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Wu D, Goldfeld KS, Petkova E, Park HG. A Bayesian multivariate hierarchical model for developing a treatment benefit index using mixed types of outcomes. BMC Med Res Methodol 2024; 24:218. [PMID: 39333874 PMCID: PMC11437666 DOI: 10.1186/s12874-024-02333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/06/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Precision medicine has led to the development of targeted treatment strategies tailored to individual patients based on their characteristics and disease manifestations. Although precision medicine often focuses on a single health outcome for individualized treatment decision rules (ITRs), relying only on a single outcome rather than all available outcomes information leads to suboptimal data usage when developing optimal ITRs. METHODS To address this limitation, we propose a Bayesian multivariate hierarchical model that leverages the wealth of correlated health outcomes collected in clinical trials. The approach jointly models mixed types of correlated outcomes, facilitating the "borrowing of information" across the multivariate outcomes, and results in a more accurate estimation of heterogeneous treatment effects compared to using single regression models for each outcome. We develop a treatment benefit index, which quantifies the relative benefit of the experimental treatment over the control treatment, based on the proposed multivariate outcome model. RESULTS We demonstrate the strengths of the proposed approach through extensive simulations and an application to an international Coronavirus Disease 2019 (COVID-19) treatment trial. Simulation results indicate that the proposed method reduces the occurrence of erroneous treatment decisions compared to a single regression model for a single health outcome. Additionally, the sensitivity analyses demonstrate the robustness of the model across various study scenarios. Application of the method to the COVID-19 trial exhibits improvements in estimating the individual-level treatment efficacy (indicated by narrower credible intervals for odds ratios) and optimal ITRs. CONCLUSION The study jointly models mixed types of outcomes in the context of developing ITRs. By considering multiple health outcomes, the proposed approach can advance the development of more effective and reliable personalized treatment.
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Affiliation(s)
- Danni Wu
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, 10016, New York, USA.
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, 02115, MA, USA.
| | - Keith S Goldfeld
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, 10016, New York, USA
| | - Eva Petkova
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, 10016, New York, USA
| | - Hyung G Park
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, 10016, New York, USA
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Gao D, Wang Y, Zeng D. Fusing Individualized Treatment Rules Using Secondary Outcomes. PROCEEDINGS OF MACHINE LEARNING RESEARCH 2024; 238:712-720. [PMID: 39371406 PMCID: PMC11450767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
An individualized treatment rule (ITR) is a decision rule that recommends treatments for patients based on their individual feature variables. In many practices, the ideal ITR for the primary outcome is also expected to cause minimal harm to other secondary outcomes. Therefore, our objective is to learn an ITR that not only maximizes the value function for the primary outcome, but also approximates the optimal rule for the secondary outcomes as closely as possible. To achieve this goal, we introduce a fusion penalty to encourage the ITRs based on different outcomes to yield similar recommendations. Two algorithms are proposed to estimate the ITR using surrogate loss functions. We prove that the agreement rate between the estimated ITR of the primary outcome and the optimal ITRs of the secondary outcomes converges to the true agreement rate faster than if the secondary outcomes are not taken into consideration. Furthermore, we derive the non-asymptotic properties of the value function and misclassification rate for the proposed method. Finally, simulation studies and a real data example are used to demonstrate the finite-sample performance of the proposed method.
