算法获得所有参数和潜变量的全条件后验分布。我们进行了蒙特卡罗模拟,以评估所提出的联合量化回归方法的样本性能。最后,我们分析了原发性胆汁性肝硬化序列队列研究的纵向医疗数据集,以说明所提建模方法的实际应用。
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引用次数: 0
Causal rule ensemble method for estimating heterogeneous treatment effect with consideration of prognostic effects 考虑预后效应的因果规则集合法估算异质性治疗效果
IF 2.3 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-27 DOI: 10.1177/09622802241247728
Mayu Hiraishi, Ke Wan, Kensuke Tanioka, Hiroshi Yadohisa, Toshio Shimokawa
We propose a novel framework based on the RuleFit method to estimate heterogeneous treatment effect in randomized clinical trials. The proposed method estimates a rule ensemble comprising a set of prognostic rules, a set of prescriptive rules, as well as the linear effects of the original predictor variables. The prescriptive rules provide an interpretable description of the heterogeneous treatment effect. By including a prognostic term in the proposed model, the selected rule is represented as an heterogeneous treatment effect that excludes other effects. We confirmed that the performance of the proposed method was equivalent to that of other ensemble learning methods through numerical simulations and demonstrated the interpretation of the proposed method using a real data application.
我们提出了一种基于 RuleFit 方法的新框架,用于估算随机临床试验中的异质性治疗效果。该方法估算的规则集合包括一组预后规则、一组描述性规则以及原始预测变量的线性效应。规定性规则提供了对异质性治疗效果的可解释性描述。通过在拟议模型中加入预后项,所选规则被表示为排除了其他效应的异质性治疗效应。我们通过数值模拟证实了所提方法的性能与其他集合学习方法相当,并利用真实数据应用演示了所提方法的解释。
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引用次数: 0
The “Why” behind including “Y” in your imputation model 将 "Y "纳入估算模型背后的 "原因"
IF 2.3 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-16 DOI: 10.1177/09622802241244608
Lucy D’Agostino McGowan, Sarah C Lotspeich, Staci A Hepler
Missing data is a common challenge when analyzing epidemiological data, and imputation is often used to address this issue. Here, we investigate the scenario where a covariate used in an analysis has missingness and will be imputed. There are recommendations to include the outcome from the analysis model in the imputation model for missing covariates, but it is not necessarily clear if this recommendation always holds and why this is sometimes true. We examine deterministic imputation (i.e. single imputation with fixed values) and stochastic imputation (i.e. single or multiple imputation with random values) methods and their implications for estimating the relationship between the imputed covariate and the outcome. We mathematically demonstrate that including the outcome variable in imputation models is not just a recommendation but a requirement to achieve unbiased results when using stochastic imputation methods. Moreover, we dispel common misconceptions about deterministic imputation models and demonstrate why the outcome should not be included in these models. This article aims to bridge the gap between imputation in theory and in practice, providing mathematical derivations to explain common statistical recommendations. We offer a better understanding of the considerations involved in imputing missing covariates and emphasize when it is necessary to include the outcome variable in the imputation model.
在分析流行病学数据时,缺失数据是一个常见的挑战,通常使用估算来解决这个问题。在此,我们研究了分析中使用的协变量存在缺失并将被估算的情况。有建议称,应将分析模型中的结果纳入缺失协变量的估算模型中,但不一定清楚这一建议是否总是成立,以及为什么有时会出现这种情况。我们研究了确定性估算(即使用固定值的单次估算)和随机估算(即使用随机值的单次或多次估算)方法及其对估算协变量与结果之间关系的影响。我们用数学方法证明,在使用随机估算方法时,将结果变量纳入估算模型不仅是一种建议,而且是获得无偏结果的必要条件。此外,我们还消除了关于确定性估算模型的常见误解,并说明了为什么不应将结果纳入这些模型。本文旨在弥合理论与实践之间的差距,提供数学推导来解释常见的统计建议。我们让读者更好地理解归因缺失协变量时的注意事项,并强调何时有必要将结果变量纳入归因模型。
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引用次数: 0
A simple and robust parametric shared frailty model for recurrent events with the competing risk of death: An application to the Carvedilol Prospective Randomized Cumulative Survival trial 针对具有死亡竞争风险的复发事件的简单稳健的参数共享虚弱模型:卡维地洛前瞻性随机累积生存试验的应用
IF 2.3 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-16 DOI: 10.1177/09622802241236934
Jiren Sun, Thomas Cook
Many non-fatal events can be considered recurrent in that they can occur repeatedly over time, and some researchers may be interested in the trajectory and relative risk of non-fatal events. With the competing risk of death, the treatment effect on the mean number of recurrent events is non-identifiable since the observed mean is a function of both the recurrent event and terminal event processes. In this paper, we assume independence between the non-fatal and the terminal event process, conditional on the shared frailty, to fit a parametric model that recovers the trajectory of, and identifies the effect of treatment on, the non-fatal event process in the presence of the competing risk of death. Simulation studies are conducted to verify the reliability of our estimators. We illustrate the method and perform model diagnostics using the Carvedilol Prospective Randomized Cumulative Survival trial which involves heart-failure events.
