Incorporating historical information into the design and analysis of a new clinical trial has been the subject of much recent discussion. For example, in the context of clinical trials of antibiotics for drug resistant infections, where patients with specific infections can be difficult to recruit, there is often only limited and heterogeneous information available from the historical trials. To make the best use of the combined information at hand, we consider an approach based on the multiple power prior which allows the prior weight of each historical study to be chosen adaptively by empirical Bayes. This choice of weight has advantages in that it varies commensurably with differences in the historical and current data and can choose weights near 1 if the data from the corresponding historical study are similar enough to the data from the current study. Fully Bayesian approaches are also considered. The methods are applied to data from antibiotics trials. An analysis of the operating characteristics in a binomial setting shows that the proposed empirical Bayes adaptive method works well, compared to several alternative approaches, including the meta-analytic prior.
We develop the scale transformed power prior for settings where historical and current data involve different data types, such as binary and continuous data, respectively. This situation arises often in clinical trials, for example, when historical data involve binary responses and the current data involve time-to-event or some other type of continuous or discrete outcome. The power prior proposed by Ibrahim and Chen (2000) does not address the issue of different data types. Herein, we develop a new type of power prior, which we call the scale transformed power prior (straPP). The straPP is co…
In precision medicine, Dynamic Treatment Regimes (DTRs) are treatment protocols that adapt over time in response to a patient's observed characteristics. A DTR is a set of decision functions that takes an individual patient's information as arguments and outputs an action to be taken. Building on observed data, the aim is to identify the DTR that optimizes expected patient outcomes. Multiple methods have been proposed for optimal DTR estimation with continuous outcomes. However, optimal DTR estimation with binary outcomes is more complicated and has received comparatively little attention. Sol…
In many clinical trials, outcomes of interest include binary-valued endpoints. It is not uncommon that a binary-valued outcome is dichotomized from a continuous outcome at a threshold of clinical interest. To reach the objective, common approaches include (a) fitting the generalized linear mixed model (GLMM) to the dichotomized longitudinal binary outcome and (b) imputation method (MI): imputing the missing values in the continuous outcome, dichotomizing it into a binary outcome, and then fitting the generalized linear model for the "complete" data. We conducted comprehensive simulation studie…
We propose a class of two-sample statistics for testing the equality of proportions and the equality of survival functions. We build our proposal on a weighted combination of a score test for the difference in proportions and a Weighted Kaplan-Meier statistic-based test for the difference of survival functions. The proposed statistics are fully non-parametric and do not rely on the proportional hazards assumption for the survival outcome. We present the asymptotic distribution of these statistics, propose a variance estimator and show their asymptotic properties under fixed and local alternati…
Pathologic complete response (pCR) is a common primary endpoint for a phase II trial or even accelerated approval of neoadjuvant cancer therapy. If granted, a two-arm confirmatory trial is often required to demonstrate the efficacy with a time-to-event outcome such as overall survival. However, the design of a subsequent phase III trial based on prior information on the pCR effect is not straightforward. Aiming at designing such phase III trials with overall survival as primary endpoint using pCR information from previous trials, we consider a mixture model that incorporates both the survival …
Although approaches for handling missing data from longitudinal studies are well-developed when the patterns of missingness are monotone, fewer methods are available for non-monotone missingness. Moreover, the conventional missing at random (MAR) assumption -- a natural benchmark for monotone missingness -- does not model realistic beliefs about non-monotone missingness processes (Robins and Gill, 1997). This has provided the impetus for alternative non-monotone missing not at random (MNAR) mechanisms. The "no self-censoring" (NSC) model is such a mechanism and assumes the probability an outco…
Selective recruitment designs preferentially recruit individuals that are estimated to be statistically informative onto a clinical trial. Individuals that are expected to contribute less information have a lower probability of recruitment. Furthermore, in an information-adaptive design recruits are allocated to treatment arms in a manner that maximises information gain. The informativeness of an individual depends on their covariate (or biomarker) values and how information is defined is a critical element of information-adaptive designs. In this paper we define and evaluate four different me…
We propose a class of continuous-time Markov counting processes for analyzing correlated binary data and establish a correspondence between these models and sums of exchangeable Bernoulli random variables. Our approach generalizes many previous models for correlated outcomes, admits easily interpretable parameterizations, allows different cluster sizes, and incorporates ascertainment bias in a natural way. We demonstrate several new models for dependent outcomes and provide algorithms for computing maximum likelihood estimates. We show how to incorporate cluster-specific covariates in a regres…
In a group sequential clinical trial, accumulated data are analysed at numerous time-points in order to allow early decisions about a hypothesis of interest. These designs have historically been recommended for their ethical, administrative and economic benefits. In this work, we discuss a collection of new Stata commands for computing the stopping boundaries and required group size of various classical group sequential designs, assuming a normally distributed outcome variable. Following this, we demonstrate how the performance of several designs can be compared graphically.
