Analysis of a long-term study of neurotic disorder, with insights into the process of non-response

Summary.  The paper studies the non-response process in a long-term study of neurotic dis-order by comparing the analysis based on the responses that were collected by the established practice of interviewing the subjects, at dates arranged in advance (appointments), with the analysis of the nearly complete set of responses that were collected by an extensive effort that involved attempts to interview without seeking a prior agreement. The method of multiple imputation is applied, and its properties are explored in a setting that is not perfectly suited for its application: a relatively small sample size, ordinal score outcomes and the likelihood that the outcomes are missing not at random.     

An application of the mixed-effects model and pattern mixture model to treatment groups with differential missingness suspected not-missing-at-random

Likelihood-based, mixed-effects models for repeated measures (MMRMs) are occasionally used in primary analyses for group comparisons of incomplete continuous longitudinal data. Although MMRM analysis is generally valid under missing-at-random assumptions, it is invalid under not-missing-at-random (NMAR) assumptions. We consider the possibility of bias of estimated treatment effect using standard MMRM analysis in a motivational case, and propose simple and easily implementable pattern mixture models within the framework of mixed-effects modeling, to handle the NMAR data with differential missingness between treatment groups. The proposed models are a new form of pattern mixture model that employ a categorical time variable when modeling the outcome and a continuous time variable when modeling the missingness-data patterns. The models can directly provide an overall estimate of the treatment effect of interest using the average of the distribution of the missingness indicator and a categorical time variable in the same manner as MMRM analysis. Our simulation results indicate that the bias of the treatment effect for MMRM analysis was considerably larger than that for the pattern mixture model analysis under NMAR assumptions. In the case study, it would be dangerous to interpret only the results of the MMRM analysis, and the proposed pattern mixture model would be useful as a sensitivity analysis for treatment effect evaluation.     

Bayesian comparison of diagnostic tests with largely non-informative missing data

This work was motivated by a real problem of comparing binary diagnostic tests based upon a gold standard, where the collected data showed that the large majority of classifications were incomplete and the feedback received from the medical doctors allowed us to consider the missingness as non-informative. Taking into account the degree of data incompleteness, we used a Bayesian approach via MCMC methods for drawing inferences of interest on accuracy measures. Its direct implementation by well-known software demonstrated serious problems of chain convergence. The difficulties were overcome by the proposal of a simple, efficient and easily adaptable data augmentation algorithm, performed through an ad hoc computer program.     

Coping with missing data in phase III pivotal registration trials: Tolvaptan in subjects with kidney disease,a case study

Missing data cause challenging issues, particularly in phase III registration trials, as highlighted by the European Medicines Agency (EMA) and the US National Research Council. We explore, as a case study, how the issues from missing data were tackled in a double‐blind phase III trial in subjects with autosomal dominant polycystic kidney disease. A total of 1445 subjects were randomized in a 2:1 ratio to receive active treatment (tolvaptan), or placebo. The primary outcome, the rate of change in total kidney volume, favored tolvaptan (P < .0001). The key secondary efficacy endpoints of clinical progression of disease and rate of decline in kidney function also favored tolvaptan. However, as highlighted by Food and Drug Administration and EMA, the interpretation of results was hampered by a high number of unevenly distributed dropouts, particularly early dropouts. In this paper, we outline the analyses undertaken to address the issue of missing data thoroughly. “Tipping point analyses” were performed to explore how extreme and detrimental outcomes among subjects with missing data must be to overturn the positive treatment effect attained in those subjects who had complete data. Nonparametric rank‐based analyses were also performed accounting for missing data. In conclusion, straightforward and transparent analyses directly taking into account missing data convincingly support the robustness of the preplanned analyses on the primary and secondary endpoints. Tolvaptan was confirmed to be effective in slowing total kidney volume growth, which is considered an efficacy endpoint by EMA, and in lessening the decline in renal function in patients with autosomal dominant polycystic kidney disease.     

Robust logistic regression of family data in the presence of missing genotypes

Large cohort studies are commonly launched to study the risk effect of genetic variants or other risk factors on a chronic disorder. In these studies, family data are often collected to provide additional information for the purpose of improving the inference results. Statistical analysis of the family data can be very challenging due to the missing observations of genotypes, incomplete records of disease occurrences in family members, and the complicated dependence attributed to the shared genetic background and environmental factors. In this article, we investigate a class of logistic models with family-shared random effects to tackle these challenges, and develop a robust regression method based on the conditional logistic technique for statistical inference. An expectation–maximization (EM) algorithm with fast computation speed is developed to handle the missing genotypes. The proposed estimators are shown to be consistent and asymptotically normal. Additionally, a score test based on the proposed method is derived to test the genetic effect. Extensive simulation studies demonstrate that the proposed method performs well in finite samples in terms of estimate accuracy, robustness and computational speed. The proposed procedure is applied to an Alzheimer's disease study.     

