Risk controlled decision trees and random forests for precision Medicine

Machine learning approaches to evaluate heterogeneous treatment effects in randomized controlled trials: a scoping review

BACKGROUND AND OBJECTIVES

Estimating heterogeneous treatment effects (HTEs) in randomized controlled trials (RCTs) has received substantial attention recently. This has led to the development of several statistical and machine learning (ML) algorithms to assess HTEs through identifying individualized treatment effects. However, a comprehensive review of these algorithms is lacking. We thus aimed to catalog and outline currently available statistical and ML methods for identifying HTEs via effect modeling using clinical RCT data and summarize how they have been applied in practice.

STUDY DESIGN AND SETTING

We performed a scoping review using prespecified search terms in MEDLINE and Embase, aiming to identify studies that assessed HTEs using advanced statistical and ML methods in RCT data published from 2010 to 2022.

RESULTS

Among a total of 32 studies identified in the review, 17 studies applied existing algorithms to RCT data, and 15 extended existing algorithms or proposed new algorithms. Applied algorithms included penalized regression, causal forest, Bayesian causal forest, and other metalearner frameworks. Of these methods, causal forest was the most frequently used (7 studies) followed by Bayesian causal forest (4 studies). Most applications were in cardiology (6 studies), followed by psychiatry (4 studies). We provide example R codes in simulated data to illustrate how to implement these algorithms.

CONCLUSION

This review identified and outlined various algorithms currently used to identify HTEs and individualized treatment effects in RCT data. Given the increasing availability of new algorithms, analysts should carefully select them after examining model performance and considering how the models will be used in practice.

Modern approaches for evaluating treatment effect heterogeneity from clinical trials and observational data

In this paper, we review recent advances in statistical methods for the evaluation of the heterogeneity of treatment effects (HTE), including subgroup identification and estimation of individualized treatment regimens, from randomized clinical trials and observational studies. We identify several types of approaches using the features introduced in Lipkovich et al (Stat Med 2017;36: 136-196) that distinguish the recommended principled methods from basic methods for HTE evaluation that typically rely on rules of thumb and general guidelines (the methods are often referred to as common practices). We discuss the advantages and disadvantages of various principled methods as well as common measures for evaluating their performance. We use simulated data and a case study based on a historical clinical trial to illustrate several new approaches to HTE evaluation.

Research on landslide susceptibility prediction model based on LSTM-RF-MDBN

The occurrence of landslide disasters causes huge economic losses and casualties. Although many achievements have been made in predicting the probability of landslide disasters, various factors such as the scale and spatial location of landslide geological disasters should still be fully considered. Further research on how to quantitatively characterize the susceptibility of landslide geological disasters is necessarily important. To this end, taking the Wenchuan earthquake as the research area and extracting eight influencing factors, including terrain information entropy (Ht), lithology, distance from rivers, distance from faults, vegetation coverage (NDVI), distance from roads, peak ground motion acceleration (PGA), and annual rainfall, a landslide susceptibility prediction model was hereby established based on LSTM-RF-MDBN, a landslide susceptibility prediction map was drawn, and the spatial distribution characteristics of landslide disasters were analyzed. The results showed that (1) LSTM had good prediction results for the eight influencing factors, with an average prediction accuracy of 85%; (2) compared with models such as DNN and LR for predicting landslide disaster points, the AUC value of RF for predicting landslide point positions reached 0.88, presenting a higher accuracy compared to other models; (3) the AUC value of the landslide susceptibility prediction model based on LSTM-RF-MDBN reached 0.965, which had a high accuracy in predicting landslide susceptibility. Overall, the research results can provide a scientific basis for selecting the best strategy for landslide disaster warning, prevention, and mitigation.

A predictive model for lung cancer screening nonadherence in a community setting health-care network

BACKGROUND

Lung cancer screening (LCS) decreases lung cancer mortality. However, its benefit may be limited by nonadherence to screening. Although factors associated with LCS nonadherence have been identified, to the best of our knowledge, no predictive models have been developed to predict LCS nonadherence. The purpose of this study was to develop a predictive model leveraging a machine learning model to predict LCS nonadherence risk.

METHODS

A retrospective cohort of patients who enrolled in our LCS program between 2015 and 2018 was used to develop a model to predict the risk of nonadherence to annual LCS after the baseline examination. Clinical and demographic data were used to fit logistic regression, random forest, and gradient-boosting models that were internally validated on the basis of accuracy and area under the receiver operating curve.

RESULTS

A total of 1875 individuals with baseline LCS were included in the analysis, with 1264 (67.4%) as nonadherent. Nonadherence was defined on the basis of baseline chest computed tomography (CT) findings. Clinical and demographic predictors were used on the basis of availability and statistical significance. The gradient-boosting model had the highest area under the receiver operating curve (0.89, 95% confidence interval = 0.87 to 0.90), with a mean accuracy of 0.82. Referral specialty, insurance type, and baseline Lung CT Screening Reporting & Data System (LungRADS) score were the best predictors of nonadherence to LCS.

CONCLUSIONS

We developed a machine learning model using readily available clinical and demographic data to predict LCS nonadherence with high accuracy and discrimination. After further prospective validation, this model can be used to identify patients for interventions to improve LCS adherence and decrease lung cancer burden.

CAPITAL: Optimal subgroup identification via constrained policy tree search

Personalized medicine, a paradigm of medicine tailored to a patient's characteristics, is an increasingly attractive field in health care. An important goal of personalized medicine is to identify a subgroup of patients, based on baseline covariates, that benefits more from the targeted treatment than other comparative treatments. Most of the current subgroup identification methods only focus on obtaining a subgroup with an enhanced treatment effect without paying attention to subgroup size. Yet, a clinically meaningful subgroup learning approach should identify the maximum number of patients who can benefit from the better treatment. In this article, we present an optimal subgroup selection rule (SSR) that maximizes the number of selected patients, and in the meantime, achieves the pre‐specified clinically meaningful mean outcome, such as the average treatment effect. We derive two equivalent theoretical forms of the optimal SSR based on the contrast function that describes the treatment‐covariates interaction in the outcome. We further propose a constrained policy tree search algorithm (CAPITAL) to find the optimal SSR within the interpretable decision tree class. The proposed method is flexible to handle multiple constraints that penalize the inclusion of patients with negative treatment effects, and to address time to event data using the restricted mean survival time as the clinically interesting mean outcome. Extensive simulations, comparison studies, and real data applications are conducted to demonstrate the validity and utility of our method.