pvisim: parameters, simulator, claims records, tests; calibration of all worlds to Medicare targets
- latent-severity DGP with physicians (skill, style), policies A/B1/B2/sequential, common random numbers - sharp null exact at the patient level (tested) - 01_calibrate.R: joint logit-scale update; all worlds match early PVI 3.2%, late PVI 22.5/3.6%, CLTI 7.8%, death 35% - W4 deferral target 15% (trial-like crossover); post-CLTI PVI lowered so late PVI is mostly elective Co-Authored-By: Claude Opus 5.5 <[email protected]>
This commit is contained in:
Claude Opus 5.5
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.Rproj.user
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.Rhistory
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.RData
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results/
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*.parquet
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.DS_Store
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Package: pvisim
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Title: Known-Truth Simulator for Target Trial Emulation of Early Peripheral Vascular Intervention
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Version: 0.1.0
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Authors@R: person("Chen", "Dun", email = "[email protected]", role = c("aut", "cre"))
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Description: Data-generating process (claudicants nested in physicians, latent
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severity, physician skill and style), truths by simulating interventions,
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target trial emulation designs (naive, landmark, sequential trials,
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clone-censor-weight), simulated RCTs, physician-level variants, negative
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controls and performance metrics. Not for CRAN.
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License: MIT
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Encoding: UTF-8
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Depends: R (>= 4.3)
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Imports:
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stats,
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utils,
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yaml,
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data.table
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Suggests:
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testthat (>= 3.0.0),
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fastglm,
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sandwich,
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glmmTMB,
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pkgload
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Config/testthat/edition: 3
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exportPattern("^[a-z]")
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import(data.table)
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importFrom(stats, plogis, qlogis, qnorm, qpois, rnorm, runif, rbinom, rlnorm, rgamma, setNames)
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# Parameters: read the YAML, then apply a world and a truth scenario as overrides.
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#' Recursively merge `override` into `base` (lists only; scalars replace).
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deep_merge <- function(base, override) {
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for (nm in names(override)) {
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if (is.list(override[[nm]]) && is.list(base[[nm]])) {
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base[[nm]] <- deep_merge(base[[nm]], override[[nm]])
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} else {
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base[[nm]] <- override[[nm]]
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}
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}
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base
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}
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#' Path of the default parameter file, inside the installed or loaded package.
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default_params_path <- function() {
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p <- system.file("params", "dgp_default.yml", package = "pvisim")
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if (p == "") stop("dgp_default.yml not found; load the package with pkgload::load_all('pvisim')")
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p
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}
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#' Load parameters for one world and one truth scenario.
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#'
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#' @param world name in `worlds:` (W0, W1, W1_rho0, W2, W3, W4, W5, WR).
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#' @param scenario name in `scenarios:` (null, harm, benefit_harm).
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#' @param path YAML file; defaults to the package's dgp_default.yml.
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#' @param overrides optional list merged last (used by calibration and tests).
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#' @param calibrated apply the world's entry in `calibration_file` (intercepts solved by
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#' simulations/01_calibrate.R under the null scenario), after the world and before the
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#' scenario. Calibration itself runs with FALSE.
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load_params <- function(world = "W0", scenario = "null", path = default_params_path(),
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overrides = NULL, calibrated = TRUE,
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calibration_file = "simulations/config/calibrated.yml") {
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raw <- yaml::read_yaml(path)
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if (!world %in% names(raw$worlds)) stop("unknown world: ", world)
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if (!scenario %in% names(raw$scenarios)) stop("unknown scenario: ", scenario)
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par <- raw[setdiff(names(raw), c("worlds", "scenarios"))]
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par <- deep_merge(par, raw$worlds[[world]])
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if (calibrated && file.exists(calibration_file)) {
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cal <- yaml::read_yaml(calibration_file)[[world]]
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if (!is.null(cal)) par <- deep_merge(par, cal)
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par$calibrated <- !is.null(cal)
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} else {
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par$calibrated <- FALSE
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}
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par <- deep_merge(par, raw$scenarios[[scenario]])
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if (!is.null(overrides)) par <- deep_merge(par, overrides)
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par$world <- world
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par$scenario <- scenario
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par
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}
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# What the analyst sees: simulated Medicare claims (plan D17).
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# Latent quantities (Z_t, true smoking, frailty, skill, style, progression rate) never
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# leave this function except in `hidden`, which analysis code must not touch.
