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A robust method for estimating optimal treatment regimes.

Publication ,  Journal Article
Zhang, B; Tsiatis, AA; Laber, EB; Davidian, M
Published in: Biometrics
December 2012

A treatment regime is a rule that assigns a treatment, among a set of possible treatments, to a patient as a function of his/her observed characteristics, hence "personalizing" treatment to the patient. The goal is to identify the optimal treatment regime that, if followed by the entire population of patients, would lead to the best outcome on average. Given data from a clinical trial or observational study, for a single treatment decision, the optimal regime can be found by assuming a regression model for the expected outcome conditional on treatment and covariates, where, for a given set of covariates, the optimal treatment is the one that yields the most favorable expected outcome. However, treatment assignment via such a regime is suspect if the regression model is incorrectly specified. Recognizing that, even if misspecified, such a regression model defines a class of regimes, we instead consider finding the optimal regime within such a class by finding the regime that optimizes an estimator of overall population mean outcome. To take into account possible confounding in an observational study and to increase precision, we use a doubly robust augmented inverse probability weighted estimator for this purpose. Simulations and application to data from a breast cancer clinical trial demonstrate the performance of the method.

Duke Scholars

Published In

Biometrics

DOI

EISSN

1541-0420

Publication Date

December 2012

Volume

68

Issue

4

Start / End Page

1010 / 1018

Location

England

Related Subject Headings

  • Treatment Outcome
  • Statistics & Probability
  • Regression Analysis
  • Prevalence
  • Outcome Assessment, Health Care
  • Models, Statistical
  • Humans
  • Female
  • Decision Support Systems, Clinical
  • Computer Simulation
 

Citation

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Zhang, B., Tsiatis, A. A., Laber, E. B., & Davidian, M. (2012). A robust method for estimating optimal treatment regimes. Biometrics, 68(4), 1010–1018. https://doi.org/10.1111/j.1541-0420.2012.01763.x
Zhang, Baqun, Anastasios A. Tsiatis, Eric B. Laber, and Marie Davidian. “A robust method for estimating optimal treatment regimes.Biometrics 68, no. 4 (December 2012): 1010–18. https://doi.org/10.1111/j.1541-0420.2012.01763.x.
Zhang B, Tsiatis AA, Laber EB, Davidian M. A robust method for estimating optimal treatment regimes. Biometrics. 2012 Dec;68(4):1010–8.
Zhang, Baqun, et al. “A robust method for estimating optimal treatment regimes.Biometrics, vol. 68, no. 4, Dec. 2012, pp. 1010–18. Pubmed, doi:10.1111/j.1541-0420.2012.01763.x.
Zhang B, Tsiatis AA, Laber EB, Davidian M. A robust method for estimating optimal treatment regimes. Biometrics. 2012 Dec;68(4):1010–1018.
Journal cover image

Published In

Biometrics

DOI

EISSN

1541-0420

Publication Date

December 2012

Volume

68

Issue

4

Start / End Page

1010 / 1018

Location

England

Related Subject Headings

  • Treatment Outcome
  • Statistics & Probability
  • Regression Analysis
  • Prevalence
  • Outcome Assessment, Health Care
  • Models, Statistical
  • Humans
  • Female
  • Decision Support Systems, Clinical
  • Computer Simulation