Joint modeling of longitudinal outcomes and survival using latent growth modeling approach in a mesothelioma trial

Joint modeling of longitudinal and survival data can provide more efficient and less biased estimates of treatment effects through accounting for the associations between these two data types. Sponsors of oncology clinical trials routinely and increasingly include patient-reported outcome (PRO) instruments to evaluate the effect of treatment on symptoms, functioning, and quality of life. Known publications of these trials typically do not include jointly modeled analyses and results. We formulated several joint models based on a latent growth model for longitudinal PRO data and a Cox proportional hazards model for survival data. The longitudinal and survival components were linked through either a latent growth trajectory or shared random effects. We applied these models to data from a randomized phase III oncology clinical trial in mesothelioma. We compared the results derived under different model specifications and showed that the use of joint modeling may result in improved estimates of the overall treatment effect

MCMC implementation for Bayesian hidden semi-Markov models with illustrative applications

Copyright © Springer 2013. The final publication is available at Springer via http://dx.doi.org/10.1007/s11222-013-9399-zHidden Markov models (HMMs) are flexible, well established models useful in a diverse range of applications. However, one potential limitation of such models lies in their inability to explicitly structure the holding times of each hidden state. Hidden semi-Markov models (HSMMs) are more useful in the latter respect as they incorporate additional temporal structure by explicit modelling of the holding times. However, HSMMs have generally received less attention in the literature, mainly due to their intensive computational requirements. Here a Bayesian implementation of HSMMs is presented. Recursive algorithms are proposed in conjunction with Metropolis-Hastings in such a way as to avoid sampling from the distribution of the hidden state sequence in the MCMC sampler. This provides a computationally tractable estimation framework for HSMMs avoiding the limitations associated with the conventional EM algorithm regarding model flexibility. Performance of the proposed implementation is demonstrated through simulation experiments as well as an illustrative application relating to recurrent failures in a network of underground water pipes where random effects are also included into the HSMM to allow for pipe heterogeneity

Some Aspects of Latent Structure Analysis

Latent structure models involve real, potentially observable variables and latent, unobservable variables. The framework includes various particular types of model, such as factor analysis, latent class analysis, latent trait analysis, latent profile models, mixtures of factor analysers, state-space models and others. The simplest scenario, of a single discrete latent variable, includes finite mixture models, hidden Markov chain models and hidden Markov random field models. The paper gives a brief tutorial of the application of maximum likelihood and Bayesian approaches to the estimation of parameters within these models, emphasising especially the fact that computational complexity varies greatly among the different scenarios. In the case of a single discrete latent variable, the issue of assessing its cardinality is discussed. Techniques such as the EM algorithm, Markov chain Monte Carlo methods and variational approximations are mentioned

Multilevel structured additive regression

Models with structured additive predictor provide a very broad and rich framework for complex regression modeling. They can deal simultaneously with nonlinear covariate effects and time trends, unit- or cluster-specific heterogeneity, spatial heterogeneity and complex interactions between covariates of different type. In this paper, we propose a hierarchical or multilevel version of regression models with structured additive predictor where the regression coefficients of a particular nonlinear term may obey another regression model with structured additive predictor. In that sense, the model is composed of a hierarchy of complex structured additive regression models. The proposed model may be regarded as an extended version of a multilevel model with nonlinear covariate terms in every level of the hierarchy. The model framework is also the basis for generalized random slope modeling based on multiplicative random effects. Inference is fully Bayesian and based on Markov chain Monte Carlo simulation techniques. We provide an in depth description of several highly efficient sampling schemes that allow to estimate complex models with several hierarchy levels and a large number of observations within a couple of minutes (often even seconds). We demonstrate the practicability of the approach in a complex application on childhood undernutrition with large sample size and three hierarchy levels