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HIDDEN_COLS <- c("skill", "style", "frailty", "fi_noise", "smoking_true", "z0", "rate", "venous", "z")
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#' Turn a population and its simulated course into claims-like records.
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#'
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#' @return list(patients = one row per patient: measured baseline and coded event times;
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#' pm = person-months (id, t, sev_obs) from month 0 to death or month 59;
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#' hidden = latent traits, for oracle analyses and checks only).
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make_records <- function(pop, course, par) {
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pat <- pop$pat; ev <- course$events; ms <- par$measurement
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M <- par$size$months
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smoking <- if (isTRUE(ms$smoking) || identical(ms$smoking, "true")) pat$smoking_true else pat$smoking_coded
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rel <- ms$frailty_reliability
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fi <- sqrt(rel) * pat$frailty + sqrt(1 - rel) * pat$fi_noise
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patients <- data.table(id = pat$id, phys_id = pat$phys_id, obl = pat$obl, age = pat$age,
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female = pat$female, black = pat$black, year = pat$year,
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diabetes = pat$diabetes, ckd = pat$ckd, chf = pat$chf, copd = pat$copd,
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prior_cvd = pat$prior_cvd, smoking = smoking, frailty_index = fi)
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patients <- cbind(patients, ev[, !"id"])
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# t_clti_true is latent: only the coded date is in claims
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patients[, t_clti_true := NULL]
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# observed severity: exact Z_t (clean worlds) or a claims proxy (world W5, WR)
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last <- pmin(ifelse(is.na(ev$t_death), M - 1L, ev$t_death), M - 1L)
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nrep <- last + 1L
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id <- rep(pat$id, nrep)
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t <- sequence(nrep) - 1L
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idx <- cbind(id, t + 1L)
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if (identical(ms$severity, "exact")) {
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sev <- course$z[idx]
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} else {
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w <- ms$proxy_window
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cs <- t(apply(course$counts, 1, function(x) { x[is.na(x)] <- 0L; cumsum(x) }))
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lagged <- cbind(matrix(0, nrow(cs), w), cs)[, seq_len(M)]
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sev <- log1p(cs[idx] - lagged[idx])
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}
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pm <- data.table(id = id, t = t, sev_obs = sev)
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hidden <- data.table(id = pat$id, skill = pat$skill, style = pat$style, frailty = pat$frailty,
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smoking_true = pat$smoking_true, rate = pat$rate,
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t_clti_true = ev$t_clti_true)
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list(patients = patients, pm = pm, hidden = hidden, par = par)
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}
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#' Stop if an analysis table carries a latent column.
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assert_no_hidden <- function(dt) {
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bad <- intersect(names(dt), HIDDEN_COLS)
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if (length(bad)) stop("latent columns in analysis data: ", paste(bad, collapse = ", "))
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invisible(TRUE)
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}
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#' One replicate's records: population, natural course, claims view.
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simulate_records <- function(par, rep = 1L, n = par$size$n_patients) {
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seed <- replicate_seed(par$world, par$scenario, rep)
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pop <- make_population(par, n = n, seed = seed)
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course <- simulate_course(pop, par, policy("natural"), seed = seed + 104729L, record = TRUE)
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make_records(pop, course, par)
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}
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#' Reproducible seed for a world x scenario x replicate.
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replicate_seed <- function(world, scenario, rep) {
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key <- paste(world, scenario, rep, sep = "|")
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h <- sum(utf8ToInt(key) * seq_along(utf8ToInt(key))^2)
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as.integer((h * 2654435761) %% 2147483647)
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}
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# The simulated world: physicians, patients, and the monthly course of disease and care.
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# Analysis plan v1.0, section 5.1.
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#
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# Common random numbers. simulate_course() draws the same uniforms for every patient
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# in every month, in a fixed order, whatever the patient's state or the policy. So two
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# runs on the same population with the same seed differ only through the policy. This
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# keeps truths under different strategies paired, and makes the sharp null exact at the
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# patient level (tested).
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STREAMS <- c("eps", "proxy", "clti", "false_code", "amp", "bypass", "rr", "clti_revasc",
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"nco1", "nco2", "nce", "pvi", "death")
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#' Physicians: latent skill k and style s (standard normal, correlated), setting, panel weight.