A parametric expression for causal natural direct and indirect effects is derived for the setting of a binary outcome with a binary mediator. The proposed effect decomposition does not require the outcome to be rare and generalizes the existing ones, allowing for interactions between both the exposure and the mediator and confounding covariates. Further, it outlines the relationship between the causal effects and the correspondent pathway-specific logistic regression parameters, in parallel with results derived under the rare outcome assumption. Formulae for standard errors, obtained via the d…
Historical Functional Linear Models (HFLM) quantify associations between a functional predictor and functional outcome where the predictor is an exposure variable that occurs before, or at least concurrently with, the outcome. Current work on the HFLM is largely limited to frequentist estimation techniques that employ spline-based basis representations. In this work, we propose a novel use of the discrete wavelet-packet transformation, which has not previously been used in functional models, to estimate historical relationships in a fully Bayesian model. Since inference has not been an emphasi…
Inspired by the pioneering work of Rubin (1978), we employ the potential outcomes framework to develop a finite-population Bayesian causal inference framework for randomized controlled $2^K$ factorial designs with binary outcomes, which are common in medical research. As demonstrated by simulated and empirical examples, the proposed framework corrects the well-known variance over-estimation issue of the classic "Neymanian" inference framework, under various settings.
It is common that in multiarm randomized trials, the outcome of interest is "truncated by death," meaning that it is only observed or well defined conditioning on an intermediate outcome. In this case, in addition to pairwise contrasts, the joint inference for all treatment arms is also of interest. Under a monotonicity assumption we present methods for both pairwise and joint causal analyses of ordinal treatments and binary outcomes in presence of truncation by death. We illustrate via examples the appropriateness of our assumptions in different scientific contexts.
We propose an iterative variable selection scheme for high-dimensional data with binary outcomes. The scheme adopts a structured screen-and-select framework and uses non-local prior-based Bayesian model selection within the same. The structured screening is based on the association of the independent variables with the outcome which is measured in terms of the maximum marginal likelihood estimator. Performance comparison with several well-known methods in terms of true positive rate and false discovery rate shows that our proposed method stands to be a competitive alternative for sparse high-d…
Analyses of biomedical studies often necessitate modeling longitudinal causal effects. The current focus on personalized medicine and effect heterogeneity makes this task even more challenging. Towards this end, structural nested mean models (SNMMs) are fundamental tools for studying heterogeneous treatment effects in longitudinal studies. However, when outcomes are binary, current methods for estimating multiplicative and additive SNMM parameters suffer from variation dependence between the causal parameters and the non-causal nuisance parameters. This leads to a series of difficulties in int…
Causal inference on multiple non-independent outcomes raises serious challenges, because multivariate techniques that properly account for the outcome's dependence structure need to be considered. We focus on the case of binary outcomes framing our discussion in the potential outcome approach to causal inference. We define causal effects of treatment on joint outcomes introducing the notion of product outcomes. We also discuss a decomposition of the causal effect on product outcomes into intrinsic and extrinsic causal effects, which respectively provide information on treatment effect on the i…
$2^K$ factorial designs are widely adopted by statisticians and the broader scientific community. In this short note, under the potential outcomes framework (Neyman, 1923; Rubin, 1974), we adopt the partial identification approach and derive the sharp lower bound of the sampling variance of the estimated factorial effects, which leads to an "improved" Neymanian variance estimator that mitigates the over-estimation issue suffered by the classic Neymanian variance estimator by Dasgupta et al. (2015).
