Uncertainty and the Value of Diagnostic Information With Application to Axillary Lymph Node Dissection in Breast Cancer

In clinical decision making, it is common to ask whether, and how much, a diagnostic procedure is contributing to subsequent treatment decisions. Statistically, quantification of the value of the information provided by a diagnostic procedure can be carried out using decision trees with multiple decision points, representing both the diagnostic test and the subsequent treatments that may depend on the test\u27s results. This article investigates probabilistic sensitivity analysis approaches for exploring and communicating parameter uncertainty in such decision trees. Complexities arise because uncertainty about a model\u27s inputs determines uncertainty about optimal decisions at all decision nodes of a tree. We present the expected utility solution strategy for multistage decision problems in the presence of uncertainty on input parameters, propose a set of graphical displays and summarization tools for probabilistic sensitivity analysis in multistage decision trees, and provide an application to axillary lymph node dissection in breast cancer

Generalized Quantile Treatment Effect: A Flexible Bayesian Approach Using Quantile Ratio Smoothing

We propose a new general approach for estimating the effect of a binary treatment on a continuous and potentially highly skewed response variable, the generalized quantile treatment effect (GQTE). The GQTE is defined as the difference between a function of the quantiles under the two treatment conditions. As such, it represents a generalization over the standard approaches typically used for estimating a treatment effect (i.e., the average treatment effect and the quantile treatment effect) because it allows the comparison of any arbitrary characteristic of the outcome's distribution under the two treatments. Following Dominici et al. (2005), we assume that a pre-specified transformation of the two quantiles is modeled as a smooth function of the percentiles. This assumption allows us to link the two quantile functions and thus to borrow information from one distribution to the other. The main theoretical contribution we provide is the analytical derivation of a closed form expression for the likelihood of the model. Exploiting this result we propose a novel Bayesian inferential methodology for the GQTE. We show some finite sample properties of our approach through a simulation study which confirms that in some cases it performs better than other nonparametric methods. As an illustration we finally apply our methodology to the 1987 National Medicare Expenditure Survey data to estimate the difference in the single hospitalization medical cost distributions between cases (i.e., subjects affected by smoking attributable diseases) and controls.Comment: Published at http://dx.doi.org/10.1214/14-BA922 in the Bayesian Analysis (http://projecteuclid.org/euclid.ba) by the International Society of Bayesian Analysis (http://bayesian.org/

Defining Replicability of Prediction Rules

In this article I propose an approach for defining replicability for prediction rules. Motivated by a recent NAS report, I start from the perspective that replicability is obtaining consistent results across studies suitable to address the same prediction question, each of which has obtained its own data. I then discuss concept and issues in defining key elements of this statement. I focus specifically on the meaning of "consistent results" in typical utilization contexts, and propose a multi-agent framework for defining replicability, in which agents are neither partners nor adversaries. I recover some of the prevalent practical approaches as special cases. I hope to provide guidance for a more systematic assessment of replicability in machine learning

COMBINATIONAL MIXTURES OF MULTIPARAMETER DISTRIBUTIONS

We introduce combinatorial mixtures - a flexible class of models for inference on mixture distributions whose component have multidimensional parameters. The key idea is to allow each element of the component-specific parameter vectors to be shared by a subset of other components. This approach allows for mixtures that range from very flexible to very parsimonious, and unifies inference on component-specific parameters with inference on the number of components. We develop Bayesian inference and computation approaches for this class of distributions, and illustrate them in an application. This work was originally motivated by the analysis of cancer subtypes: in terms of biological measures of interest, subtypes may be characterized by differences in location, scale, correlations or any of the combinations. We illustrate our approach using data on molecular subtypes of lung cancer