Targeted maximum likelihood estimation for dynamic treatment regimes in sequentially randomized controlled trials

Sequential Randomized Controlled Trials (SRCTs) are rapidly becoming essential tools in the search for optimized treatment regimes in ongoing treatment settings. Analyzing data for multiple time-point treatments with a view toward optimal treatment regimes is of interest in many types of afflictions: HIV infection, Attention Deficit Hyperactivity Disorder in children, leukemia, prostate cancer, renal failure, and many others. Methods for analyzing data from SRCTs exist but they are either inefficient or suffer from the drawbacks of estimating equation methodology. We describe an estimation procedure, targeted maximum likelihood estimation (TMLE), which has been fully developed and implemented in point treatment settings, including time to event outcomes, binary outcomes and continuous outcomes. Here we develop and implement TMLE in the SRCT setting. As in the former settings, the TMLE procedure is targeted toward a pre-specified parameter of the distribution of the observed data, and thereby achieves important bias reduction in estimation of that parameter. As with the so-called Augmented Inverse Probability of Censoring Weight (A-IPCW) estimator, TMLE is double-robust and locally efficient. We report simulation results corresponding to two data-generating distributions from a longitudinal data structure.     

Targeted minimum loss based estimator that outperforms a given estimator

Targeted minimum loss based estimation (TMLE) provides a template for the construction of semiparametric locally efficient double robust substitution estimators of the target parameter of the data generating distribution in a semiparametric censored data or causal inference model (van der Laan and Rubin (2006), van der Laan (2008), van der Laan and Rose (2011)). In this article we demonstrate how to construct a TMLE that also satisfies the property that it is at least as efficient as a user supplied asymptotically linear estimator. In particular it is shown that this type of TMLE can incorporate empirical efficiency maximization as in Rubin and van der Laan (2008), Tan (2008, 2010), Rotnitzky et al. (2012), and retain double robustness. For the sake of illustration we focus on estimation of the additive average causal effect of a point treatment on an outcome, adjusting for baseline covariates.     

Population intervention causal effects based on stochastic interventions

Estimating the causal effect of an intervention on a population typically involves defining parameters in a nonparametric structural equation model (Pearl, 2000, Causality: Models, Reasoning, and Inference) in which the treatment or exposure is deterministically assigned in a static or dynamic way. We define a new causal parameter that takes into account the fact that intervention policies can result in stochastically assigned exposures. The statistical parameter that identifies the causal parameter of interest is established. Inverse probability of treatment weighting (IPTW), augmented IPTW (A-IPTW), and targeted maximum likelihood estimators (TMLE) are developed. A simulation study is performed to demonstrate the properties of these estimators, which include the double robustness of the A-IPTW and the TMLE. An application example using physical activity data is presented.     

Estimating species richness by a Poisson-compound gamma model

We propose a Poisson-compound gamma approach for species richness estimation. Based on the denseness and nesting properties of the gamma mixture, we fix the shape parameter of each gamma component at a unified value, and estimate the mixture using nonparametric maximum likelihood. A least-squares crossvalidation procedure is proposed for the choice of the common shape parameter. The performance of the resulting estimator of N is assessed using numerical studies and genomic data.     

One-step targeted maximum likelihood estimation for time-to-event outcomes

Researchers in observational survival analysis are interested in not only estimating survival curve nonparametrically but also having statistical inference for the parameter. We consider right-censored failure time data where we observe n independent and identically distributed observations of a vector random variable consisting of baseline covariates, a binary treatment at baseline, a survival time subject to right censoring, and the censoring indicator. We assume the baseline covariates are allowed to affect the treatment and censoring so that an estimator that ignores covariate information would be inconsistent. The goal is to use these data to estimate the counterfactual average survival curve of the population if all subjects are assigned the same treatment at baseline. Existing observational survival analysis methods do not result in monotone survival curve estimators, which is undesirable and may lose efficiency by not constraining the shape of the estimator using the prior knowledge of the estimand. In this paper, we present a one-step Targeted Maximum Likelihood Estimator (TMLE) for estimating the counterfactual average survival curve. We show that this new TMLE can be executed via recursion in small local updates. We demonstrate the finite sample performance of this one-step TMLE in simulations and an application to a monoclonal gammopathy data.     