许多非致命性事件可被视为复发性事件,因为它们会随着时间的推移反复发生,一些研究人员可能会对非致命性事件的轨迹和相对风险感兴趣。由于存在死亡的竞争风险,治疗对复发事件平均次数的影响是不可识别的,因为观察到的平均值是复发事件和终末事件过程的函数。在本文中,我们假定非致命性事件和终末事件过程之间具有独立性,并以共同的虚弱性为条件,拟合出一个参数模型,该模型可以还原存在死亡竞争风险时非致命性事件过程的轨迹,并确定治疗对非致命性事件过程的影响。我们进行了模拟研究,以验证我们的估计值的可靠性。我们使用涉及心衰事件的卡维地洛前瞻性随机累积生存试验来说明该方法并进行模型诊断。
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引用次数: 0
Estimating dynamic treatment regimes for ordinal outcomes with household interference: Application in household smoking cessation 估计有家庭干扰的序数结果的动态治疗制度:在家庭戒烟中的应用
IF 2.3 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-16 DOI: 10.1177/09622802241242313
Cong Jiang, Mary Thompson, Michael Wallace
The focus of precision medicine is on decision support, often in the form of dynamic treatment regimes, which are sequences of decision rules. At each decision point, the decision rules determine the next treatment according to the patient’s baseline characteristics, the information on treatments and responses accrued by that point, and the patient’s current health status, including symptom severity and other measures. However, dynamic treatment regime estimation with ordinal outcomes is rarely studied, and rarer still in the context of interference – where one patient’s treatment may affect another’s outcome. In this paper, we introduce the weighted proportional odds model: a regression based, approximate doubly-robust approach to single-stage dynamic treatment regime estimation for ordinal outcomes. This method also accounts for the possibility of interference between individuals sharing a household through the use of covariate balancing weights derived from joint propensity scores. Examining different types of balancing weights, we verify the approximate double robustness of weighted proportional odds model with our adjusted weights via simulation studies. We further extend weighted proportional odds model to multi-stage dynamic treatment regime estimation with household interference, namely dynamic weighted proportional odds model. Lastly, we demonstrate our proposed methodology in the analysis of longitudinal survey data from the Population Assessment of Tobacco and Health study, which motivates this work. Furthermore, considering interference, we provide optimal treatment strategies for households to achieve smoking cessation of the pair in the household.