Unobserved confounding presents a major threat to causal inference from observational studies. Recently, several authors suggest that this problem may be overcome in a shared confounding setting where multiple treatments are independent given a common latent confounder. It has been shown that under a linear Gaussian model for the treatments, the causal effect is not identifiable without parametric assumptions on the outcome model. In this paper, we show that the causal effect is indeed identifiable if we assume a general binary choice model for the outcome with a non-probit link. Our identific…
In medical research, a scenario often entertained is randomized controlled $2^2$ factorial design with a binary outcome. By utilizing the concept of potential outcomes, Dasgupta et al. (2015) proposed a randomization-based causal inference framework, allowing flexible and simultaneous estimations and inferences of the factorial effects. However, a fundamental challenge that Dasgupta et al. (2015)'s proposed methodology faces is that the sampling variance of the randomization-based factorial effect estimator is unidentifiable, rendering the corresponding classic "Neymanian" variance estimator s…
To improve confounder adjustments, observational studies are often matched on potential confounders. While matched case-control studies are common and well covered in the literature, our focus here is on matched cohort studies, which are less common and sparsely discussed in the literature. Matched data also arise naturally in twin studies, as a cohort of exposure-discordant twins can be viewed as being matched on a large number of potential confounders. The analysis of twin studies will be given special attention. We give an overview of various analysis methods for matched cohort studies with…
Studies that collect multi-outcome data such as tobacco and alcohol use are becoming increasingly common. In principle, multi-outcomes studies investigate the correlations between outcomes, including, causal links and/or joint distributions. Although there are many methods for studying multivariate outcomes, significant limitations regarding scale and interpretation persist. Here we introduce a model based on the exponential-family for discrete binary outcomes that provides a flexible framework for hypothesis testing of multiple binary outcomes in a computationally efficient fashion.
Advances in wearables and digital technology now make it possible to deliver behavioral mobile health interventions to individuals in their everyday life. The micro-randomized trial (MRT) is increasingly used to provide data to inform the construction of these interventions. In an MRT, each individual is repeatedly randomized among multiple intervention options, often hundreds or even thousands of times, over the course of the trial. This work is motivated by multiple MRTs that have been conducted, or are currently in the field, in which the primary outcome is a longitudinal binary outcome. Th…
Missing outcomes are a commonly occurring problem for cluster randomised trials, which can lead to biased and inefficient inference if ignored or handled inappropriately. Two approaches for analysing such trials are cluster-level analysis and individual-level analysis. In this study, we assessed the performance of unadjusted cluster-level analysis, baseline covariate adjusted cluster-level analysis, random effects logistic regression (RELR) and generalised estimating equations (GEE) when binary outcomes are missing under a baseline covariate dependent missingness mechanism. Missing outcomes we…
Standard measures of effect, including the risk ratio, the odds ratio, and the risk difference, are associated with a number of well-described shortcomings, and no consensus exists about the conditions under which investigators should choose one effect measure over another. In this paper, we introduce a new framework for reasoning about choice of effect measure by linking two separate versions of the risk ratio to a counterfactual causal model. In our approach, effects are defined in terms of "counterfactual outcome state transition parameters", that is, the proportion of those individuals who…
The Regression Discontinuity (RD) design is a quasi-experimental design which emulates a randomised study by exploiting situations where treatment is assigned according to a continuous variable as is common in many drug treatment guidelines. The RD design literature focuses principally on continuous outcomes. In this paper we exploit the link between the RD design and instrumental variables to obtain a causal effect estimator, the risk ratio for the treated (RRT), for the RD design when the outcome is binary. Occasionally the RRT estimator can give negative lower confindence bounds. In the Bay…
Covariate adjustment and methods of incorporating historical data in randomized clinical trials (RCTs) each provide opportunities to increase trial power. We unite these approaches for the analysis of RCTs with binary outcomes based on the Cochran-Mantel-Haenszel (CMH) test for marginal risk ratio (RR). In PROCOVA-CMH, subjects are stratified on a single prognostic covariate reflective of their predicted outcome on the control treatment (e.g. placebo). This prognostic score is generated based on baseline covariates through a model trained on historical data. We propose two closed-form prospect…
Clinical prediction models (CPMs) are used to predict clinically relevant outcomes or events. Typically, prognostic CPMs are derived to predict the risk of a single future outcome. However, with rising emphasis on the prediction of multi-morbidity, there is growing need for CPMs to simultaneously predict risks for each of multiple future outcomes. A common approach to multi-outcome risk prediction is to derive a CPM for each outcome separately, then multiply the predicted risks. This approach is only valid if the outcomes are conditionally independent given the covariates, and it fails to expl…
