arXiv subjects

Eric B. Laber

Publications and source records attributed to Eric B. Laber.

25 records · Page 2Linked to original sources

arXiv2015

Interactive Q-learning for Probabilities and Quantiles

A dynamic treatment regime is a sequence of decision rules in which each decision rule recommends treatment based on features of patient medical history such as past treatments and outcomes. Existing methods for estimating optimal dynamic treatment regimes from data optimize the mean of a response variable. However, the mean may not always be the most appropriate summary of performance. We derive estimators of decision rules for optimizing probabilities and quantiles computed with respect to the response distribution for two-stage, binary treatment settings. This enables estimation of dynamic treatment regimes that optimize the cumulative distribution function of the response at a prespecified point or a prespecified quantile of the response distribution such as the median. The proposed methods perform favorably in simulation experiments. We illustrate our approach with data from a sequentially randomized trial where the primary outcome is remission of depression symptoms.

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arXiv2015

Using Decision Lists to Construct Interpretable and Parsimonious Treatment Regimes

A treatment regime formalizes personalized medicine as a function from individual patient characteristics to a recommended treatment. A high-quality treatment regime can improve patient outcomes while reducing cost, resource consumption, and treatment burden. Thus, there is tremendous interest in estimating treatment regimes from observational and randomized studies. However, the development of treatment regimes for application in clinical practice requires the long-term, joint effort of statisticians and clinical scientists. In this collaborative process, the statistician must integrate clinical science into the statistical models underlying a treatment regime and the clinician must scrutinize the estimated treatment regime for scientific validity. To facilitate meaningful information exchange, it is important that estimated treatment regimes be interpretable in a subject-matter context. We propose a simple, yet flexible class of treatment regimes whose members are representable as a short list of if-then statements. Regimes in this class are immediately interpretable and are therefore an appealing choice for broad application in practice. We derive a robust estimator of the optimal regime within this class and demonstrate its finite sample performance using simulation experiments. The proposed method is illustrated with data from two clinical trials.

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arXiv2015

$Q$- and $A$-Learning Methods for Estimating Optimal Dynamic Treatment Regimes

In clinical practice, physicians make a series of treatment decisions over the course of a patient's disease based on his/her baseline and evolving characteristics. A dynamic treatment regime is a set of sequential decision rules that operationalizes this process. Each rule corresponds to a decision point and dictates the next treatment action based on the accrued information. Using existing data, a key goal is estimating the optimal regime, that, if followed by the patient population, would yield the most favorable outcome on average. Q- and A-learning are two main approaches for this purpose. We provide a detailed account of these methods, study their performance, and illustrate them using data from a depression study.

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arXiv2013

Statistical Inference in Dynamic Treatment Regimes

Dynamic treatment regimes are of growing interest across the clinical sciences as these regimes provide one way to operationalize and thus inform sequential personalized clinical decision making. A dynamic treatment regime is a sequence of decision rules, with a decision rule per stage of clinical intervention; each decision rule maps up-to-date patient information to a recommended treatment. We briefly review a variety of approaches for using data to construct the decision rules. We then review an interesting challenge, that of nonregularity that often arises in this area. By nonregularity, we mean the parameters indexing the optimal dynamic treatment regime are nonsmooth functionals of the underlying generative distribution. A consequence is that no regular or asymptotically unbiased estimator of these parameters exists. Nonregularity arises in inference for parameters in the optimal dynamic treatment regime; we illustrate the effect of nonregularity on asymptotic bias and via sensitivity of asymptotic, limiting, distributions to local perturbations. We propose and evaluate a locally consistent Adaptive Confidence Interval (ACI) for the parameters of the optimal dynamic treatment regime. We use data from the Adaptive Interventions for Children with ADHD study as an illustrative example. We conclude by highlighting and discussing emerging theoretical problems in this area.

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arXiv2012

Set-valued dynamic treatment regimes for competing outcomes

Dynamic treatment regimes operationalize the clinical decision process as a sequence of functions, one for each clinical decision, where each function takes as input up-to-date patient information and gives as output a single recommended treatment. Current methods for estimating optimal dynamic treatment regimes, for example Q-learning, require the specification of a single outcome by which the `goodness' of competing dynamic treatment regimes are measured. However, this is an over-simplification of the goal of clinical decision making, which aims to balance several potentially competing outcomes. For example, often a balance must be struck between treatment effectiveness and side-effect burden. We propose a method for constructing dynamic treatment regimes that accommodates competing outcomes by recommending sets of treatments at each decision point. Formally, we construct a sequence of set-valued functions that take as input up-to-date patient information and give as output a recommended subset of the possible treatments. For a given patient history, the recommended set of treatments contains all treatments that are not inferior according to any of the competing outcomes. When there is more than one decision point, constructing these set-valued functions requires solving a non-trivial enumeration problem. We offer an exact enumeration algorithm by recasting the problem as a linear mixed integer program. The proposed methods are illustrated using data from a depression study and the CATIE schizophrenia study.

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arXiv2012

Small Sample Inference for Generalization Error in Classification Using the CUD Bound

Confidence measures for the generalization error are crucial when small training samples are used to construct classifiers. A common approach is to estimate the generalization error by resampling and then assume the resampled estimator follows a known distribution to form a confidence set [Kohavi 1995, Martin 1996,Yang 2006]. Alternatively, one might bootstrap the resampled estimator of the generalization error to form a confidence set. Unfortunately, these methods do not reliably provide sets of the desired confidence. The poor performance appears to be due to the lack of smoothness of the generalization error as a function of the learned classifier. This results in a non-normal distribution of the estimated generalization error. We construct a confidence set for the generalization error by use of a smooth upper bound on the deviation between the resampled estimate and generalization error. The confidence set is formed by bootstrapping this upper bound. In cases in which the approximation class for the classifier can be represented as a parametric additive model, we provide a computationally efficient algorithm. This method exhibits superior performance across a series of test and simulated data sets.

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arXiv2012

An imputation method for estimating the learning curve in classification problems

The learning curve expresses the error rate of a predictive modeling procedure as a function of the sample size of the training dataset. It typically is a decreasing, convex function with a positive limiting value. An estimate of the learning curve can be used to assess whether a modeling procedure should be expected to become substantially more accurate if additional training data become available. This article proposes a new procedure for estimating learning curves using imputation. We focus on classification, although the idea is applicable to other predictive modeling settings. Simulation studies indicate that the learning curve can be estimated with useful accuracy for a roughly four-fold increase in the size of the training set relative to the available data, and that the proposed imputation approach outperforms an alternative estimation approach based on parameterizing the learning curve. We illustrate the method with an application that predicts the risk of disease progression for people with chronic lymphocytic leukemia.

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