Targeted maximum likelihood estimation of effect modification parameters in survival analysis

The Cox proportional hazards model or its discrete time analogue, the logistic failure time model, posit highly restrictive parametric models and attempt to estimate parameters which are specific to the model proposed. These methods are typically implemented when assessing effect modification in survival analyses despite their flaws. The targeted maximum likelihood estimation (TMLE) methodology is more robust than the methods typically implemented and allows practitioners to estimate parameters that directly answer the question of interest. TMLE will be used in this paper to estimate two newly proposed parameters of interest that quantify effect modification in the time to event setting. These methods are then applied to the Tshepo study to assess if either gender or baseline CD4 level modify the effect of two cART therapies of interest, efavirenz (EFV) and nevirapine (NVP), on the progression of HIV. The results show that women tend to have more favorable outcomes using EFV while males tend to have more favorable outcomes with NVP. Furthermore, EFV tends to be favorable compared to NVP for individuals at high CD4 levels.     

Targeted maximum likelihood estimation of the parameter of a marginal structural model

Targeted maximum likelihood estimation is a versatile tool for estimating parameters in semiparametric and nonparametric models. We work through an example applying targeted maximum likelihood methodology to estimate the parameter of a marginal structural model. In the case we consider, we show how this can be easily done by clever use of standard statistical software. We point out differences between targeted maximum likelihood estimation and other approaches (including estimating function based methods). The application we consider is to estimate the effect of adherence to antiretroviral medications on virologic failure in HIV positive individuals.     

Brownian models and coalescent structures

Brownian motions on coalescent structures have a biological relevance, either as an approximation of the stepwise mutation model for microsatellites, or as a model of spatial evolution considering the locations of individuals at successive generations. We discuss estimation procedures for the dispersal parameter of a Brownian motion defined on coalescent trees. First, we consider the mean square distance unbiased estimator and compute its variance. In a second approach, we introduce a phylogenetic estimator. Given the UPGMA topology, the likelihood of the parameter is computed thanks to a new dynamical programming method. By a proper correction, an unbiased estimator is derived from the pseudomaximum of the likelihood. The last approach consists of computing the likelihood by a Markov chain Monte Carlo sampling method. In the one-dimensional Brownian motion, this method seems less reliable than pseudomaximum-likelihood.     

A Positive Stable Frailty Model for Clustered Failure Time Data with Covariate‐Dependent Frailty

Summary In this article, we propose a positive stable shared frailty Cox model for clustered failure time data where the frailty distribution varies with cluster‐level covariates. The proposed model accounts for covariate‐dependent intracluster correlation and permits both conditional and marginal inferences. We obtain marginal inference directly from a marginal model, then use a stratified Cox‐type pseudo‐partial likelihood approach to estimate the regression coefficient for the frailty parameter. The proposed estimators are consistent and asymptotically normal and a consistent estimator of the covariance matrix is provided. Simulation studies show that the proposed estimation procedure is appropriate for practical use with a realistic number of clusters. Finally, we present an application of the proposed method to kidney transplantation data from the Scientific Registry of Transplant Recipients.     

Asymptotic Distribution of Density-Dependent Stage-Grouped Population Dynamics Models

Matrix models are widely used in biology to predict the temporal evolution of stage-structured populations. One issue related to matrix models that is often disregarded is the sampling variability. As the sample used to estimate the vital rates of the models are of finite size, a sampling error is attached to parameter estimation, which has in turn repercussions on all the predictions of the model. In this study, we address the question of building confidence bounds around the predictions of matrix models due to sampling variability. We focus on a density-dependent Usher model, the maximum likelihood estimator of parameters, and the predicted stationary stage vector. The asymptotic distribution of the stationary stage vector is specified, assuming that the parameters of the model remain in a set of the parameter space where the model admits one unique equilibrium point. Tests for density-dependence are also incidentally provided. The model is applied to a tropical rain forest in French Guiana.     

Asymptotic behavior of the scaled mutation rate estimators

Important aspects of population evolution have been investigated using nucleotide sequences. Under the neutral Wright–Fisher model, the scaled mutation rate represents twice the average number of new mutations per generations and it is one of the key parameters in population genetics. In this study, we present various methods of estimation of this parameter, analytical studies of their asymptotic behavior as well as comparisons of the distribution's behavior of these estimators through simulations. As knowledge of the genealogy is needed to estimate the maximum likelihood estimator (MLE), an application with real data is also presented, using jackknife to correct the bias of the MLE, which can be generated by the estimation of the tree. We proved analytically that the Waterson's estimator and the MLE are asymptotically equivalent with the same rate of convergence to normality. Furthermore, we showed that the MLE has a better rate of convergence than Waterson's estimator for values of the parameter greater than one and this relationship is reversed when the parameter is less than one.     