In randomized experiments, the actual treatments received by some experimental units may differ from their treatment assignments. This non-compliance issue often occurs in clinical trials, social experiments, and the applications of randomized experiments in many other fields. Under certain assumptions, the average treatment effect for the compliers is identifiable and equal to the ratio of the intention-to-treat effects of the potential outcomes to that of the potential treatment received. To improve the estimation efficiency, we propose three model-assisted estimators for the complier averag…
We discuss the recent paper on "excursion effect" by T. Qian et al. (2020). We show that the methods presented have close relationships to others in the literature, in particular to a series of papers by Robins, Hernán and collaborators on analyzing observational studies as a series of randomized trials. There is also a close relationship to the history-restricted and the history-adjusted marginal structural models (MSM). Important differences and their methodological implications are clarified. We also demonstrate that the excursion effect can depend on the design and discuss its suitability …
Comparative effectiveness research often involves evaluating the differences in the risks of an event of interest between two or more treatments using observational data. Often, the post-treatment outcome of interest is whether the event happens within a pre-specified time window, which leads to a binary outcome. One source of bias for estimating the causal treatment effect is the presence of confounders, which are usually controlled using propensity score-based methods. An additional source of bias is right-censoring, which occurs when the information on the outcome of interest is not complet…
Use copula to model dependency of variable extends multivariate gaussian assumption. In this paper we first empirically studied copula regression model with continous response. Both simulation study and real data study are given. Secondly we give a novel copula regression model with binary outcome, and we propose a score gradient estimation algorithms to fit the model. Both simulation study and real data study are given for our model and fitting algorithm.
It is becoming increasingly popular to elicit informative priors on the basis of historical data. Popular existing priors, including the power prior, commensurate prior, and robust meta-analytic prior provide blanket discounting. Thus, if only a subset of participants in the historical data are exchangeable with the current data, these priors may not be appropriate. In order to combat this issue, propensity score (PS) approaches have been proposed. However, PS approaches are only concerned with the covariate distribution, whereas exchangeability is typically assessed with parameters pertaining…
Testing effect size homogeneity is an essential part when conducting a meta-analysis. Comparative studies of effect size homogeneity tests in case of binary outcomes are found in the literature, but no test has come out as an absolute winner. A alternative approach would be to carry out multiple effect size homogeneity tests on the same meta-analysis and combine the resulting dependent p-values. In this article we applied the correlated Lancaster method for dependent statistical tests. To investigate the proposed approach's performance, we applied eight different effect size homogeneity tests …
Cluster-randomized trials (CRTs) involve randomizing entire groups of participants -- called clusters -- to treatment arms but are often comprised of a limited or fixed number of available clusters. While covariate adjustment can account for chance imbalances between treatment arms and increase statistical efficiency in individually-randomized trials, analytical methods for individual-level covariate adjustment in small CRTs have received little attention to date. In this paper, we systematically investigate, through extensive simulations, the operating characteristics of propensity score weig…
Instrumental variable methods can identify causal effects even when the treatment and outcome are confounded. We study the problem of imperfect measurements of the binary instrumental variable, treatment or outcome. We first consider non-differential measurement errors, that is, the mis-measured variable does not depend on other variables given its true value. We show that the measurement error of the instrumental variable does not bias the estimate, the measurement error of the treatment biases the estimate away from zero, and the measurement error of the outcome biases the estimate toward ze…
Comparative binary outcome data are of fundamental interest in statistics and are often pooled in meta-analyses. Here we examine the simplest case where for each study there are two patient groups and a binary event of interest, giving rise to a series of $2 \times 2$ tables. A variety of measures of treatment effect are then available and are conventionally used in meta-analyses, such as the odds ratio, the risk ratio and the risk difference. Here we propose a new type of measure of treatment effect for this type of data that is very easily interpretable by lay audiences. We give the rational…
Mendelian randomization uses genetic variants to make causal inferences about a modifiable exposure. Subject to a genetic variant satisfying the instrumental variable assumptions, an association between the variant and outcome implies a causal effect of the exposure on the outcome. Complications arise with a binary exposure that is a dichotomization of a continuous risk factor (for example, hypertension is a dichotomization of blood pressure). This can lead to violation of the exclusion restriction assumption: the genetic variant can influence the outcome via the continuous risk factor even if…
