An Algorithm for Generating Individualized Treatment Decision Trees and Random Forests

With new treatments and novel technology available, precision medicine has become a key topic in the new era of healthcare. Traditional statistical methods for precision medicine focus on subgroup discovery through identifying interactions between a few markers and treatment regimes. However, given the large scale and high dimensionality of modern data sets, it is difficult to detect the interactions between treatment and high dimensional covariates. Recently, novel approaches have emerged that seek to directly estimate individualized treatment rules (ITR) via maximizing the expected clinical reward by using, for example, support vector machines (SVM) or decision trees. The latter enjoys great popularity in clinical practice due to its interpretability. In this paper, we propose a new reward function and a novel decision tree algorithm to directly maximize rewards. We further improve a single tree decision rule by an ensemble decision tree algorithm, ITR random forests. Our final decision rule is an average over single decision trees and it is a soft probability rather than a hard choice. Depending on how strong the treatment recommendation is, physicians can make decisions based on our model along with their own judgment and experience. Performance of ITR forest and tree methods is assessed through simulations along with applications to a randomized controlled trial (RCT) of 1385 patients with diabetes and an EMR cohort of 5177 patients with diabetes. ITR forest and tree methods are implemented using statistical software R (https://github.com/kdoub5ha/ITR.Forest).

Medienart:

E-Artikel

Erscheinungsjahr:

2018

Erschienen:

2018

Enthalten in:

Zur Gesamtaufnahme - volume:27

Enthalten in:

Journal of computational and graphical statistics : a joint publication of American Statistical Association, Institute of Mathematical Statistics, Interface Foundation of North America - 27(2018), 4 vom: 28., Seite 849-860

Sprache:

Englisch

Beteiligte Personen:

Doubleday, Kevin [VerfasserIn]
Zhou, Hua [VerfasserIn]
Fu, Haoda [VerfasserIn]
Zhou, Jin [VerfasserIn]

Links:

Volltext

Themen:

Journal Article
Optimization
Precision Medicine
Recursive Partitioning
Subgroup Identification
Value Function
Variable Importance

Anmerkungen:

Date Revised 11.11.2023

published: Print-Electronic

Citation Status PubMed-not-MEDLINE

doi:

10.1080/10618600.2018.1451337

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM311026001