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Wu D, Goldfeld KS, Petkova E, Park HG. Improving Individualized Treatment Decisions: A Bayesian Multivariate Hierarchical Model for Developing a Treatment Benefit Index using Mixed Types of Outcomes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.11.17.23298711. [PMID: 38014277 PMCID: PMC10680905 DOI: 10.1101/2023.11.17.23298711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Precision medicine has led to the development of targeted treatment strategies tailored to individual patients based on their characteristics and disease manifestations. Although precision medicine often focuses on a single health outcome for individualized treatment decision rules (ITRs), relying only on a single outcome rather than all available outcomes information leads to suboptimal data usage when developing optimal ITRs. Methods To address this limitation, we propose a Bayesian multivariate hierarchical model that leverages the wealth of correlated health outcomes collected in clinical trials. The approach jointly models mixed types of correlated outcomes, facilitating the "borrowing of information" across the multivariate outcomes, and results in a more accurate estimation of heterogeneous treatment effects compared to using single regression models for each outcome. We develop a treatment benefit index, which quantifies the relative treatment benefit of the experimental treatment over the control treatment, based on the proposed multivariate outcome model. Results We demonstrate the strengths of the proposed approach through extensive simulations and an application to an international Coronavirus Disease 2019 (COVID-19) treatment trial. Simulation results indicate that the proposed method reduces the occurrence of erroneous treatment decisions compared to a single regression model for a single health outcome. Additionally, the sensitivity analysis demonstrates the robustness of the model across various study scenarios. Application of the method to the COVID-19 trial exhibits improvements in estimating the individual-level treatment efficacy (indicated by narrower credible intervals for odds ratios) and optimal ITRs. Conclusion The study jointly models mixed types of outcomes in the context of developing ITRs. By considering multiple health outcomes, the proposed approach can advance the development of more effective and reliable personalized treatment.
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Affiliation(s)
- Danni Wu
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, 10016, New York, USA
| | - Keith S. Goldfeld
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, 10016, New York, USA
| | - Eva Petkova
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, 10016, New York, USA
| | - Hyung G. Park
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, 10016, New York, USA
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Tran TD, Abad AA, Verbeke G, Molenberghs G, Van Mechelen I. Reflections on the concept of optimality of single decision point treatment regimes. Biom J 2023; 65:e2200285. [PMID: 37736675 DOI: 10.1002/bimj.202200285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 06/28/2023] [Accepted: 07/30/2023] [Indexed: 09/23/2023]
Abstract
In many areas, applied researchers as well as practitioners have to choose between different solutions for a problem at hand; this calls for optimal decision rules to settle the choices involved. As a key example, one may think of the search for optimal treatment regimes (OTRs) in clinical research, that specify which treatment alternative should be administered to each patient under study. Motivated by the fact that the concept of optimality of decision rules in general and treatment regimes in particular has received so far relatively little attention and discussion, we will present a number of reflections on it, starting from the basics of any optimization problem. Specifically, we will analyze the search space and the to be optimized criterion function underlying the search of single decision point OTRs, along with the many choice aspects that show up in their specification. Special attention is paid to formal characteristics and properties as well as to substantive concerns and hypotheses that may guide these choices. We illustrate with a few empirical examples taken from the literature. Finally, we discuss how the presented reflections may help sharpen statistical thinking about optimality of decision rules for treatment assignment and to facilitate the dialogue between the statistical consultant and the applied researcher in search of an OTR.
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Affiliation(s)
- Trung Dung Tran
- Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | | | - Geert Verbeke
- I-BioStat, KU Leuven, Leuven, Belgium
- I-BioStat, Universiteit Hasselt, Hasselt, Belgium
| | - Geert Molenberghs
- I-BioStat, KU Leuven, Leuven, Belgium
- I-BioStat, Universiteit Hasselt, Hasselt, Belgium
| | - Iven Van Mechelen
- Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
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Li Z, Chen J, Laber E, Liu F, Baumgartner R. Optimal Treatment Regimes: A Review and Empirical Comparison. Int Stat Rev 2023. [DOI: 10.1111/insr.12536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Zhen Li
- Department of Statistics North Carolina State University Raleigh 27607 NC USA
| | - Jie Chen
- Department of Biometrics Overland Pharmaceuticals Dover 19901 DE USA
| | - Eric Laber
- Department of Statistical Science, Department of Biostatistics and Bioinformatics Duke University Durham 27708 NC USA
| | - Fang Liu