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make_physicians <- function(par, seed) {
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set.seed(seed)
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J <- par$size$n_physicians
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rho <- par$physician$rho_skill_style
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z1 <- rnorm(J); z2 <- rnorm(J)
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s <- z1
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k <- rho * z1 + sqrt(1 - rho^2) * z2
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obl <- rbinom(J, 1, plogis(par$physician$obl_intercept + par$physician$obl_style * s))
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w <- rlnorm(J, 0, par$size$panel_sdlog)
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data.table(phys_id = seq_len(J), skill = k, style = s, obl = obl, weight = w / sum(w))
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}
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#' Patients at diagnosis: measured baseline, latent traits, and assigned physician.
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make_patients <- function(par, n, phys, seed) {
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set.seed(seed)
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pp <- par$patient
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phys_id <- sample(phys$phys_id, n, replace = TRUE, prob = phys$weight)
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age <- pp$age_min + rgamma(n, shape = pp$age_shape, scale = pp$age_scale)
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frailty <- rnorm(n)
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a10 <- (age - 76) / 10
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comorb <- lapply(pp$comorbidity, function(cm)
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rbinom(n, 1, plogis(qlogis(cm$prev) + cm$age_coef * a10 + cm$frailty_coef * frailty)))
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smoking <- rbinom(n, 1, plogis(qlogis(pp$smoking$prev) + pp$smoking$age_coef * a10))
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sv <- par$severity
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z0 <- sv$z0_diabetes * comorb$diabetes + sv$z0_smoking * smoking + sv$z0_ckd * comorb$ckd +
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rnorm(n, 0, sv$z0_sd)
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rate <- sv$r0 + sv$r_diabetes * comorb$diabetes + sv$r_smoking * smoking + rnorm(n, 0, sv$r_sd)
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venous <- rnorm(n)
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year <- sample(pp$year_min:pp$year_max, n, replace = TRUE)
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# what claims show for smoking and frailty (the analyst's versions; plan D17)
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ms <- par$measurement
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smoking_coded <- ifelse(smoking == 1, rbinom(n, 1, ms$smoking_sens), rbinom(n, 1, 1 - ms$smoking_spec))
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fi_noise <- rnorm(n)
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pat <- data.table(id = seq_len(n), phys_id = phys_id, age = age,
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female = rbinom(n, 1, pp$p_female), black = rbinom(n, 1, pp$p_black),
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year = year)
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for (nm in names(comorb)) set(pat, j = nm, value = comorb[[nm]])
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pat[, `:=`(smoking_true = smoking, smoking_coded = smoking_coded, frailty = frailty,
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fi_noise = fi_noise, z0 = z0, rate = rate, venous = venous)]
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pat <- merge(pat, phys[, .(phys_id, skill, style, obl)], by = "phys_id", sort = FALSE)
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setorder(pat, id)
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pat[]
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}
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#' A full population for one replicate (or for the truths).
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make_population <- function(par, n = par$size$n_patients, seed = 1L, phys = NULL) {
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if (is.null(phys)) phys <- make_physicians(par, seed)
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pat <- make_patients(par, n, phys, seed + 7919L)
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list(phys = phys, pat = pat)
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}
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# ---- policies -----------------------------------------------------------------------
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# A policy overrides the natural elective-PVI decision among patients eligible in month t
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# (alive, no PVI yet, no MALE yet). Non-elective revascularization after CLTI is never
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# overridden: it happens after a MALE event, which every strategy allows.
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# natural observed practice
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# A natural in months 0..(w-2); everyone still eligible gets PVI at w-1
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# B1 no PVI in months 0..(w-1); natural afterwards
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# B2 no elective PVI ever
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# seq_force / seq_forbid (m) natural except PVI forced / forbidden at month m
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policy <- function(type = "natural", m = NA_integer_) {
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stopifnot(type %in% c("natural", "A", "B1", "B2", "seq_force", "seq_forbid"))
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list(type = type, m = m)
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}
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apply_policy <- function(pol, t, natural, window) {
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switch(pol$type,
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natural = natural,
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A = if (t < window - 1) natural else if (t == window - 1) rep(TRUE, length(natural)) else natural,
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B1 = if (t < window) rep(FALSE, length(natural)) else natural,
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B2 = rep(FALSE, length(natural)),
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seq_force = if (t == pol$m) rep(TRUE, length(natural)) else natural,
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seq_forbid = if (t == pol$m) rep(FALSE, length(natural)) else natural)
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}
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# ---- the monthly course -------------------------------------------------------------
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#' Simulate months 0..(months-1) for every patient under a policy.