Nonparametric estimation of the causal effect of a stochastic threshold-based intervention

Identifying a biomarker or treatment-dose threshold that marks a specified level of risk is an important problem, especially in clinical trials. In view of this goal, we consider a covariate-adjusted threshold-based interventional estimand, which happens to equal the binary treatment–specific mean estimand from the causal inference literature obtained by dichotomizing the continuous biomarker or treatment as above or below a threshold. The unadjusted version of this estimand was considered in Donovan et al.. Expanding upon Stitelman et al., we show that this estimand, under conditions, identifies the expected outcome of a stochastic intervention that sets the treatment dose of all participants above the threshold. We propose a novel nonparametric efficient estimator for the covariate-adjusted threshold-response function for the case of informative outcome missingness, which utilizes machine learning and targeted minimum-loss estimation (TMLE). We prove the estimator is efficient and characterize its asymptotic distribution and robustness properties. Construction of simultaneous 95% confidence bands for the threshold-specific estimand across a set of thresholds is discussed. In the Supporting Information, we discuss how to adjust our estimator when the biomarker is missing at random, as occurs in clinical trials with biased sampling designs, using inverse probability weighting. Efficiency and bias reduction of the proposed estimator are assessed in simulations. The methods are employed to estimate neutralizing antibody thresholds for virologically confirmed dengue risk in the CYD14 and CYD15 dengue vaccine trials.     

Application of pattern-mixture models to outcomes that are potentially missing not at random using pseudo maximum likelihood estimation

In this work, we fit pattern-mixture models to data sets with responses that are potentially missing not at random (MNAR, Little and Rubin, 1987). In estimating the regression parameters that are identifiable, we use the pseudo maximum likelihood method based on exponential families. This procedure provides consistent estimators when the mean structure is correctly specified for each pattern, with further information on the variance structure giving an efficient estimator. The proposed method can be used to handle a variety of continuous and discrete outcomes. A test built on this approach is also developed for model simplification in order to improve efficiency. Simulations are carried out to compare the proposed estimation procedure with other methods. In combination with sensitivity analysis, our approach can be used to fit parsimonious semi-parametric pattern-mixture models to outcomes that are potentially MNAR. We apply the proposed method to an epidemiologic cohort study to examine cognition decline among elderly.     

Unbiased and efficient log-likelihood estimation with inverse binomial sampling

The fate of scientific hypotheses often relies on the ability of a computational model to explain the data, quantified in modern statistical approaches by the likelihood function. The log-likelihood is the key element for parameter estimation and model evaluation. However, the log-likelihood of complex models in fields such as computational biology and neuroscience is often intractable to compute analytically or numerically. In those cases, researchers can often only estimate the log-likelihood by comparing observed data with synthetic observations generated by model simulations. Standard techniques to approximate the likelihood via simulation either use summary statistics of the data or are at risk of producing substantial biases in the estimate. Here, we explore another method, inverse binomial sampling (IBS), which can estimate the log-likelihood of an entire data set efficiently and without bias. For each observation, IBS draws samples from the simulator model until one matches the observation. The log-likelihood estimate is then a function of the number of samples drawn. The variance of this estimator is uniformly bounded, achieves the minimum variance for an unbiased estimator, and we can compute calibrated estimates of the variance. We provide theoretical arguments in favor of IBS and an empirical assessment of the method for maximum-likelihood estimation with simulation-based models. As case studies, we take three model-fitting problems of increasing complexity from computational and cognitive neuroscience. In all problems, IBS generally produces lower error in the estimated parameters and maximum log-likelihood values than alternative sampling methods with the same average number of samples. Our results demonstrate the potential of IBS as a practical, robust, and easy to implement method for log-likelihood evaluation when exact techniques are not available.     

Semiparametric estimation of the transformation model by leveraging external aggregate data in the presence of population heterogeneity

Leveraging information in aggregate data from external sources to improve estimation efficiency and prediction accuracy with smaller scale studies has drawn a great deal of attention in recent years. Yet, conventional methods often either ignore uncertainty in the external information or fail to account for the heterogeneity between internal and external studies. This article proposes an empirical likelihood-based framework to improve the estimation of the semiparametric transformation models by incorporating information about the t-year subgroup survival probability from external sources. The proposed estimation procedure incorporates an additional likelihood component to account for uncertainty in the external information and employs a density ratio model to characterize population heterogeneity. We establish the consistency and asymptotic normality of the proposed estimator and show that it is more efficient than the conventional pseudopartial likelihood estimator without combining information. Simulation studies show that the proposed estimator yields little bias and outperforms the conventional approach even in the presence of information uncertainty and heterogeneity. The proposed methodologies are illustrated with an analysis of a pancreatic cancer study.     

