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Grady KL, Dew MA, Pagani FD, Spertus JA, Hsich E, Yuzefpolskaya M, Lampert B, Kirklin JK, Petty M, Kao A, Yancy C, Hartupee J, Pamboukian SV, Johnson M, Murray M, Wu T, Andrei AC. A comparison of quality-adjusted life years in older adults after heart transplantation versus long-term mechanical support: Findings from the SUSTAIN-IT study. J Heart Lung Transplant 2024:S1053-2498(24)01680-2. [PMID: 38762215 DOI: 10.1016/j.healun.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/19/2024] [Accepted: 05/12/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND The quality-adjusted life year (QALY) measures disease burden and treatment, combining overall survival and health-related quality of life (HRQOL). We estimated QALYs in 3 groups of older patients (60-80 years) with heart failure (HF) who underwent heart transplantation (HT, with pre-transplant mechanical circulatory support [HT MCS] or HT without pre-transplant MCS [HT Non-MCS]) or long-term MCS (destination therapy). We also identified factors associated with gains in QALYs through 24 months follow-up. METHODS Of 393 eligible patients enrolled (10/1/15-12/31/18) at 13 U.S. sites, 161 underwent HT (n = 68 HT MCS, n = 93 HT Non-MCS) and 144 underwent long-term MCS. Survival and HRQOL data were collected through 24 months. QALY health utilities were based on patient self-report of EQ-5D-3L dimensions. Mean-restricted QALYs were compared among groups using generalized linear models. RESULTS For the entire cohort, mean age in years closest to surgery was 67 (standard deviation, SD: 4.7), 78% were male, and 83% were White. By 18 months post-surgery, sustained significant differences in adjusted average ± SD QALYs emerged across groups, with the HT Non-MCS group having the highest average QALYs (24-month window: HT Non-MCS = 22.58 ± 1.1, HT MCS = 19.53 ± 1.33, Long-term MCS = 19.49 ± 1.3, p = 0.003). At 24 months post-operatively, a lower gain in QALYs was associated with HT MCS, long-term MCS, a lower pre-operative LVEF, NYHA class III or IV before surgery, and an ischemic or other etiology of HF. CONCLUSIONS Determination of QALYs may provide important information for policy makers and clinicians to consider regarding benefits of HT and long-term MCS as treatment options for older patients with HF.
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Affiliation(s)
- Kathleen L Grady
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois.
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - John A Spertus
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Eileen Hsich
- Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York
| | - Brent Lampert
- Department of Medicine, Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio
| | | | - Michael Petty
- Department of Nursing, University of Minnesota Medical Center, Fairview, Minnesota
| | - Andrew Kao
- Cardiovascular Disease, Advanced Heart Failure and Transplant Cardiology, St. Luke's Health System, Kansas City, Missouri
| | - Clyde Yancy
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Justin Hartupee
- Department of Medicine, Division of Cardiovascular Medicine, Washington University, St. Louis, Missouri
| | - Salpy V Pamboukian
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Maryl Johnson
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin, Madison, Wisconsin
| | - Margaret Murray
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin, Madison, Wisconsin
| | - Tingqing Wu
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
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Su CL, Chiou SH, Lin FC, Platt RW. Analysis of survival data with cure fraction and variable selection: A pseudo-observations approach. Stat Methods Med Res 2022; 31:2037-2053. [PMID: 35754373 PMCID: PMC9660265 DOI: 10.1177/09622802221108579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
In biomedical studies, survival data with a cure fraction (the proportion of
subjects cured of disease) are commonly encountered. The mixture cure and
bounded cumulative hazard models are two main types of cure fraction models when
analyzing survival data with long-term survivors. In this article, in the
framework of the Cox proportional hazards mixture cure model and bounded
cumulative hazard model, we propose several estimators utilizing
pseudo-observations to assess the effects of covariates on the cure rate and the
risk of having the event of interest for survival data with a cure fraction. A
variable selection procedure is also presented based on the pseudo-observations
using penalized generalized estimating equations for proportional hazards
mixture cure and bounded cumulative hazard models. Extensive simulation studies
are conducted to examine the proposed methods. The proposed technique is
demonstrated through applications to a melanoma study and a dental data set with
high-dimensional covariates.
