Identification of subpopulations with distinct treatment benefit rate using the Bayesian tree.

Pubmed ID: 27356196

Journal: Biometrical journal. Biometrische Zeitschrift

Publication Date: Nov. 1, 2016

Affiliation: Clinical Electrophysiology Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.

MeSH Terms: Humans, Bayes Theorem, Randomized Controlled Trials as Topic, Treatment Outcome, Computer Simulation, Models, Statistical, Patient Selection, Defibrillators, Implantable, Probability, Arrhythmias, Cardiac, Precision Medicine

Authors: Wang Y, Li X, Shen C, Hu Y, Chen PS, Buxton AE

Cite As: Shen C, Hu Y, Li X, Wang Y, Chen PS, Buxton AE. Identification of subpopulations with distinct treatment benefit rate using the Bayesian tree. Biom J 2016 Nov;58(6):1357-1375. Epub 2016 Jun 29.

Studies:

Abstract

Characterization of a subpopulation by the difference in marginal means of the outcome under the intervention and control may not be sufficient to provide informative guidance for individual decision and public policy making. Specifically, often we are interested in the treatment benefit rate (TBR), that is, the probability of benefitting an intervention in a meaningful way. For binary outcomes, TBR is the proportion that has "unfavorable" outcome under the control and "favorable" outcome under the intervention. Identification of subpopulations with distinct TBR by baseline characteristics will have significant implications in clinical setting where a medical intervention with potential negative health impact is under consideration for a given patient. In addition, these subpopulations with unique TBR set the basis for guidance in implementing the intervention toward a more personalized scheme of treatment. In this article, we propose a Bayesian tree based latent variable model to seek subpopulations with distinct TBR. Our method offers a nonparametric Bayesian framework that accounts for the uncertainty in estimating potential outcomes and allows more exhaustive search of the partitions of the baseline covariates space. The method is evaluated through a simulation study and applied to a randomized clinical trial of implantable cardioverter defibrillators to reduce mortality.