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#'
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#' Within a month the order is: severity update; outcome events (CLTI, coding, amputation,
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#' bypass, repeat revascularization, revascularization after CLTI, negative controls);
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#' death; then the elective PVI decision among survivors still eligible. A MALE event
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#' and death in the same month count the MALE event first.
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#'
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#' @return list(pat = patient table with event times, z = N x months matrix of Z_t
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#' (record = TRUE only), counts = N x months matrix of proxy counts, pvi_month = vector).
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simulate_course <- function(pop, par, pol = policy("natural"), seed = 1L, record = TRUE) {
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pat <- pop$pat
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N <- nrow(pat)
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M <- par$size$months
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W <- par$size$window
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tr <- par$treatment; oc <- par$outcomes; nc <- par$negative_controls; ef <- par$effect
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a10 <- (pat$age - 76) / 10
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# time-fixed parts of each linear predictor
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lp_win <- tr$window$intercept + tr$window$frailty * pat$frailty + tr$window$age10 * a10 +
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tr$window$diabetes * pat$diabetes + tr$window$ckd * pat$ckd + tr$window$smoking * pat$smoking_true +
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tr$window$style * pat$style + tr$window$obl * pat$obl + tr$window$year * (pat$year - par$patient$year_min)
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lp_def <- tr$deferred$intercept + tr$deferred$style * pat$style + tr$deferred$obl * pat$obl
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d <- oc$death
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lp_death0 <- d$intercept + d$chf * pat$chf + d$ckd * pat$ckd + d$copd * pat$copd + d$frailty * pat$frailty
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cl <- oc$clti
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lp_clti0 <- cl$intercept + cl$diabetes * pat$diabetes + cl$ckd * pat$ckd + cl$smoking * pat$smoking_true +
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cl$frailty * pat$frailty
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lp_false <- oc$clti_false_code$intercept + oc$clti_false_code$style * pat$style
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am <- oc$amputation
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lp_amp0 <- am$intercept + am$diabetes * pat$diabetes + am$ckd * pat$ckd
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rr <- oc$repeat_revasc
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lp_rr0 <- rr$intercept + rr$skill * pat$skill + rr$style * pat$style
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lp_nco1 <- nc$nco1$intercept + nc$nco1$frailty * pat$frailty + nc$nco1$smoking * pat$smoking_true +
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nc$nco1$age10 * a10
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lp_nco2 <- nc$nco2$intercept + nc$nco2$style * pat$style + nc$nco2$venous * pat$venous
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lp_nce <- nc$nce$intercept + nc$nce$style * pat$style + nc$nce$frailty * pat$frailty
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kappa_post <- ef$kappa * exp(-ef$skill_kappa * pat$skill)
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# state
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Z <- pat$z0
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alive <- rep(TRUE, N); treated <- rep(FALSE, N); clti_true <- rep(FALSE, N)
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clti_code <- rep(FALSE, N); male <- rep(FALSE, N)
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t_pvi <- t_clti_true <- t_clti_code <- t_amp <- t_bypass <- t_rr <- t_male <- t_death <-