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Affiliation(s)
- Chien-Lin Su
- Department of Epidemiology, Biostatistics and Occupational Health, 5620McGill University, Montréal, Québec, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Québec, Canada.,Peri and Post Approval Studies, Strategic and Scientific Affairs, PPD, part of Thermo Fisher Scientific, Montréal, Québec, Canada
| | - Sy Han Chiou
- Department of Mathematical Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Robert W Platt
- Department of Epidemiology, Biostatistics and Occupational Health, 5620McGill University, Montréal, Québec, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Québec, Canada
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3
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Dutta S, Halabi S. A semiparametric modeling approach for analyzing clinical biomarkers restricted to limits of detection. Pharm Stat 2021; 20:1061-1073. [PMID: 33855778 DOI: 10.1002/pst.2125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 01/14/2021] [Accepted: 03/22/2021] [Indexed: 11/08/2022]
Abstract
Before biomarkers can be used in clinical trials or patients' management, the laboratory assays that measure their levels have to go through development and analytical validation. One of the most critical performance metrics for validation of any assay is related to the minimum amount of values that can be detected and any value below this limit is referred to as below the limit of detection (LOD). Most of the existing approaches that model such biomarkers, restricted by LOD, are parametric in nature. These parametric models, however, heavily depend on the distributional assumptions, and can result in loss of precision under the model or the distributional misspecifications. Using an example from a prostate cancer clinical trial, we show how a critical relationship between serum androgen biomarker and a prognostic factor of overall survival is completely missed by the widely used parametric Tobit model. Motivated by this example, we implement a semiparametric approach, through a pseudo-value technique, that effectively captures the important relationship between the LOD restricted serum androgen and the prognostic factor. Our simulations show that the pseudo-value based semiparametric model outperforms a commonly used parametric model for modeling below LOD biomarkers by having lower mean square errors of estimation.
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Affiliation(s)
- Sandipan Dutta
- Department of Mathematics and Statistics, Old Dominion University, Norfolk, Virginia, USA
| | - Susan Halabi
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
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4
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Su CL, Platt RW, Plante JF. Causal inference for recurrent event data using pseudo-observations. Biostatistics 2020; 23:189-206. [PMID: 32432686 DOI: 10.1093/biostatistics/kxaa020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/13/2022] Open
Abstract
Recurrent event data are commonly encountered in observational studies where each subject may experience a particular event repeatedly over time. In this article, we aim to compare cumulative rate functions (CRFs) of two groups when treatment assignment may depend on the unbalanced distribution of confounders. Several estimators based on pseudo-observations are proposed to adjust for the confounding effects, namely inverse probability of treatment weighting estimator, regression model-based estimators, and doubly robust estimators. The proposed marginal regression estimator and doubly robust estimators based on pseudo-observations are shown to be consistent and asymptotically normal. A bootstrap approach is proposed for the variance estimation of the proposed estimators. Model diagnostic plots of residuals are presented to assess the goodness-of-fit for the proposed regression models. A family of adjusted two-sample pseudo-score tests is proposed to compare two CRFs. Simulation studies are conducted to assess finite sample performance of the proposed method. The proposed technique is demonstrated through an application to a hospital readmission data set.
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Affiliation(s)
- Chien-Lin Su
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University and Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Québec, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University and Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Québec, Canada
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5
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Xia M, Murray S, Tayob N. Regression analysis of recurrent-event-free time from multiple follow-up windows. Stat Med 2020; 39:1-15. [PMID: 31663647 DOI: 10.1002/sim.8385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/21/2019] [Accepted: 09/12/2019] [Indexed: 11/11/2022]
Abstract
This research develops multivariable restricted time models appropriate for analysis of recurrent events data, where data is repurposed into censored longitudinal time-to-first-event outcomes in τ-length follow-up windows. We develop two approaches for addressing the censored nature of the outcomes: a pseudo-observation (PO) approach and a multiple-imputation (MI) approach. Each of these approaches allows for complete data methods, such as generalized estimating equations, to be used for the analysis of the newly constructed correlated outcomes. Through simulation, this manuscript assesses the performance of the proposed PO and MI methods. Both PO and MI approaches show attractive results with either correlated or independent gap times in an individual. We also demonstrate how to apply the proposed methods in the data from azithromycin in Chronic Obstructive Pulmonary Disease Trial.
