Welcome to the StratifiedMedicine R package. The overall goal of this package is to develop analytic and visualization tools to aid in stratified and personalized medicine. Stratified medicine aims to find subsets or subgroups of patients with similar treatment effects, for example responders vs non-responders, while personalized medicine aims to understand treatment effects at the individual level (does a specific individual respond to treatment A?).

Currently, the main tools in this package area: (1) Filter Models (identify important variables and reduce input covariate space), (2) Patient-Level Estimate Models (using regression models, estimate counterfactual quantities, such as the conditional average treatment effect or CATE), (3) Subgroup Models (identify groups of patients using tree-based approaches), and (4) Parameter Estimation (across the identified subgroups), and (5) PRISM (Patient Response Identifiers for Stratified Medicine; combines tools 1-4). Development of this package is ongoing.

As a running example, consider a continuous outcome (ex: % change in tumor size) with a binary treatment (study drug vs standard of care). The estimand of interest is the average treatment effect, \(\theta_0 = E(Y|A=1)-E(Y|A=0)\). First, we simulate continuous data where roughly 30% of the patients receive no treatment-benefit for using \(A=1\) vs \(A=0\). Responders vs non-responders are defined by the continuous predictive covariates \(X_1\) and \(X_2\) for a total of four subgroups. Subgroup treatment effects are: \(\theta_{1} = 0\) (\(X_1 \leq 0, X_2 \leq 0\)), \(\theta_{2} = 0.25 (X_1 > 0, X_2 \leq 0)\), \(\theta_{3} = 0.45 (X_1 \leq 0, X2 > 0\)), \(\theta_{4} = 0.65 (X_1>0, X_2>0)\).

```
library(ggplot2)
library(dplyr)
library(partykit)
library(StratifiedMedicine)
library(survival)
dat_ctns = generate_subgrp_data(family="gaussian")
Y = dat_ctns$Y
X = dat_ctns$X # 50 covariates, 46 are noise variables, X1 and X2 are truly predictive
A = dat_ctns$A # binary treatment, 1:1 randomized
length(Y)
#> [1] 800
table(A)
#> A
#> 0 1
#> 409 391
dim(X)
#> [1] 800 50
```

The aim of filter models is to potentially reduce the covariate space such that subsequent analyses focus on the “important” variables. For example, we may want to identify variables that are prognostic and/or predictive of the outcome across treatment levels. Filter models can be run using the “filter_train” function. The default is search for prognostic variables using elastic net (Y~ENET(X); Hou and Hastie 2005). Random forest based importance (filter=“ranger”) is also available. See below for an example. Note that the object “filter.vars” contains the variables that pass the filter, while “plot_importance” shows us the relative importance of the input variables. For glmnet, this corresponds to the standardized regression coefficients (variables with coefficients=0 are not shown).

```
res_f <- filter_train(Y, A, X, filter="glmnet")
res_f$filter.vars
#> [1] "X1" "X2" "X3" "X5" "X7" "X8" "X10" "X12" "X16" "X18" "X24" "X26"
#> [13] "X31" "X40" "X46" "X50"
plot_importance(res_f)
```

An alternative approach is to search for variables that are potentially prognostic and/or predictive by forcing variable by treatment interactions, or Y~ENET(X,XA). Variables with estimated coefficients of 0 in both the main effects (X) and interaction effects (XA) are filtered. This can be implemented by tweaking the hyper-parameters:

Here, note that both the main effects of X1 and X2, along with the interaction effects (labeled X1_trtA and X2_trtA), have relatively large estimated coefficients.

The aim of PLE models is to estimate counterfactual quantities, for example the CATE. This is implemented through the “ple_train” function. The “ple_train” follows the framework of Kunzel et al 2019, which utilizes base learners and meta learners to obtain estimates of interest. For family=“gaussian”, “binomial”, this output estimates of and treatment differences. For family=“survival”, either logHR or restricted mean survival time (RMST) estimates are obtained. Current base-leaner options include “linear” (lm/glm/or cox), “ranger” (random forest through ranger R package), “glmnet” (elastic net), and “bart” (Bayesian Additive Regression Trees through BART R package). Meta-learners include the “T-Leaner” (treatment specific models), “S-learner” (single regression model), and “X-learner” (2-stage approach, see Kunzel et al 2019). See below for an example. Note that the object “mu_train” contains the training set patient-level estimates (outcome-based and propensity scores), “plot_ple” shows a waterfall plot of the estimated CATEs, and “plot_dependence” shows the partial dependence plot for variable “X1” with respect to the estimated CATE.

```
res_p1 <- ple_train(Y, A, X, ple="ranger", meta="T-learner")
summary(res_p1$mu_train)
#> mu_0 mu_1 diff_1_0 pi_0
#> Min. :0.6493 Min. :0.5308 Min. :-1.12502 Min. :0.5112
#> 1st Qu.:1.4166 1st Qu.:1.5707 1st Qu.:-0.02003 1st Qu.:0.5112
#> Median :1.6217 Median :1.8048 Median : 0.20715 Median :0.5112
#> Mean :1.6340 Mean :1.8458 Mean : 0.21181 Mean :0.5112
#> 3rd Qu.:1.8422 3rd Qu.:2.1153 3rd Qu.: 0.46391 3rd Qu.:0.5112
#> Max. :2.6318 Max. :3.0649 Max. : 1.20451 Max. :0.5112
#> pi_1
#> Min. :0.4888
#> 1st Qu.:0.4888
#> Median :0.4888
#> Mean :0.4888
#> 3rd Qu.:0.4888
#> Max. :0.4888
plot_ple(res_p1)
```

Next, let’s illustrate how to change the meta-learner and the hyper-parameters. See below, along with a 2-dimension PDP example.