Accounting for treatment during the development or validation of prediction models

Abstract

Clinical prediction models are widely used to predict adverse outcomes in patients, and are often employed to guide clinical decision-making. Clinical data typically consist of patients who received different treatments. Many prediction modeling studies fail to account for differences in patient treatment appropriately, which results in the development of prediction models that show poor accuracy and generalizability. In this paper, we list the most common methods used to handle patient treatments and discuss certain caveats associated with each method. We believe that proper handling of differences in patient treatment is crucial for the development of accurate and generalizable models. As different treatment strategies are employed for different diseases, the best approach to properly handle differences in patient treatment is specific to each individual situation. We use the Ma-Spore acute lymphoblastic leukemia data set as a case study to demonstrate the complexities associated with differences in patient treatment, and offer suggestions on incorporating treatment information during evaluation of prediction models. In clinical data, patients are typically treated on a case by case basis, with unique cases occurring more frequently than expected. Hence, there are many subtleties to consider during the analysis and evaluation of clinical prediction models.