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t_nco1 <- t_nco2 <- t_nce <- rep(NA_integer_, N)
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pvi_elective <- rep(NA, N)
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||||||
|
n_proc <- integer(N)
|
||||||
|
zmat <- if (record) matrix(NA_real_, N, M) else NULL
|
||||||
|
cmat <- if (record) matrix(NA_integer_, N, M) else NULL
|
||||||
|
ns <- length(STREAMS)
|
||||||
|
|
||||||
|
set.seed(seed)
|
||||||
|
for (t in 0:(M - 1)) {
|
||||||
|
U <- matrix(runif(N * ns), N, ns, dimnames = list(NULL, STREAMS))
|
||||||
|
a <- alive
|
||||||
|
if (t > 0) Z[a] <- Z[a] + pat$rate[a] + kappa_post[a] * treated[a] +
|
||||||
|
par$severity$eps_sd * qnorm(U[a, "eps"])
|
||||||
|
if (record) {
|
||||||
|
zmat[a, t + 1] <- Z[a]
|
||||||
|
cmat[a, t + 1] <- qpois(U[a, "proxy"], exp(par$measurement$proxy_intercept + par$measurement$proxy_z * Z[a]))
|
||||||
|
}
|
||||||
|
|
||||||
|
# true CLTI, and its coding (true onset always coded; false codes by physician style)
|
||||||
|
new_clti <- a & !clti_true & U[, "clti"] < plogis(lp_clti0 + cl$z * Z)
|
||||||
|
clti_true[new_clti] <- TRUE; t_clti_true[new_clti] <- t
|
||||||
|
new_code <- a & !clti_code & (new_clti | U[, "false_code"] < plogis(lp_false))
|
||||||
|
clti_code[new_code] <- TRUE; t_clti_code[new_code] <- t
|
||||||
|
|
||||||
|
new_amp <- a & is.na(t_amp) & U[, "amp"] < plogis(lp_amp0 + am$clti * clti_true + am$z * Z)
|
||||||
|
t_amp[new_amp] <- t
|
||||||
|
new_byp <- a & is.na(t_bypass) & U[, "bypass"] < plogis(oc$bypass$intercept + oc$bypass$z * Z)
|
||||||
|
t_bypass[new_byp] <- t
|
||||||
|
n_proc[new_byp] <- n_proc[new_byp] + 1L
|
||||||
|
|
||||||
|
# repeat revascularization: only after the index PVI (from the month after it)
|
||||||
|
new_rr <- a & treated & !is.na(t_pvi) & t > t_pvi & U[, "rr"] < plogis(lp_rr0 + rr$z * Z)
|
||||||
|
t_rr[new_rr & is.na(t_rr)] <- t
|
||||||
|
n_proc[new_rr] <- n_proc[new_rr] + 1L
|
||||||
|
|
||||||
|
# revascularization after a CLTI diagnosis (not elective; allowed by every strategy)
|
||||||
|
cr <- a & clti_code & U[, "clti_revasc"] < plogis(oc$clti_revasc$intercept)
|
||||||
|
first <- cr & !treated
|
||||||
|
rep_ <- cr & treated & !new_rr
|
||||||
|
t_rr[rep_ & is.na(t_rr)] <- t
|
||||||
|
n_proc[cr & !new_rr] <- n_proc[cr & !new_rr] + 1L
|
||||||
|
if (any(first)) {
|
||||||
|
treated[first] <- TRUE; t_pvi[first] <- t; pvi_elective[first] <- FALSE
|
||||||
|
Z[first] <- Z[first] - ef$relief
|
||||||
|
}
|
||||||
|
|
||||||
|
# negative controls (never depend on PVI)
|
||||||
|
x <- a & is.na(t_nco1) & U[, "nco1"] < plogis(lp_nco1); t_nco1[x] <- t
|
||||||
|
x <- a & is.na(t_nco2) & U[, "nco2"] < plogis(lp_nco2); t_nco2[x] <- t
|
||||||
|
if (t < W) { x <- a & is.na(t_nce) & U[, "nce"] < plogis(lp_nce); t_nce[x] <- t }
|
||||||
|
|
||||||
|
# MALE: coded CLTI, amputation, bypass, or repeat revascularization
|
||||||
|
new_male <- a & !male & (clti_code | !is.na(t_amp) | !is.na(t_bypass) | !is.na(t_rr))
|
||||||
|
male[new_male] <- TRUE; t_male[new_male] <- t
|
||||||
|
|
||||||
|
# death
|
||||||
|
dies <- a & U[, "death"] < plogis(lp_death0 + d$age10 * a10 + d$age10 * t / 120 + d$z * Z + d$clti * clti_true)
|
||||||
|
alive[dies] <- FALSE; t_death[dies] <- t
|
||||||
|
|
||||||
|
# elective PVI among survivors still eligible
|
||||||
|
elig <- alive & !treated & !male
|
||||||
|
if (any(elig)) {
|
||||||
|
lp <- if (t < W) lp_win[elig] + tr$window$z * Z[elig] else lp_def[elig] + tr$deferred$z * Z[elig]
|
||||||
|
natural <- U[elig, "pvi"] < plogis(lp)
|
||||||
|
go <- apply_policy(pol, t, natural, W)
|
||||||
|
idx <- which(elig)[go]
|
||||||
|
if (length(idx)) {
|
||||||
|
treated[idx] <- TRUE; t_pvi[idx] <- t; pvi_elective[idx] <- TRUE
|
||||||
|
n_proc[idx] <- n_proc[idx] + 1L
|
||||||
|
Z[idx] <- Z[idx] - ef$relief
|
||||||
|
}
|
||||||
|
}
|
||||||
|
}
|
||||||
|
|
||||||
|
# disease composite (D34): coded CLTI or major amputation
|
||||||
|
t_disease <- pmin(t_clti_code, t_amp, na.rm = TRUE)
|
||||||
|
out <- data.table(id = pat$id, t_pvi, pvi_elective, t_clti_true, t_clti_code, t_amp, t_bypass,
|
||||||
|
t_rr, t_male, t_disease, t_death, t_nco1, t_nco2, t_nce, n_proc)
|
||||||
|
list(events = out, z = zmat, counts = cmat, policy = pol)
|
||||||
|
}
|
||||||
|
|
||||||
|
#' Cumulative incidence by month `h` (event in months 0..h-1, before death or in the same month).