Extending Zelterman's approach for robust estimation of population size to zero-truncated clustered Data

Estimation of population size with missing zero-class is an important problem that is encountered in epidemiological assessment studies. Fitting a Poisson model to the observed data by the method of maximum likelihood and estimation of the population size based on this fit is an approach that has been widely used for this purpose. In practice, however, the Poisson assumption is seldom satisfied. Zelterman (1988) has proposed a robust estimator for unclustered data that works well in a wide class of distributions applicable for count data. In the work presented here, we extend this estimator to clustered data. The estimator requires fitting a zero-truncated homogeneous Poisson model by maximum likelihood and thereby using a Horvitz-Thompson estimator of population size. This was found to work well, when the data follow the hypothesized homogeneous Poisson model. However, when the true distribution deviates from the hypothesized model, the population size was found to be underestimated. In the search of a more robust estimator, we focused on three models that use all clusters with exactly one case, those clusters with exactly two cases and those with exactly three cases to estimate the probability of the zero-class and thereby use data collected on all the clusters in the Horvitz-Thompson estimator of population size. Loss in efficiency associated with gain in robustness was examined based on a simulation study. As a trade-off between gain in robustness and loss in efficiency, the model that uses data collected on clusters with at most three cases to estimate the probability of the zero-class was found to be preferred in general. In applications, we recommend obtaining estimates from all three models and making a choice considering the estimates from the three models, robustness and the loss in efficiency.     

On symmetric semiparametric two-sample problem

We consider a two-sample problem where data come from symmetric distributions. Usual two-sample data with only magnitudes recorded, arising from case-control studies or logistic discriminant analyses, may constitute a symmetric two-sample problem. We propose a semiparametric model such that, in addition to symmetry, the log ratio of two unknown density functions is modeled in a known parametric form. The new semiparametric model, tailor-made for symmetric two-sample data, can also be viewed as a biased sampling model subject to symmetric constraint. A maximum empirical likelihood estimation approach is adopted to estimate the unknown model parameters, and the corresponding profile empirical likelihood ratio test is utilized to perform hypothesis testing regarding the two population distributions. Symmetry, however, comes with irregularity. It is shown that, under the null hypothesis of equal symmetric distributions, the maximum empirical likelihood estimator has degenerate Fisher information, and the test statistic has a mixture of χ²-type asymptotic distribution. Extensive simulation studies have been conducted to demonstrate promising statistical powers under correct and misspecified models. We apply the proposed methods to two real examples.     

A Likelihood Approach to Populations Samples of Microsatellite Alleles

This paper presents a likelihood approach to population samples of microsatellite alleles. A Markov chain recursion method previously published by GRIFFITHS and TAVARE is applied to estimate the likelihood function under different models of microsatellite evolution. The method presented can be applied to estimate a fundamental population genetics parameter θ as well as parameters of the mutational model. The new likelihood estimator provides a better estimator of θ in terms of the mean square error than previous approaches. Furthermore, it is demonstrated how the method may easily be applied to test models of microsatellite evolution. In particular it is shown how to compare a one-step model of microsatellite evolution to a multi-step model by a likelihood ratio test.     

Improved semiparametric estimation of the proportional rate model with recurrent event data

Owing to its robustness properties, marginal interpretations, and ease of implementation, the pseudo-partial likelihood method proposed in the seminal papers of Pepe and Cai and Lin et al. has become the default approach for analyzing recurrent event data with Cox-type proportional rate models. However, the construction of the pseudo-partial score function ignores the dependency among recurrent events and thus can be inefficient. An attempt to investigate the asymptotic efficiency of weighted pseudo-partial likelihood estimation found that the optimal weight function involves the unknown variance–covariance process of the recurrent event process and may not have closed-form expression. Thus, instead of deriving the optimal weights, we propose to combine a system of pre-specified weighted pseudo-partial score equations via the generalized method of moments and empirical likelihood estimation. We show that a substantial efficiency gain can be easily achieved without imposing additional model assumptions. More importantly, the proposed estimation procedures can be implemented with existing software. Theoretical and numerical analyses show that the empirical likelihood estimator is more appealing than the generalized method of moments estimator when the sample size is sufficiently large. An analysis of readmission risk in colorectal cancer patients is presented to illustrate the proposed methodology.