精准医疗的重点是决策支持,通常采用动态治疗方案的形式,即决策规则序列。在每个决策点,决策规则都会根据患者的基线特征、该点之前积累的治疗和反应信息以及患者当前的健康状况(包括症状严重程度和其他指标)决定下一步治疗。然而,对具有序数结果的动态治疗方案进行估计的研究很少,而在干扰的情况下,即一个病人的治疗可能会影响另一个病人的结果的情况下,这种研究就更少了。本文介绍了加权比例几率模型:一种基于回归的近似双稳健方法,用于序数结果的单阶段动态治疗方案估计。该方法还通过使用从联合倾向评分中得出的协变量平衡权重,考虑了同户个体之间可能存在的干扰。通过不同类型的平衡权重,我们通过模拟研究验证了加权比例几率模型与我们调整后的权重的近似双重稳健性。我们进一步将加权比例几率模型扩展到有家庭干扰的多阶段动态治疗制度估计,即动态加权比例几率模型。最后,我们在烟草与健康人口评估研究的纵向调查数据分析中演示了我们提出的方法,这也是这项工作的动机所在。此外,考虑到干扰因素,我们还为家庭提供了最佳治疗策略,以实现家庭中一对吸烟者的戒烟。
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引用次数: 0
Non-stationary Bayesian spatial model for disease mapping based on sub-regions 基于次区域的疾病绘图非稳态贝叶斯空间模型
IF 2.3 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-10 DOI: 10.1177/09622802241244613
Esmail Abdul-Fattah, Elias Krainski, Janet Van Niekerk, Håvard Rue
This paper aims to extend the Besag model, a widely used Bayesian spatial model in disease mapping, to a non-stationary spatial model for irregular lattice-type data. The goal is to improve the model’s ability to capture complex spatial dependence patterns and increase interpretability. The proposed model uses multiple precision parameters, accounting for different intensities of spatial dependence in different sub-regions. We derive a joint penalized complexity prior to the flexible local precision parameters to prevent overfitting and ensure contraction to the stationary model at a user-defined rate. The proposed methodology can be used as a basis for the development of various other non-stationary effects over other domains such as time. An accompanying R package fbesag equips the reader with the necessary tools for immediate use and application. We illustrate the novelty of the proposal by modeling the risk of dengue in Brazil, where the stationary spatial assumption fails and interesting risk profiles are estimated when accounting for spatial non-stationary. Additionally, we model different causes of death in Brazil, where we use the new model to investigate the spatial stationarity of these causes.
本文旨在将疾病绘图中广泛使用的贝叶斯空间模型 Besag 模型扩展为不规则网格型数据的非稳态空间模型。目的是提高模型捕捉复杂空间依赖模式的能力,增加可解释性。建议的模型使用多个精确参数,以反映不同子区域的不同空间依赖强度。我们为灵活的局部精度参数推导了一个联合惩罚复杂性先验,以防止过拟合,并确保以用户定义的速率收缩到静态模型。所提出的方法可作为开发其他领域(如时间)各种非稳态效应的基础。随附的 R 软件包 fbesag 为读者提供了立即使用和应用的必要工具。我们通过对巴西登革热风险的建模来说明该建议的新颖性,在巴西,静态空间假设失效,在考虑空间非静态因素时,可以估算出有趣的风险概况。此外,我们还对巴西的不同死因进行了建模,并利用新模型对这些死因的空间静止性进行了研究。
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引用次数: 0
Variable selection for latent class analysis in the presence of missing data with application to record linkage 缺失数据情况下的潜类分析变量选择与记录关联的应用
IF 2.3 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-09 DOI: 10.1177/09622802241242317
Huiping Xu, Xiaochun Li, Zuoyi Zhang, Shaun Grannis
The Fellegi-Sunter model is a latent class model widely used in probabilistic linkage to identify records that belong to the same entity. Record linkage practitioners typically employ all available matching fields in the model with the premise that more fields convey greater information about the true match status and hence result in improved match performance. In the context of model-based clustering, it is well known that such a premise is incorrect and the inclusion of noisy variables could compromise the clustering. Variable selection procedures have therefore been developed to remove noisy variables. Although these procedures have the potential to improve record matching, they cannot be applied directly due to the ubiquity of the missing data in record linkage applications. In this paper, we modify the stepwise variable selection procedure proposed by Fop, Smart, and Murphy and extend it to account for missing data common in record linkage. Through simulation studies, our proposed method is shown to select the correct set of matching fields across various settings, leading to better-performing algorithms. The improved match performance is also seen in a real-world application. We therefore recommend the use of our proposed selection procedure to identify informative matching fields for probabilistic record linkage algorithms.
