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Kavelaars X, Mulder J, Kaptein M. Bayesian Multivariate Logistic Regression for Superiority and Inferiority Decision-Making under Observable Treatment Heterogeneity. Multivariate Behav Res 2024:1-24. [PMID: 38733304 DOI: 10.1080/00273171.2024.2337340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
The effects of treatments may differ between persons with different characteristics. Addressing such treatment heterogeneity is crucial to investigate whether patients with specific characteristics are likely to benefit from a new treatment. The current paper presents a novel Bayesian method for superiority decision-making in the context of randomized controlled trials with multivariate binary responses and heterogeneous treatment effects. The framework is based on three elements: a) Bayesian multivariate logistic regression analysis with a Pólya-Gamma expansion; b) a transformation procedure to transfer obtained regression coefficients to a more intuitive multivariate probability scale (i.e., success probabilities and the differences between them); and c) a compatible decision procedure for treatment comparison with prespecified decision error rates. Procedures for a priori sample size estimation under a non-informative prior distribution are included. A numerical evaluation demonstrated that decisions based on a priori sample size estimation resulted in anticipated error rates among the trial population as well as subpopulations. Further, average and conditional treatment effect parameters could be estimated unbiasedly when the sample was large enough. Illustration with the International Stroke Trial dataset revealed a trend toward heterogeneous effects among stroke patients: Something that would have remained undetected when analyses were limited to average treatment effects.
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Affiliation(s)
- Xynthia Kavelaars
- Department of Methodology and Statistics, Tilburg University
- Department of Theory, Methodology and Statistics, Open University of the Netherlands
| | - Joris Mulder
- Department of Methodology and Statistics, Tilburg University
| | - Maurits Kaptein
- Eindhoven University of Technology, Mathematics and Computer Science
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Segal JB, Varadhan R, Groenwold RH, Henderson NC, Li X, Nomura K, Kaplan S, Ardeshirrouhanifard S, Heyward J, Nyberg F, Burcu M. Assessing Heterogeneity of Treatment Effect in Real-World Data. Ann Intern Med 2023; 176:536-544. [PMID: 36940440 PMCID: PMC10273137 DOI: 10.7326/m22-1510] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
Increasing availability of real-world data (RWD) generated from patient care enables the generation of evidence to inform clinical decisions for subpopulations of patients and perhaps even individuals. There is growing opportunity to identify important heterogeneity of treatment effects (HTE) in these subgroups. Thus, HTE is relevant to all with interest in patients' responses to interventions, including regulators who must make decisions about products when signals of harms arise postapproval and payers who make coverage decisions based on expected net benefit to their beneficiaries. Prior work discussed HTE in randomized studies. Here, we address methodological considerations when investigating HTE in observational studies. We propose 4 primary goals of HTE analyses and the corresponding approaches in the context of RWD: to confirm subgroup effects, to describe the magnitude of HTE, to discover clinically important subgroups, and to predict individual effects. We discuss other possible goals including exploring prognostic score- and propensity score-based treatment effects, and testing the transportability of trial results to populations different from trial participants. Finally, we outline methodological needs for enhancing real-world HTE analysis.