- Biostatistics and Research Decision Sciences Merck & Co., Inc. Kenilworth NJ 07033 USA
| | - Richard Baumgartner
- Biostatistics and Research Decision Sciences Merck & Co., Inc. Kenilworth NJ 07033 USA
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Rudolph KE, Williams NT, Goodwin ATS, Shulman M, Fishman M, Díaz I, Luo S, Rotrosen J, Nunes EV. Buprenorphine & methadone dosing strategies to reduce risk of relapse in the treatment of opioid use disorder. Drug Alcohol Depend 2022; 239:109609. [PMID: 36075154 PMCID: PMC9741946 DOI: 10.1016/j.drugalcdep.2022.109609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although there is consensus that having a "high-enough" dose of buprenorphine (BUP-NX) or methadone is important for reducing relapse to opioid use, there is debate about what this dose is and how it should be attained. We estimated the extent to which different dosing strategies would affect risk of relapse over 12 weeks of treatment, separately for BUP-NX and methadone. METHODS This was a secondary analysis of three comparative effectiveness trials. We examined four dosing strategies: 1) increasing dose in response to participant-specific opioid use, 2) increasing dose weekly until some minimum dose (16 mg BUP, 100 mg methadone) was reached, 3) increasing dose weekly until some minimum and increasing dose in response to opioid use thereafter (referred to as the "hybrid strategy"), and 4) keeping dose constant after the first 2 weeks of treatment. We used a longitudinal sequentially doubly robust estimator to estimate contrasts between dosing strategies on risk of relapse. RESULTS For BUP-NX, increasing dose following the hybrid strategy resulted in the lowest risk of relapse. For methadone, holding dose constant resulted in greatest risk of relapse; the other three strategies performed similarly. For example, the hybrid strategy reduced week 12 relapse risk by 13 % (RR: 0.87, 95 %CI: 0.83-0.95) and by 20 % (RR: 0.80, 95 %CI: 0.71-0.90) for BUP-NX and methadone respectively, as compared to holding dose constant. CONCLUSIONS Doses should be targeted toward minimum thresholds and, in the case of BUP-NX, raised when patients continue to use opioids.
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Affiliation(s)
- Kara E Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Nicholas T Williams
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alicia T Singham Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Matisyahu Shulman
- Department of Psychiatry, School of Medicine, Columbia University, and New York State Psychiatric Institute, New York, NY, USA
| | - Marc Fishman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, and Maryland Treatment Centers, Baltimore, MD, USA
| | - Iván Díaz
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Sean Luo
- Department of Psychiatry, School of Medicine, Columbia University, and New York State Psychiatric Institute, New York, NY, USA
| | - John Rotrosen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Edward V Nunes
- Department of Psychiatry, School of Medicine, Columbia University, and New York State Psychiatric Institute, New York, NY, USA
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Rudolph KE, Shulman M, Fishman M, Díaz I, Rotrosen J, Nunes EV. Association between dynamic dose increases of buprenorphine for treatment of opioid use disorder and risk of relapse. Addiction 2022; 117:637-645. [PMID: 34338389 PMCID: PMC9717480 DOI: 10.1111/add.15654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Dynamic, adaptive pharmacologic treatment for opioid use disorder (OUD) has been previously recommended over static dosing to prevent relapse, and is aligned with personalized medicine. However, there has been no quantitative evidence demonstrating its advantage. Our objective was to estimate the extent to which a hypothetical intervention that increased buprenorphine dose in response to opioid use would affect risk of relapse over 24 weeks of follow-up. DESIGN A secondary analysis of the buprenorphine arm of an open-label randomized controlled 24-week comparative effectiveness trial, 2014-17. SETTING Eight community addiction treatment programs in the United States. PARTICIPANTS English-speaking adults with DSM-5 OUD, recruited during inpatient admission (n = 270). Participants were mainly white (65%) and male (72%). INTERVENTION(S) Participants were treated with daily sublingual buprenorphine-naloxone (BUP-NX), with dose based on clinical indication, determined by the provider. We examined a hypothetical intervention of increasing dose in response to opioid use. MEASUREMENTS Outcome was relapse to regular opioid use during the 24 weeks of outpatient treatment, assessed in a survival framework. We estimated the relapse-free survival curves of participants under a hypothetical (i.e. counterfactual) intervention in which their BUP-NX dosage would be increased following their own subject-specific opioid use during the first 12 weeks of treatment versus a hypothetical intervention in which dose would remain constant. FINDINGS We estimated that increasing BUP-NX dose in response to recent opioid use would lower risk of relapse by 19.17 percentage points [95% confidence interval (CI) = -32.17, -6.18) (additive risk)] and 32% (0.68, 95% CI = 0.49, 0.86) (relative risk). The number-needed-to-treat with this intervention to prevent a single relapse is 6. CONCLUSIONS In people with opioid use disorder, a hypothetical intervention that increases sublingual buprenorphine-naloxone dose in response to opioid use during the first 12 weeks of treatment appears to reduce risk of relapse over 24 weeks, compared with holding the dose constant after week 2.