|
||||||
|
cum_inc <- function(t_event, h = 60L) mean(!is.na(t_event) & t_event < h)
|
||||||
@@ -0,0 +1,125 @@
|
|||||||
|
# Every number that defines the simulated world. Analysis plan v1.0, section 5.
|
||||||
|
# Time unit: month. Hazards are monthly, on the logit scale.
|
||||||
|
# Starting values are placeholders, to be tuned by calibration
|
||||||
|
# (simulations/01_calibrate.R, targets in plan section 5.4).
|
||||||
|
# Physician traits (skill k, style s) and patient frailty F are standard normal;
|
||||||
|
# their influence is set by the coefficients that multiply them.
|
||||||
|
|
||||||
|
size:
|
||||||
|
n_patients: 50000
|
||||||
|
n_physicians: 1500
|
||||||
|
panel_sdlog: 1.0 # lognormal panel weights; median panel about 20 at n = 50,000
|
||||||
|
months: 60 # follow-up months 0-59
|
||||||
|
window: 6 # strategy A: PVI in months 0-5
|
||||||
|
|
||||||
|
physician:
|
||||||
|
rho_skill_style: -0.3 # corr(k, s). Has no effect unless skill matters (world W1)
|
||||||
|
obl_intercept: 0.0 # logit P(office-based lab / ASC); about 50% of physicians
|
||||||
|
obl_style: 0.8 # high-style physicians more often work in OBL/ASC
|
||||||
|
|
||||||
|
patient:
|
||||||
|
age_min: 66
|
||||||
|
age_shape: 2.5 # age = 66 + Gamma(shape, scale); mean about 76
|
||||||
|
age_scale: 4.0
|
||||||
|
p_female: 0.50
|
||||||
|
p_black: 0.10
|
||||||
|
# comorbidities: logit P = qlogis(prev) + age_coef * (age - 76) / 10 + frailty_coef * F
|
||||||
|
comorbidity:
|
||||||
|
diabetes: {prev: 0.40, age_coef: -0.10, frailty_coef: 0.4}
|
||||||
|
ckd: {prev: 0.20, age_coef: 0.30, frailty_coef: 0.5}
|
||||||
|
chf: {prev: 0.20, age_coef: 0.40, frailty_coef: 0.6}
|
||||||
|
copd: {prev: 0.25, age_coef: 0.10, frailty_coef: 0.4}
|
||||||
|
prior_cvd: {prev: 0.45, age_coef: 0.20, frailty_coef: 0.3}
|
||||||
|
smoking: {prev: 0.25, age_coef: -0.40}
|
||||||
|
year_min: 2015
|
||||||
|
year_max: 2019
|
||||||
|
|
||||||
|
severity: # latent Z_t: walking limitation / ABI on a standard scale
|
||||||
|
z0_diabetes: 0.3
|
||||||
|
z0_smoking: 0.3
|
||||||
|
z0_ckd: 0.2
|
||||||
|
z0_sd: 1.0
|
||||||
|
r0: 0.02 # mean drift per month
|
||||||
|
r_diabetes: 0.01
|
||||||
|
r_smoking: 0.01
|
||||||
|
r_sd: 0.01 # patient-specific progression rate
|
||||||
|
eps_sd: 0.05 # month-to-month noise
|
||||||
|
|
||||||
|
treatment:
|
||||||
|
window: # elective PVI hazard, months 0-5, among the eligible
|
||||||
|
intercept: -5.4
|
||||||
|
z: 0.9 # confounding by indication
|
||||||
|
frailty: -0.3 # frail patients are less often offered PVI
