IDEAS home Printed from https://ideas.repec.org/a/sae/medema/v42y2022i2p208-216.html
   My bibliography  Save this article

Testing for a Sweet Spot in Randomized Trials

Author

Listed:
  • Donald A. Redelmeier

    (Department of Medicine, University of Toronto, Toronto, ON, Canada
    Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
    Institute for Clinical Evaluative Sciences
    Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada)

  • Deva Thiruchelvam

    (Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
    Institute for Clinical Evaluative Sciences)

  • Robert J. Tibshirani

    (Department of Biomedical Data Sciences, Stanford University, Stanford, CA, USA
    Department of Statistics, Stanford University, Stanford, CA, USA)

Abstract

Introduction Randomized trials recruit diverse patients, including some individuals who may be unresponsive to the treatment. Here we follow up on prior conceptual advances and introduce a specific method that does not rely on stratification analysis and that tests whether patients in the intermediate range of disease severity experience more relative benefit than patients at the extremes of disease severity (sweet spot). Methods We contrast linear models to sigmoidal models when describing associations between disease severity and accumulating treatment benefit. The Gompertz curve is highlighted as a specific sigmoidal curve along with the Akaike information criterion (AIC) as a measure of goodness of fit. This approach is then applied to a matched analysis of a published landmark randomized trial evaluating whether implantable defibrillators reduce overall mortality in cardiac patients ( n = 2,521). Results The linear model suggested a significant survival advantage across the spectrum of increasing disease severity (β = 0.0847, P

Suggested Citation

  • Donald A. Redelmeier & Deva Thiruchelvam & Robert J. Tibshirani, 2022. "Testing for a Sweet Spot in Randomized Trials," Medical Decision Making, , vol. 42(2), pages 208-216, February.
  • Handle: RePEc:sae:medema:v:42:y:2022:i:2:p:208-216
    DOI: 10.1177/0272989X211025525
    as

    Download full text from publisher

    File URL: https://journals.sagepub.com/doi/10.1177/0272989X211025525
    Download Restriction: no

    File URL: https://libkey.io/10.1177/0272989X211025525?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. James J. Bailey & Morrison Hodges & Timothy R. Church, 2007. "Decision to Implant a Cardioverter Defibrillator after Myocardial Infarction: The Role of Ejection Fraction v. Other Risk Factor Markers," Medical Decision Making, , vol. 27(2), pages 151-160, March.
    2. Regina Kwon & Larry A. Allen & Laura D. Scherer & Jocelyn S. Thompson & Madiha F. Abdel-Maksoud & Colleen K. McIlvennan & Daniel D. Matlock, 2018. "The Effect of Total Cost Information on Consumer Treatment Decisions: An Experimental Survey," Medical Decision Making, , vol. 38(5), pages 584-592, July.
    3. Anirban Basu & Josh J. Carlson & David L. Veenstra, 2016. "A Framework for Prioritizing Research Investments in Precision Medicine," Medical Decision Making, , vol. 36(5), pages 567-580, July.
    4. Abualbishr Alshreef & Nicholas Latimer & Paul Tappenden & Ruth Wong & Dyfrig Hughes & James Fotheringham & Simon Dixon, 2019. "Statistical Methods for Adjusting Estimates of Treatment Effectiveness for Patient Nonadherence in the Context of Time-to-Event Outcomes and Health Technology Assessment: A Systematic Review of Method," Medical Decision Making, , vol. 39(8), pages 910-925, November.
    5. Elliott Tolbert & Michael Brundage & Elissa Bantug & Amanda L. Blackford & Katherine Smith & Claire Snyder, 2018. "Picture This: Presenting Longitudinal Patient-Reported Outcome Research Study Results to Patients," Medical Decision Making, , vol. 38(8), pages 994-1005, November.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Manuel Antonio Espinoza & Andrea Manca & Karl Claxton & Mark Sculpher, 2018. "Social value and individual choice: The value of a choice‐based decision‐making process in a collectively funded health system," Health Economics, John Wiley & Sons, Ltd., vol. 27(2), pages 28-40, February.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:sae:medema:v:42:y:2022:i:2:p:208-216. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: SAGE Publications (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.