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Affiliation(s)
- Kara E. Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Matisyahu Shulman
- Department of Psychiatry, School of Medicine, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Marc Fishman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Maryland Treatment Centers, Baltimore, MD, USA
| | - Iván Díaz
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - John Rotrosen
- Department of Psychiatry, School of Medicine, New York University, New York, NY, USA
| | - Edward V. Nunes
- Department of Psychiatry, School of Medicine, Columbia University and New York State Psychiatric Institute, New York, NY, USA
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Caniglia EC, Murray EJ, Hernán MA, Shahn Z. Estimating optimal dynamic treatment strategies under resource constraints using dynamic marginal structural models. Stat Med 2021; 40:4996-5005. [PMID: 34184763 DOI: 10.1002/sim.9107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/23/2021] [Accepted: 06/06/2021] [Indexed: 11/07/2022]
Abstract
Methods for estimating optimal treatment strategies typically assume unlimited access to resources. However, when a health system has resource constraints, such as limited funds, access to medication, or monitoring capabilities, medical decisions must account for competition between individuals in resource usage. The problem of incorporating resource constraints into optimal treatment strategies has been solved for point exposures (1), that is, treatment strategies entailing a decision at just one time point. However, attempts to directly generalize the point exposure solution to dynamic time-varying treatment strategies run into complications. We sidestep these complications by targeting the optimal strategy within a clinically defined subclass. Our approach is to employ dynamic marginal structural models to estimate (counterfactual) resource usage under the class of candidate treatment strategies and solve a constrained optimization problem to choose the optimal strategy for which expected resource usage is within acceptable limits. We apply this method to determine the optimal dynamic monitoring strategy for people living with HIV when resource limits on monitoring exist using observational data from the HIV-CAUSAL Collaboration.
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Affiliation(s)
- Ellen C Caniglia
- Department of Population Health, New York University School of Medicine, New York, USA
| | - Eleanor J Murray
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Miguel A Hernán
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Zach Shahn
- IBM Research, Yorktown Heights, New York, USA.,MIT-IBM Watson AI Lab, Cambridge, Massachusetts, USA
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Park H, Petkova E, Tarpey T, Ogden RT. A single-index model with a surface-link for optimizing individualized dose rules. J Comput Graph Stat 2021; 31:553-562. [PMID: 35873662 PMCID: PMC9306450 DOI: 10.1080/10618600.2021.1923521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 03/16/2021] [Accepted: 04/23/2021] [Indexed: 01/03/2023]
Abstract
This paper focuses on the problem of modeling and estimating interaction effects between covariates and a continuous treatment variable on an outcome, using a single-index regression. The primary motivation is to estimate an optimal individualized dose rule and individualized treatment effects. To model possibly nonlinear interaction effects between patients' covariates and a continuous treatment variable, we employ a two-dimensional penalized spline regression on an index-treatment domain, where the index is defined as a linear projection of the covariates. The method is illustrated using two applications as well as simulation experiments. A unique contribution of this work is in the parsimonious (single-index) parametrization specifically defined for the interaction effect term.
