Survextrap: a package for flexible and transparent survival extrapolation
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ABSTRACT:
SUBMITTER: Jackson C
PROVIDER: S-EPMC10685663 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
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Project description:BackgroundExtrapolation of survival data is a key task in health technology assessments (HTAs), which may be improved by incorporating general population mortality data via relative survival models. Dynamic survival models are a promising method for extrapolation that may be expanded to dynamic relative survival models (DRSMs), a novel development presented here. There are currently neither examples of dynamic models in HTA nor comparisons of DRSMs with other relative survival models when used for survival extrapolation.MethodsAn existing appraisal, for which there had been disagreement over the approach to survival extrapolation, was chosen and the health economic model recreated. The sensitivity of estimates of cost-effectiveness to different model choices (standard survival models, DSMs, and DRSMs) and specifications was examined. The appraisal informed a simulation study to evaluate DRSMs with relative survival models based on both standard and spline-based (flexible) models.ResultsDynamic models provided insight into the behavior of the trend in the hazard function and how it may vary during the extrapolated phase. DRSMs led to extrapolations with improved plausibility for which model choice may be based on clinical input. In the simulation study, the flexible and dynamic relative survival models performed similarly and provided highly variable extrapolations.LimitationsFurther experience with these models is required to identify settings when they are most useful, and they provide sufficiently accurate extrapolations.ConclusionsDynamic models provide a flexible and attractive method for extrapolating survival data and facilitate the use of clinical input for model choice. Flexible and dynamic relative survival models make few structural assumptions and can improve extrapolation plausibility, but further research is required into methods for reducing the variability in extrapolations.
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Project description:The uptake of technologies such as airborne laser scanning (ALS) and more recently digital aerial photogrammetry (DAP) enable the characterization of 3-dimensional (3D) forest structure. These forest structural attributes are widely applied in the development of modern enhanced forest inventories. As an alternative to extensive ALS or DAP based forest inventories, regional forest attribute maps can be built from relationships between ALS or DAP and wall-to-wall satellite data products. To date, a number of different approaches exist, with varying code implementations using different programming environments and tailored to specific needs. With the motivation for open, simple and modern software, we present FOSTER (Forest Structure Extrapolation in R), a versatile and computationally efficient framework for modeling and imputation of 3D forest attributes. FOSTER derives spectral trends in remote sensing time series, implements a structurally guided sampling approach to sample these often spatially auto correlated datasets, to then allow a modelling approach (currently k-NN imputation) to extrapolate these 3D forest structure measures. The k-NN imputation approach that FOSTER implements has a number of benefits over conventional regression based approaches including lower bias and reduced over fitting. This paper provides an overview of the general framework followed by a demonstration of the performance and outputs of FOSTER. Two ALS-derived variables, the 95th percentile of first returns height (elev_p95) and canopy cover above mean height (cover), were imputed over a research forest in British Columbia, Canada with relative RMSE of 18.5% and 11.4% and relative bias of -0.6% and 1.4% respectively. The processing sequence developed within FOSTER represents an innovative and versatile framework that should be useful to researchers and managers alike looking to make forest management decisions over entire forest estates.
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Project description:We investigated the electrical, optical and mechanical properties of silver (Ag) nanowire (NW) embedded into a silk fibroin (SF) substrate to create high performance, flexible, transparent, biocompatible, and biodegradable heaters for use in wearable electronics. The Ag NW-embedded SF showed a low sheet resistance of 15 Ω sq-1, high optical transmittance of 85.1%, and a small inner/outer critical bending radius of 1 mm. In addition, the Ag NW-embedded SF showed a constant resistance change during repeated bending, folding, and rolling because the connectivity of the Ag NW embedded into the SF substrate was well maintained. Furthermore, the biocompatible and biodegradable Ag NW-embedded SF substrate served as a flexible interconnector for wearable electronics. The high performance of the transparent and flexible heater demonstrated that an Ag NW-embedded SF-based heater can act as a biocompatible and biodegradable substrate for wearable heaters for the human body.
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Project description:BackgroundIn health technology assessment, restricted mean survival time and life expectancy are commonly evaluated. Parametric models are typically used for extrapolation. Spline models using a relative survival framework have been shown to estimate life expectancy of cancer patients more reliably; however, more research is needed to assess spline models using an all-cause survival framework and standard parametric models using a relative survival framework.AimTo assess survival extrapolation using standard parametric models and spline models within relative survival and all-cause survival frameworks.MethodsFrom the Swedish Cancer Registry, we identified patients diagnosed with 5 types of cancer (colon, breast, melanoma, prostate, and chronic myeloid leukemia) between 1981 and 1990 with follow-up until 2020. Patients were categorized into 15 cancer cohorts by cancer and age group (18-59, 60-69, and 70-99 y). We right-censored the follow-up at 2, 3, 5, and 10 y and fitted the parametric models within an all-cause and a relative survival framework to extrapolate to 10 y and lifetime in comparison with the observed Kaplan-Meier survival estimates. All cohorts were modeled with 6 standard parametric models (exponential, Weibull, Gompertz, log-logistic, log-normal, and generalized gamma) and 3 spline models (on hazard, odds, and normal scales).ResultsFor predicting 10-y survival, spline models generally performed better than standard parametric models. However, using an all-cause or a relative survival framework did not show any distinct difference. For lifetime survival, extrapolating from a relative survival framework agreed better with the observed survival, particularly using spline models.ConclusionsFor extrapolation to 10 y, we recommend spline models. For extrapolation to lifetime, we suggest extrapolating in a relative survival framework, especially using spline models.HighlightsFor survival extrapolation to 10 y, spline models generally performed better than standard parametric models did. However, using an all-cause or a relative survival framework showed no distinct difference under the same parametric model.Survival extrapolation to lifetime within a relative survival framework agreed well with the observed data, especially using spline models.Extrapolating parametric models within an all-cause survival framework may overestimate survival proportions at lifetime; models for the relative survival approach may underestimate instead.
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