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Affiliation(s)
- Meng Xia
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Susan Murray
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Nabihah Tayob
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
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6
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Wang J. A simple, doubly robust, efficient estimator for survival functions using pseudo observations. Pharm Stat 2017; 17:38-48. [DOI: 10.1002/pst.1834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/01/2017] [Accepted: 09/18/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Jixian Wang
- Celgene International Sarl; Boudry Switzerland
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7
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Han S, Andrei AC, Tsui KW. A flexible semiparametric modeling approach for doubly censored data with an application to prostate cancer. Stat Methods Med Res 2016; 25:1718-35. [PMID: 23907782 PMCID: PMC8380435 DOI: 10.1177/0962280213498325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Doubly censored data often arise in medical studies of disease progression involving two related events for which both an originating and a terminating event are interval-censored. Although regression modeling for such doubly censored data may be complicated, we propose a simple semiparametric regression modeling strategy based on jackknife pseudo-observations obtained using nonparametric estimators of the survival function. Inference is carried out via generalized estimating equations. Simulations studies show that the proposed method produces virtually unbiased covariate effect estimates, even for moderate sample sizes. A prostate cancer study example illustrates the practical advantages of the proposed approach.
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Affiliation(s)
- Seungbong Han
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Adin-Cristian Andrei
- BCVI Clinical Trials Unit, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kam-Wah Tsui
- Department of Statistics, University of Wisconsin-Madison, Madison, WI, USA
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8
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Singer LG, Chowdhury NA, Faughnan ME, Granton J, Keshavjee S, Marras TK, Tullis DE, Waddell TK, Tomlinson G. Effects of Recipient Age and Diagnosis on Health-related Quality-of-Life Benefit of Lung Transplantation. Am J Respir Crit Care Med 2016; 192:965-73. [PMID: 26131729 DOI: 10.1164/rccm.201501-0126oc] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
RATIONALE The average age of lung transplant recipients is increasing, and the mix of recipient indications for transplantation is changing. OBJECTIVES To determine whether the health-related quality-of-life (HRQL) benefit of lung transplantation differs by recipient age and diagnosis. METHODS In this prospective cohort study, we obtained serial HRQL measurements in adults with advanced lung disease who subsequently underwent lung transplantation (2004-2012). HRQL assessments included the St. George's Respiratory Questionnaire, 36-Item Short-Form Health Survey (SF-36), EQ-5D, Standard Gamble, and Visual Analog Scale for current health. We used linear mixed effects models for associations between age or diagnosis and changes in HRQL with transplantation. To address potential survivorship bias, we fitted Markov models to the distribution of discrete post-transplant health states (HRQL better than pretransplant, not better, or dead) and estimated quality-adjusted life-years post-transplant. MEASUREMENTS AND MAIN RESULTS A total of 430 subjects were listed, 387 were transplanted, and 326 provided both pretransplant and post-transplant data. Transplantation conferred large improvements in all HRQL measures: St. George's change of -47 units (95% confidence interval, -48 to -44), 36-Item Short-Form Health Survey physical component summary score of 17.7 (16.5-18.9), EQ-5D of 0.27 (0.24-0.30), Standard Gamble of 0.48 (0.44-0.51), and Visual Analog of 44 (42-47). Age was not associated with meaningful differences in the HRQL benefits of transplantation. There was less HRQL benefit in interstitial lung disease than in cystic fibrosis. CONCLUSIONS Lung transplantation confers large HRQL benefits, which vary by recipient diagnosis, but do not differ substantially in older recipients.
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Affiliation(s)
- Lianne G Singer
- 1 Department of Medicine and.,2 University Health Network, Toronto, Ontario, Canada
| | | | - Marie E Faughnan
- 1 Department of Medicine and.,3 St. Michael's Hospital, Toronto, Ontario, Canada; and.,4 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - John Granton
- 1 Department of Medicine and.,2 University Health Network, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- 5 Department of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada.,2 University Health Network, Toronto, Ontario, Canada
| | - Theodore K Marras
- 1 Department of Medicine and.,2 University Health Network, Toronto, Ontario, Canada
| | - D Elizabeth Tullis
- 1 Department of Medicine and.,3 St. Michael's Hospital, Toronto, Ontario, Canada; and
| | - Thomas K Waddell
- 5 Department of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada.,2 University Health Network, Toronto, Ontario, Canada
| | - George Tomlinson
- 1 Department of Medicine and.,2 University Health Network, Toronto, Ontario, Canada
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Tattar PN, Vaman HJ. The k-sample problem in a multi-state model and testing transition probability matrices. LIFETIME DATA ANALYSIS 2014; 20:387-403. [PMID: 23722306 DOI: 10.1007/s10985-013-9267-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 05/16/2013] [Indexed: 06/02/2023]
Abstract
The choice of multi-state models is natural in analysis of survival data, e.g., when the subjects in a study pass through different states like 'healthy', 'in a state of remission', 'relapse' or 'dead' in a health related quality of life study. Competing risks is another common instance of the use of multi-state models. Statistical inference for such event history data can be carried out by assuming a stochastic process model. Under such a setting, comparison of the event history data generated by two different treatments calls for testing equality of the corresponding transition probability matrices. The present paper proposes solution to this class of problems by assuming a non-homogeneous Markov process to describe the transitions among the health states. A class of test statistics are derived for comparison of [Formula: see text] treatments by using a 'weight process'. This class, in particular, yields generalisations of the log-rank, Gehan, Peto-Peto and Harrington-Fleming tests. For an intrinsic comparison of the treatments, the 'leave-one-out' jackknife method is employed for identifying influential observations. The proposed methods are then used to develop the Kolmogorov-Smirnov type supremum tests corresponding to the various extended tests. To demonstrate the usefulness of the test procedures developed, a simulation study was carried out and an application to the Trial V data provided by International Breast Cancer Study Group is discussed.