|
||||||
|
age10: -0.3
|
||||||
|
diabetes: 0.1
|
||||||
|
ckd: -0.1
|
||||||
|
smoking: 0.1
|
||||||
|
style: 0.5 # physician style; world W2 sets it to the strong level
|
||||||
|
obl: 0.3
|
||||||
|
year: 0.05 # per calendar year after year_min
|
||||||
|
deferred: # elective PVI hazard from month 6 on (deferral / crossover)
|
||||||
|
intercept: -7.2
|
||||||
|
z: 0.0 # world W4 makes deferral severity-driven
|
||||||
|
style: 0.5
|
||||||
|
obl: 0.3
|
||||||
|
|
||||||
|
effect: # what a PVI does. Set by the truth scenario
|
||||||
|
relief: 0.0 # immediate drop in Z at PVI
|
||||||
|
kappa: 0.0 # extra Z drift per month after PVI
|
||||||
|
skill_kappa: 0.0 # kappa * exp(-skill_kappa * k): skill slows post-PVI progression
|
||||||
|
|
||||||
|
outcomes:
|
||||||
|
death: {intercept: -5.0, age10: 0.7, chf: 0.4, ckd: 0.4, copd: 0.3, frailty: 0.4, z: 0.1, clti: 0.8}
|
||||||
|
clti: {intercept: -6.6, z: 0.6, diabetes: 0.4, ckd: 0.3, smoking: 0.3, frailty: 0.2}
|
||||||
|
clti_false_code: {intercept: -9.0, style: 0.0} # factor 3 sets style
|
||||||
|
amputation: {intercept: -8.5, clti: 3.0, diabetes: 0.4, ckd: 0.4, z: 0.2}
|
||||||
|
bypass: {intercept: -7.8, z: 0.5}
|
||||||
|
repeat_revasc: {intercept: -5.3, skill: 0.0, style: 0.0, z: 0.2} # only after the index PVI
|
||||||
|
clti_revasc: {intercept: -4.5} # PVI after CLTI (not elective); most CLTI patients get bypass, tibial work, amputation or nothing
|
||||||
|
|
||||||
|
negative_controls: # never depend on PVI
|
||||||
|
nco1: {intercept: -6.4, frailty: 0.5, smoking: 0.4, age10: 0.3} # hip fracture / pneumonia
|
||||||
|
nco2: {intercept: -7.1, style: 0.8, venous: 0.5} # varicose-vein ablation
|
||||||
|
nce: {intercept: -5.7, style: 0.8, frailty: -0.2} # low-value procedure, months 0-5
|
||||||
|
|
||||||
|
measurement: # what the analyst sees. World W5 switches to claims proxies
|
||||||
|
severity: exact # exact: analyst sees Z_t. proxy: only visit/testing counts
|
||||||
|
proxy_intercept: -1.0 # monthly count ~ Poisson(exp(proxy_intercept + proxy_z * Z_t))
|
||||||
|
proxy_z: 0.5
|
||||||
|
proxy_window: 3 # observed severity = log1p(sum of counts over the last 3 months)
|
||||||
|
frailty_reliability: 1.0 # frailty index = sqrt(rel) * F + sqrt(1 - rel) * noise
|
||||||
|
smoking: true # true: analyst sees true smoking. coded: sensitivity / specificity below
|
||||||
|
smoking_sens: 0.6
|
||||||
|
smoking_spec: 0.98
|
||||||
|
|
||||||
|
worlds: # one factor at a time (plan section 5.2, D24). Overrides on the default.
