Fast Bayesian inference using Laplace approximations in a flexible promotion time cure model based on P-splines

Bayesian design of multi-regional clinical trials with time-to-event endpoints

Sponsors often rely on multi-regional clinical trials (MRCTs) to introduce new treatments more rapidly into the global market. Many commonly used statistical methods do not account for regional differences, and small regional sample sizes frequently result in lower estimation quality of region-specific treatment effects. The International Council for Harmonization E17 guidelines suggest consideration of methods that allow for information borrowing across regions to improve estimation. In response to these guidelines, we develop a novel methodology to estimate global and region-specific treatment effects from MRCTs with time-to-event endpoints using Bayesian model averaging (BMA). This approach accounts for the possibility of heterogeneous treatment effects between regions, and we discuss how to assess the consistency of these effects using posterior model probabilities. We obtain posterior samples of the treatment effects using a Laplace approximation, and we show through simulation studies that the proposed modeling approach estimates region-specific treatment effects with lower mean squared error than a Cox proportional hazards model while resulting in a similar rejection rate of the global treatment effect. We then apply the BMA approach to data from the LEADER trial, an MRCT designed to evaluate the cardiovascular safety of an anti-diabetic treatment.

An approximate Bayesian approach for estimation of the instantaneous reproduction number under misreported epidemic data

In epidemic models, the effective reproduction number is of central importance to assess the transmission dynamics of an infectious disease and to orient health intervention strategies. Publicly shared data during an outbreak often suffers from two sources of misreporting (underreporting and delay in reporting) that should not be overlooked when estimating epidemiological parameters. The main statistical challenge in models that intrinsically account for a misreporting process lies in the joint estimation of the time-varying reproduction number and the delay/underreporting parameters. Existing Bayesian approaches typically rely on Markov chain Monte Carlo algorithms that are extremely costly from a computational perspective. We propose a much faster alternative based on Laplacian-P-splines (LPS) that combines Bayesian penalized B-splines for flexible and smooth estimation of the instantaneous reproduction number and Laplace approximations to selected posterior distributions for fast computation. Assuming a known generation interval distribution, the incidence at a given calendar time is governed by the epidemic renewal equation and the delay structure is specified through a composite link framework. Laplace approximations to the conditional posterior of the spline vector are obtained from analytical versions of the gradient and Hessian of the log-likelihood, implying a drastic speed-up in the computation of posterior estimates. Furthermore, the proposed LPS approach can be used to obtain point estimates and approximate credible intervals for the delay and reporting probabilities. Simulation of epidemics with different combinations for the underreporting rate and delay structure (one-day, two-day, and weekend delays) show that the proposed LPS methodology delivers fast and accurate estimates outperforming existing methods that do not take into account underreporting and delay patterns. Finally, LPS is illustrated in two real case studies of epidemic outbreaks.

Laplacian‐P‐splines for Bayesian inference in the mixture cure model

The mixture cure model for analyzing survival data is characterized by the assumption that the population under study is divided into a group of subjects who will experience the event of interest over some finite time horizon and another group of cured subjects who will never experience the event irrespective of the duration of follow‐up. When using the Bayesian paradigm for inference in survival models with a cure fraction, it is common practice to rely on Markov chain Monte Carlo (MCMC) methods to sample from posterior distributions. Although computationally feasible, the iterative nature of MCMC often implies long sampling times to explore the target space with chains that may suffer from slow convergence and poor mixing. Furthermore, extra efforts have to be invested in diagnostic checks to monitor the reliability of the generated posterior samples. A sampling‐free strategy for fast and flexible Bayesian inference in the mixture cure model is suggested in this article by combining Laplace approximations and penalized B‐splines. A logistic regression model is assumed for the cure proportion and a Cox proportional hazards model with a P‐spline approximated baseline hazard is used to specify the conditional survival function of susceptible subjects. Laplace approximations to the posterior conditional latent vector are based on analytical formulas for the gradient and Hessian of the log‐likelihood, resulting in a substantial speed‐up in approximating posterior distributions. The spline specification yields smooth estimates of survival curves and functions of latent variables together with their associated credible interval are estimated in seconds. A fully stochastic algorithm based on a Metropolis‐Langevin‐within‐Gibbs sampler is also suggested as an alternative to the proposed Laplacian‐P‐splines mixture cure (LPSMC) methodology. The statistical performance and computational efficiency of LPSMC is assessed in a simulation study. Results show that LPSMC is an appealing alternative to MCMC for approximate Bayesian inference in standard mixture cure models. Finally, the novel LPSMC approach is illustrated on three applications involving real survival data.

On the use of the modified power series family of distributions in a cure rate model context

In this paper, we propose a generalization of the power series cure rate model for the number of competing causes related to the occurrence of the event of interest. The model includes distributions not yet used in the cure rate models context, such as the Borel, Haight and Restricted Generalized Poisson distributions. The model is conveniently parameterized in terms of the cure rate. Maximum likelihood estimation based on the Expectation Maximization algorithm is discussed. A simulation study designed to assess some properties of the estimators is carried out, showing the good performance of the proposed estimation procedure in finite samples. Finally, an application to a bone marrow transplant data set is presented.

Estimation and identification issues in the promotion time cure model when the same covariates influence long- and short-term survival

The promotion time cure model is a survival model acknowledging that an unidentified proportion of subjects will never experience the event of interest whatever the duration of the follow-up. We focus our interest on the challenges raised by the strong posterior correlation between some of the regression parameters when the same covariates influence long- and short-term survival. Then, the regression parameters of shared covariates are strongly correlated with, in addition, identification issues when the maximum follow-up duration is insufficiently long to identify the cured fraction. We investigate how, despite this, plausible values for these parameters can be obtained in a computationally efficient way. The theoretical properties of our strategy will be investigated by simulation and illustrated on clinical data. Practical recommendations will also be made for the analysis of survival data known to include an unidentified cured fraction.