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Affiliation(s)
- Prabhanjan N Tattar
- Dell International Services, 121, 122A, 131A, Divyasree Greens Koramangala Inner Ring Road, Challaghatta, Varthur Hobli, Bangalore, 560071, Karnataka, India,
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Tate WR, Skrepnek GH. Quality-adjusted time without symptoms or toxicity (Q-TWiST): patient-reported outcome or mathematical model? A systematic review in cancer. Psychooncology 2014; 24:253-61. [PMID: 24917078 DOI: 10.1002/pon.3595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 05/09/2014] [Accepted: 05/16/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Successful cancer treatment is defined as an increase in overall survival and/or progression-free survival. Despite their importance, these metrics omit patient quality of life. Quality-adjusted time without symptoms or toxicity (Q-TWiST) was developed to adjust survival gained, accounting for quality of life. The purpose of this systematic review was to assess the methods reported in cancer literature to determine Q-TWiST values and how these are currently translated to the clinic. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used to conduct a systematic review of studies indexed on MEDLINE and Web of Science through April 2013. Cancer studies that measured Q-TWiST either as a primary outcome or retrospectively and determined utility coefficients from a patient population were identified, and their methods reviewed to determine how the utility coefficient was calculated. Additionally, other relevant factors such as definitions of health states and significant findings were collected and summarized. RESULTS Out of 284 studies, 11 were identified that calculated patient-defined utility coefficients. Several methods to determine utility coefficients were reported, and multiple definitions of health state toxicity were applied. Of these studies, seven reported significant differences (p < 0.05) in quality-adjusted survival. No studies, however, directly discussed the clinical relevance of their findings. CONCLUSIONS Currently, Q-TWiST is utilized as a mathematical theory rather than a clinical tool. Standardization of terminology plus reliability and validity testing of determining both utility coefficients and time frame definitions must be performed before Q-TWiST can become clinically useful to physicians and patients alike for making treatment decisions.
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Affiliation(s)
- Wendy R Tate
- College of Pharmacy, The University of Arizona, Tucson, AZ, USA; The University of Arizona Cancer Center, The University of Arizona, Tucson, AZ, USA
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Han S, Andrei AC, Tsui KW. A Semiparametric Regression Method for Interval-Censored Data. COMMUN STAT-SIMUL C 2013. [DOI: 10.1080/03610918.2012.697962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Han S, Andrei AC, Tsui KW. A Flexible Modeling Approach for Current Status Survival Data via Pseudo-Observations. KOREAN JOURNAL OF APPLIED STATISTICS 2012. [DOI: 10.5351/kjas.2012.25.6.947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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13
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Cutpoint selection for discretizing a continuous covariate for generalized estimating equations. Comput Stat Data Anal 2011; 55:226-235. [DOI: 10.1016/j.csda.2010.02.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
We review recent work on the application of pseudo-observations in survival and event history analysis. This includes regression models for parameters like the survival function in a single point, the restricted mean survival time and transition or state occupation probabilities in multi-state models, e.g. the competing risks cumulative incidence function. Graphical and numerical methods for assessing goodness-of-fit for hazard regression models and for the Fine—Gray model in competing risks studies based on pseudo-observations are also reviewed. Sensitivity to covariate-dependent censoring is studied. The methods are illustrated using a data set from bone marrow transplantation.
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Affiliation(s)
- Per Kragh Andersen
- Department of Biostatistics, University of Copenhagen, O. Farimagsgade 5, PB 2099, DK 1014 Copenhagen K, Denmark,
| | - Maja Pohar Perme
- Department of Biomedical Informatics, University of Ljubljana, Vrazov trg 2, SI-1000 Ljubljana, Slovenia
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