Fellegi-Sunter 模型是一种潜类模型,被广泛应用于概率链接,以识别属于同一实体的记录。记录关联实践者通常会在模型中使用所有可用的匹配字段,前提是更多的字段能传递更多关于真实匹配状态的信息,从而提高匹配性能。众所周知,在基于模型的聚类中,这样的前提是不正确的,包含噪声变量会影响聚类效果。因此,我们开发了变量选择程序来去除噪声变量。虽然这些程序有改善记录匹配的潜力,但由于记录关联应用中缺失数据的普遍性,这些程序无法直接应用。在本文中,我们修改了 Fop、Smart 和 Murphy 提出的逐步变量选择程序,并对其进行了扩展,以考虑记录关联中常见的缺失数据。通过模拟研究,我们提出的方法可以在各种情况下选择正确的匹配字段集,从而产生性能更好的算法。在实际应用中,我们也看到了匹配性能的提高。因此,我们建议使用我们提出的选择程序来为概率记录关联算法识别信息匹配字段。
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引用次数: 0
Methods for non-proportional hazards in clinical trials: A systematic review 临床试验中的非比例危害方法:系统回顾
IF 2.3 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-09 DOI: 10.1177/09622802241242325
Maximilian Bardo, Cynthia Huber, Norbert Benda, Jonas Brugger, Tobias Fellinger, Vaidotas Galaune, Judith Heinz, Harald Heinzl, Andrew C Hooker, Florian Klinglmüller, Franz König, Tim Mathes, Martina Mittlböck, Martin Posch, Robin Ristl, Tim Friede
For the analysis of time-to-event data, frequently used methods such as the log-rank test or the Cox proportional hazards model are based on the proportional hazards assumption, which is often debatable. Although a wide range of parametric and non-parametric methods for non-proportional hazards has been proposed, there is no consensus on the best approaches. To close this gap, we conducted a systematic literature search to identify statistical methods and software appropriate under non-proportional hazard. Our literature search identified 907 abstracts, out of which we included 211 articles, mostly methodological ones. Review articles and applications were less frequently identified. The articles discuss effect measures, effect estimation and regression approaches, hypothesis tests, and sample size calculation approaches, which are often tailored to specific non-proportional hazard situations. Using a unified notation, we provide an overview of methods available. Furthermore, we derive some guidance from the identified articles.
对于时间到事件数据的分析,常用的方法如对数秩检验或 Cox 比例危险模型都是基于比例危险假设,而这一假设往往是值得商榷的。虽然针对非比例危险提出了多种参数和非参数方法,但对于最佳方法还没有达成共识。为了填补这一空白,我们进行了一次系统的文献检索,以确定适合非比例危险的统计方法和软件。我们的文献检索发现了 907 篇摘要,其中我们收录了 211 篇文章,大部分是方法论文章。综述文章和应用文章较少。这些文章讨论了效应测量、效应估计和回归方法、假设检验和样本量计算方法,这些方法通常是针对特定的非比例危害情况而设计的。我们使用统一的符号对现有方法进行了概述。此外,我们还从确定的文章中得出了一些指导意见。
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引用次数: 0
An additive-multiplicative model for longitudinal data with informative observation times 具有信息观测时间的纵向数据加乘模型
IF 2.3 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-08 DOI: 10.1177/09622802241236951
Yang Li, Wanzhu Tu
Designed clinical studies often assess outcomes at pre-planned time points. In most situations, standard statistical models, such as generalized linear mixed models and generalized additive models, are sufficient to depict the temporal trends of the outcome and produce valid inference. Complicating factors, however, do exist in practical data analyses. One complication arises when the outcome and observational processes are interdependent, that is, the observational process is informative; another challenge is patient characteristics may influence the longitudinally observed outcomes in non-additive ways, for example, by multiplicative factors. In this research, we extend the standard longitudinal models to accommodate informative observation through a more flexible modeling structure—one with additive-multiplicative components that do not require explicit specification of the dependency structure between the outcome and observation processes. Along this vein, we provide the essential theory for inference in such models. Simulation studies showed the proposed method performs well for finite-sample scenarios, and the method was applied to analyze a motivating example from an alcohol-associated hepatitis observational study.
设计的临床研究通常会在预先计划的时间点对结果进行评估。在大多数情况下,标准统计模型,如广义线性混合模型和广义加法模型,足以描述结果的时间趋势并产生有效的推论。然而,在实际数据分析中确实存在一些复杂因素。当结果和观察过程相互依存时,即观察过程具有信息性时,就会出现复杂因素;另一个挑战是患者特征可能会以非加法方式影响纵向观察结果,例如,乘法因素。在这项研究中,我们扩展了标准纵向模型,通过一种更灵活的建模结构来适应信息观察--一种具有加法-乘法成分的模型,不需要明确说明结果和观察过程之间的依赖结构。沿着这一思路,我们为这类模型的推断提供了基本理论。模拟研究表明,所提出的方法在有限样本情况下表现良好,并将该方法应用于分析酒精相关肝炎观察研究中的一个激励性实例。
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引用次数: 0
期刊
Statistical Methods in Medical Research
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