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Affiliation(s)
- Jodi B. Segal
- Johns Hopkins University School of Medicine, Baltimore, and Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Ravi Varadhan
- Johns Hopkins University School of Medicine, Baltimore, and Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Xiaojuan Li
- Harvard Medical School Department of Population Medicine and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Kaori Nomura
- Jikei University School of Medicine, Tokyo, Japan
| | - Sigal Kaplan
- Teva Pharmaceutical Industries, Petah Tikva, Israel
| | | | - James Heyward
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Chen SL, Ho CY, Lin WC, Lee CW, Chen YC, Chen JL, Chen HY. The Characteristics and Mortality of Chinese Herbal Medicine Users among Newly Diagnosed Inoperable Huge Hepatocellular Carcinoma (≥10 cm) Patients: A Retrospective Cohort Study with Exploration of Core Herbs. Int J Environ Res Public Health 2022; 19:ijerph191912480. [PMID: 36231778 PMCID: PMC9564474 DOI: 10.3390/ijerph191912480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 05/03/2023]
Abstract
For patients with inoperable huge hepatocellular carcinoma (H-HCC, tumor size ≥10 cm), treatment options are limited. This study aimed to evaluate the characteristics and outcomes of patients with H-HCC who use Chinese herbal medicine (CHM). Multi-institutional cohort data were obtained from the Chang Gung Research Database (CGRD) between 1 January 2002 and 31 December 2018. All patients were followed up for 3 years or until the occurrence of death. Characteristics of CHM users and risk of all-cause mortality were assessed, and core CHMs with potential pharmacologic pathways were explored. Among 1618 patients, clinical features of CHM users (88) and nonusers (1530) were similar except for lower serum α-fetoprotein (AFP) and higher serum albumin levels in CHM users. CHM users had significantly higher 3 year overall survival rates (15.0% vs. 9.7%) and 3 year liver-specific survival rates (13.4% vs. 10.7%), about 3 months longer median survival time, and lower risk of all-cause mortality. Core CHMs were discovered from the prescriptions, including Hedyotis diffusa Willd combined with Scutellaria barbata D.Don, Salvia miltiorrhiza Bunge., Curcuma longa L., Rheum palmatum L., and Astragalus mongholicus Bunge. CHM use appears safe and is possibly beneficial for inoperable H-HCC patients; however, further clinical trials are still required.
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Affiliation(s)
- Shu-Ling Chen
- Division of Chinese Internal and Pediatric Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan Branch, Taoyuan 333, Taiwan
| | - Chia-Ying Ho
- Division of Chinese Internal and Pediatric Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan Branch, Taoyuan 333, Taiwan
| | - Wei-Chun Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
| | - Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Guishan, Taoyuan 333, Taiwan
| | - Yu-Chun Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei 112, Taiwan
| | - Jiun-Liang Chen
- Division of Chinese Internal and Pediatric Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan Branch, Taoyuan 333, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsing-Yu Chen
- Division of Chinese Internal and Pediatric Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan Branch, Taoyuan 333, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: ; Tel.: +886-975366119; Fax: +886-3-3298995
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Austin PC. Bootstrap vs asymptotic variance estimation when using propensity score weighting with continuous and binary outcomes. Stat Med 2022; 41:4426-4443. [PMID: 35841200 PMCID: PMC9544125 DOI: 10.1002/sim.9519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 11/07/2022]
Abstract
We used Monte Carlo simulations to compare the performance of asymptotic variance estimators to that of the bootstrap when estimating standard errors of differences in means, risk differences, and relative risks using propensity score weighting. We considered four different sets of weights: conventional inverse probability of treatment weights with the average treatment effect (ATE) as the target estimand, weights for estimating the average treatment effect in the treated (ATT), matching weights, and overlap weights. We considered sample sizes ranging from 250 to 10 000 and allowed the prevalence of treatment to range from 0.1 to 0.9. We found that, when using ATE weights and sample sizes were ≤ 1000, then the use of the bootstrap resulted in estimates of SE that were more accurate than the asymptotic estimates. A similar finding was observed when using ATT weights and sample sizes were ≤ 1000 and the prevalence of treatment was moderate to high. When using matching weights and overlap weights, both the asymptotic estimator and the bootstrap resulted in accurate estimates of SE across all sample sizes and prevalences of treatment. Even when using the bootstrap with ATE weights, empirical coverage rates of confidence intervals were suboptimal when sample sizes were low to moderate and the prevalence of treatment was either very low or very high. A similar finding was observed when using the bootstrap with ATT weights when sample sizes were low to moderate and the prevalence of treatment was very high.
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Affiliation(s)
- Peter C Austin
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
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