A monte carlo comparison of the smoothing,scoring and em algorithms for dispersion matrix estimation with incomplete growth curve data

Incomplete growth curve data often result from missing or mistimed observations in a repeated measures design. Virtually all methods of analysis rely on the dispersion matrix estimates. A Monte Carlo simulation was used to compare three methods of estimation of dispersion matrices for incomplete growth curve data. The three methods were: 1) maximum likelihood estimation with a smoothing algorithm, which finds the closest positive semidefinite estimate of the pairwise estimated dispersion matrix; 2) a mixed effects model using the EM (estimation maximization) algorithm; and 3) a mixed effects model with the scoring algorithm. The simulation included 5 dispersion structures, 20 or 40 subjects with 4 or 8 observations per subject and 10 or 30% missing data. In all the simulations, the smoothing algorithm was the poorest estimator of the dispersion matrix. In most cases, there were no significant differences between the scoring and EM algorithms. The EM algorithm tended to be better than the scoring algorithm when the variances of the random effects were close to zero, especially for the simulations with 4 observations per subject and two random effects.     

An index of local sensitivity to non-ignorability for parametric survival models with potential non-random missing covariate: an application to the SEER cancer registry data

Several survival regression models have been developed to assess the effects of covariates on failure times. In various settings, including surveys, clinical trials and epidemiological studies, missing data may often occur due to incomplete covariate data. Most existing methods for lifetime data are based on the assumption of missing at random (MAR) covariates. However, in many substantive applications, it is important to assess the sensitivity of key model inferences to the MAR assumption. The index of sensitivity to non-ignorability (ISNI) is a local sensitivity tool to measure the potential sensitivity of key model parameters to small departures from the ignorability assumption, needless of estimating a complicated non-ignorable model. We extend this sensitivity index to evaluate the impact of a covariate that is potentially missing, not at random in survival analysis, using parametric survival models. The approach will be applied to investigate the impact of missing tumor grade on post-surgical mortality outcomes in individuals with pancreas-head cancer in the Surveillance, Epidemiology, and End Results data set. For patients suffering from cancer, tumor grade is an important risk factor. Many individuals in these data with pancreas-head cancer have missing tumor grade information. Our ISNI analysis shows that the magnitude of effect for most covariates (with significant effect on the survival time distribution), specifically surgery and tumor grade as some important risk factors in cancer studies, highly depends on the missing mechanism assumption of the tumor grade. Also a simulation study is conducted to evaluate the performance of the proposed index in detecting sensitivity of key model parameters.     

Estimation of the Burr type III distribution with application in unified hybrid censored sample of fracture toughness

In this paper, the statistical inference of the unknown parameters of a Burr Type III (BIII) distribution based on the unified hybrid censored sample is studied. The maximum likelihood estimators of the unknown parameters are obtained using the Expectation–Maximization algorithm. It is observed that the Bayes estimators cannot be obtained in explicit forms, hence Lindley's approximation and the Markov Chain Monte Carlo (MCMC) technique are used to compute the Bayes estimators. Further the highest posterior density credible intervals of the unknown parameters based on the MCMC samples are provided. The new model selection test is developed in discriminating between two competing models under unified hybrid censoring scheme. Finally, the potentiality of the BIII distribution to analyze the real data is illustrated by using the fracture toughness data of the three different materials namely silicon nitride (Si₃N₄), Zirconium dioxide (ZrO₂) and sialon (Si_6?xAl_xO_xN_8?x). It is observed that for the present data sets, the BIII distribution has the better fit than the Weibull distribution which is frequently used in the fracture toughness data analysis.     

EM algorithm-based likelihood estimation for a generalized Gompertz regression model in presence of survival data with long-term survivors: an application to uterine cervical cancer data

In this paper we develop a regression model for survival data in the presence of long-term survivors based on the generalized Gompertz distribution introduced by El-Gohary et al. [The generalized Gompertz distribution. Appl Math Model. 2013;37:13–24] in a defective version. This model includes as special case the Gompertz cure rate model proposed by Gieser et al. [Modelling cure rates using the Gompertz model with covariate information. Stat Med. 1998;17:831–839]. Next, an expectation maximization algorithm is then developed for determining the maximum likelihood estimates (MLEs) of the parameters of the model. In addition, we discuss the construction of confidence intervals for the parameters using the asymptotic distributions of the MLEs and the parametric bootstrap method, and assess their performance through a Monte Carlo simulation study. Finally, the proposed methodology was applied to a database on uterine cervical cancer.     

Estimating the turning point of the log-logistic hazard function in the presence of long-term survivors with an application for uterine cervical cancer data

The hazard function plays an important role in cancer patient survival studies, as it quantifies the instantaneous risk of death of a patient at any given time. Often in cancer clinical trials, unimodal hazard functions are observed, and it is of interest to detect (estimate) the turning point (mode) of hazard function, as this may be an important measure in patient treatment strategies with cancer. Moreover, when patient cure is a possibility, estimating cure rates at different stages of cancer, in addition to their proportions, may provide a better summary of the effects of stages on survival rates. Therefore, the main objective of this paper is to consider the problem of estimating the mode of hazard function of patients at different stages of cervical cancer in the presence of long-term survivors. To this end, a mixture cure rate model is proposed using the log-logistic distribution. The model is conveniently parameterized through the mode of the hazard function, in which cancer stages can affect both the cured fraction and the mode. In addition, we discuss aspects of model inference through the maximum likelihood estimation method. A Monte Carlo simulation study assesses the coverage probability of asymptotic confidence intervals.