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UBC Theses and Dissertations

Quantifying the utility of personalized treatment decision rules : extending and comparing two metrics for summarizing the heterogeneity of treatment effects Xia, Yuan


The treatment benefit prediction model is a type of clinical prediction model that quantifies the magnitude of treatment benefit given an individual's unique characteristics. As the topic of treatment effect modelling is relatively new, quantifying and summarizing the performance of treatment benefit models are not well studied. The "concordance-statistic for benefit" and the "concentration of benefit index" are two newly developed metrics that evaluate the discriminative ability of the treatment benefit prediction. However, the similarities and differences between these two metrics are not yet explored. We compare and contrast the metrics from conceptual, theoretical, and empirical perspectives and illustrate the application of the metrics. We consider the common scenario of a logistic regression model for a binary response developed based on data from a randomized controlled trial with two treatment arms. This dissertation provides two major contributions: first, the two metrics are expanded into three pairs of metrics, each having a particular scope; second, it provides results of theoretical and simulation studies that compare and contrast the construct and empirical behaviour of these metrics. We found that the heterogeneity of treatment effect appropriately influences these metrics. Metrics related to the "concordance-statistic for benefit" are sensitive to the unobservable correlation between counterfactual outcomes. In a case study, we quantify the metrics in a randomized controlled trial of acute myocardial infarction therapies on 30-day mortality. We conclude that these metrics help understand the heterogeneity of treatment effect and the consequent impact on treatment decision-making.

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