arXiv subjects

Daniel Rodriguez Duque

Publications and source records attributed to Daniel Rodriguez Duque.

2 recordsLinked to original sources

arXiv2023

Bayesian inference for optimal dynamic treatment regimes in practice

In this work, we examine recently developed methods for Bayesian inference of optimal dynamic treatment regimes (DTRs). DTRs are a set of treatment decision rules aimed at tailoring patient care to patient-specific characteristics, thereby falling within the realm of precision medicine. In this field, researchers seek to tailor therapy with the intention of improving health outcomes; therefore, they are most interested in identifying optimal DTRs. Recent work has developed Bayesian methods for identifying optimal DTRs in a family indexed by $ψ$ via Bayesian dynamic marginal structural models (MSMs) (Rodriguez Duque et al., 2022a); we review the proposed estimation procedure and illustrate its use via the new BayesDTR R package. Although methods in (Rodriguez Duque et al., 2022a) can estimate optimal DTRs well, they may lead to biased estimators when the model for the expected outcome if everyone in a population were to follow a given treatment strategy, known as a value function, is misspecified or when a grid search for the optimum is employed. We describe recent work that uses a Gaussian process ($GP$) prior on the value function as a means to robustly identify optimal DTRs (Rodriguez Duque et al., 2022b). We demonstrate how a $GP$ approach may be implemented with the BayesDTR package and contrast it with other value-search approaches to identifying optimal DTRs. We use data from an HIV therapeutic trial in order to illustrate a standard analysis with these methods, using both the original observed trial data and an additional simulated component to showcase a longitudinal (two-stage DTR) analysis.

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arXiv2022

Estimation of Optimal Dynamic Treatment Regimes using Gaussian Process Emulation

In precision medicine, identifying optimal sequences of decision rules, termed dynamic treatment regimes (DTRs), is an important undertaking. One approach investigators may take to infer about optimal DTRs is via Bayesian dynamic Marginal Structural Models (MSMs). These models represent the expected outcome under adherence to a DTR for DTRs in a family indexed by a parameter $ ψ$; the function mapping regimes in the family to the expected outcome under adherence to a DTR is known as the value function. Models that allow for the straightforward identification of an optimal DTR may lead to biased estimates. If such a model is computationally tractable, common wisdom says that a grid-search for the optimal DTR may obviate this difficulty. In a Bayesian context, computational difficulties may be compounded if a posterior mean must be calculated at each grid point. We seek to alleviate these inferential challenges by implementing Gaussian Process ($ \mathcal{GP} $) optimization methods for estimators for the causal effect of adherence to a specified DTR. We examine how to identify optimal DTRs in settings where the value function is multi-modal, which are often not addressed in the DTR literature. We conclude that a $ \mathcal{GP} $ modeling approach that acknowledges noise in the estimated response surface leads to improved results. Additionally, we find that a grid-search may not always yield a robust solution and that it is often less efficient than a $ \mathcal{GP} $ approach. We illustrate the use of the proposed methods by analyzing a clinical dataset with the aim of quantifying the effect of different patterns of HIV therapy.

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