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Affiliation(s)
- Hyung Park
- Division of Biostatistics, Department of Population Health, New York University
| | - Eva Petkova
- Division of Biostatistics, Department of Population Health, New York University
| | - Thaddeus Tarpey
- Division of Biostatistics, Department of Population Health, New York University
| | - R Todd Ogden
- Department of Biostatistics, Columbia University
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10
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Luckett DJ, Laber EB, Kim S, Kosorok MR. Estimation and Optimization of Composite Outcomes. JOURNAL OF MACHINE LEARNING RESEARCH : JMLR 2021; 22:167. [PMID: 34733120 PMCID: PMC8562677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There is tremendous interest in precision medicine as a means to improve patient outcomes by tailoring treatment to individual characteristics. An individualized treatment rule formalizes precision medicine as a map from patient information to a recommended treatment. A treatment rule is defined to be optimal if it maximizes the mean of a scalar outcome in a population of interest, e.g., symptom reduction. However, clinical and intervention scientists often seek to balance multiple and possibly competing outcomes, e.g., symptom reduction and the risk of an adverse event. One approach to precision medicine in this setting is to elicit a composite outcome which balances all competing outcomes; unfortunately, eliciting a composite outcome directly from patients is difficult without a high-quality instrument, and an expert-derived composite outcome may not account for heterogeneity in patient preferences. We propose a new paradigm for the study of precision medicine using observational data that relies solely on the assumption that clinicians are approximately (i.e., imperfectly) making decisions to maximize individual patient utility. Estimated composite outcomes are subsequently used to construct an estimator of an individualized treatment rule which maximizes the mean of patient-specific composite outcomes. The estimated composite outcomes and estimated optimal individualized treatment rule provide new insights into patient preference heterogeneity, clinician behavior, and the value of precision medicine in a given domain. We derive inference procedures for the proposed estimators under mild conditions and demonstrate their finite sample performance through a suite of simulation experiments and an illustrative application to data from a study of bipolar depression.
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Affiliation(s)
| | - Eric B Laber
- Department of Statistics, North Carolina State University, Raleigh, NC 27607, USA
| | - Siyeon Kim
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27607, USA
| | - Michael R Kosorok
- Departments of Biostatistics and Statistics & Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Affiliation(s)
- Yilun Sun
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Lu Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
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12
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Guan Q, Reich BJ, Laber EB, Bandyopadhyay D. Bayesian Nonparametric Policy Search with Application to Periodontal Recall Intervals. J Am Stat Assoc 2019; 115:1066-1078. [PMID: 33012901 PMCID: PMC7531024 DOI: 10.1080/01621459.2019.1660169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/18/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
Tooth loss from periodontal disease is a major public health burden in the United States. Standard clinical practice is to recommend a dental visit every six months; however, this practice is not evidence-based, and poor dental outcomes and increasing dental insurance premiums indicate room for improvement. We consider a tailored approach that recommends recall time based on patient characteristics and medical history to minimize disease progression without increasing resource expenditures. We formalize this method as a dynamic treatment regime which comprises a sequence of decisions, one per stage of intervention, that follow a decision rule which maps current patient information to a recommendation for their next visit time. The dynamics of periodontal health, visit frequency, and patient compliance are complex, yet the estimated optimal regime must be interpretable to domain experts if it is to be integrated into clinical practice. We combine non-parametric Bayesian dynamics modeling with policy-search algorithms to estimate the optimal dynamic treatment regime within an interpretable class of regimes. Both simulation experiments and application to a rich database of electronic dental records from the HealthPartners HMO shows that our proposed method leads to better dental health without increasing the average recommended recall time relative to competing methods.
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Affiliation(s)
- Qian Guan
- Department of Statistics, North Carolina State University, Raleigh, North Carolina
| | - Brian J. Reich
- Department of Statistics, North Carolina State University, Raleigh, North Carolina
| | - Eric B. Laber
- Department of Statistics, North Carolina State University, Raleigh, North Carolina
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Abstract
Precision medicine seeks to maximize the quality of healthcare by individualizing the healthcare process to the uniquely evolving health status of each patient. This endeavor spans a broad range of scientific areas including drug discovery, genetics/genomics, health communication, and causal inference all in support of evidence-based, i.e., data-driven, decision making. Precision medicine is formalized as a treatment regime which comprises a sequence of decision rules, one per decision point, which map up-to-date patient information to a recommended action. The potential actions could be the selection of which drug to use, the selection of dose, timing of administration, specific diet or exercise recommendation, or other aspects of treatment or care. Statistics research in precision medicine is broadly focused on methodological development for estimation of and inference for treatment regimes which maximize some cumulative clinical outcome. In this review, we provide an overview of this vibrant area of research and present important and emerging challenges.
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Affiliation(s)
- Michael R Kosorok
- Department of Biostatistics and Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 27599, U.S.A.;
| | - Eric B Laber
- Department of Statistics, North Carolina State University, Raleight, North Carolina, 27695, U.S.A.;
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