|
||||||
|
# Intercepts are then re-solved per world by calibration, so every world
|
||||||
|
# matches the same Medicare targets unless `calibration_targets` says otherwise.
|
||||||
|
W0: {}
|
||||||
|
W1:
|
||||||
|
effect: {skill_kappa: 0.5}
|
||||||
|
outcomes: {repeat_revasc: {skill: -0.6}}
|
||||||
|
W1_rho0:
|
||||||
|
physician: {rho_skill_style: 0.0}
|
||||||
|
effect: {skill_kappa: 0.5}
|
||||||
|
outcomes: {repeat_revasc: {skill: -0.6}}
|
||||||
|
W2:
|
||||||
|
treatment: {window: {style: 1.6}, deferred: {style: 1.6}}
|
||||||
|
W3:
|
||||||
|
treatment: {window: {style: 1.6}, deferred: {style: 1.6}}
|
||||||
|
outcomes: {clti_false_code: {style: 0.8}, repeat_revasc: {style: 0.6}}
|
||||||
|
W4: # deferral common (as in trial conservative arms) and severity-driven
|
||||||
|
treatment: {deferred: {z: 0.8}}
|
||||||
|
calibration_targets: {late_not: 0.15}
|
||||||
|
W5:
|
||||||
|
measurement: {severity: proxy, frailty_reliability: 0.4, smoking: coded}
|
||||||
|
WR:
|
||||||
|
effect: {skill_kappa: 0.5}
|
||||||
|
treatment: {window: {style: 1.6}, deferred: {style: 1.6, z: 0.8}} # deferral at the Sorber rate, but severity-driven
|
||||||
|
outcomes: {repeat_revasc: {skill: -0.6, style: 0.6}, clti_false_code: {style: 0.8}}
|
||||||
|
measurement: {severity: proxy, frailty_reliability: 0.4, smoking: coded}
|
||||||
|
|
||||||
|
scenarios: # truth scenarios (plan section 5.3, D34)
|
||||||
|
"null": {effect: {relief: 0.0, kappa: 0.0}} # sharp disease null
|
||||||
|
harm: {effect: {relief: 0.3, kappa: 0.03}} # tuned to RD about +5 pp (calibration)
|
||||||
|
benefit_harm: {effect: {relief: 1.2, kappa: 0.04}} # curves cross; tuned in calibration
|
||||||
@@ -0,0 +1,55 @@
|
|||||||
|
test_that("every world and scenario loads", {
|
||||||
|
raw <- yaml::read_yaml(default_params_path())
|
||||||
|
for (w in names(raw$worlds)) for (s in names(raw$scenarios)) {
|
||||||
|
par <- load_params(w, s)
|
||||||
|
expect_equal(par$world, w)
|
||||||
|
expect_true(is.numeric(par$effect$relief))
|
||||||
|
}
|
||||||
|
expect_equal(load_params("W2")$treatment$window$style, 1.6)
|
||||||
|
expect_equal(load_params("W2")$treatment$window$z, 0.9) # untouched by the override
|
||||||
|
})
|
||||||
|
|
||||||
|
small_world <- function(world = "WR", scenario = "null", n = 4000) {
|
||||||
|
par <- load_params(world, scenario, overrides = list(size = list(n_physicians = 150)))
|
||||||
|
list(par = par, pop = make_population(par, n = n, seed = 11L))
|
||||||
|
}
|
||||||
|
|
||||||
|
test_that("under the sharp null, disease, death and negative controls are identical under every policy", {
|
||||||
|
sw <- small_world("WR", "null")
|
||||||
|
runs <- lapply(list(policy("natural"), policy("A"), policy("B1"), policy("B2"),
|
||||||
|
policy("seq_force", 3L)),
|
||||||
|
function(p) simulate_course(sw$pop, sw$par, p, seed = 5L, record = FALSE)$events)
|
||||||
|
for (r in runs[-1]) {
|
||||||
|
for (col in c("t_disease", "t_clti_code", "t_amp", "t_death", "t_nco1", "t_nco2", "t_nce")) {
|
||||||
|
expect_identical(r[[col]], runs[[1]][[col]], info = col)
|
||||||
|
}
|
||||||
|
}
|
||||||
|
# MALE is not null: repeat revascularization needs an index PVI (D34)
|
||||||
|
expect_gt(cum_inc(runs[[2]]$t_male), cum_inc(runs[[3]]$t_male))
|
||||||
|
})
|
||||||
|
|
||||||
|
test_that("policies are followed", {
|
||||||
|
sw <- small_world("W0", "harm")
|
||||||
|
W <- sw$par$size$window
|
||||||
|
a <- simulate_course(sw$pop, sw$par, policy("A"), seed = 5L, record = FALSE)$events
|
||||||
|
# under A, everyone who survives month W-1 without a MALE event has had a PVI by then
|
||||||
|
# (death and MALE in a month come before that month's PVI decision)
|
||||||
|
free <- (is.na(a$t_death) | a$t_death > W - 1) & (is.na(a$t_male) | a$t_male > W - 1 | (!is.na(a$t_pvi) & a$t_pvi < a$t_male))
|
||||||
|
expect_true(all(!is.na(a$t_pvi[free]) & a$t_pvi[free] <= W - 1))
|
||||||
|
b1 <- simulate_course(sw$pop, sw$par, policy("B1"), seed = 5L, record = FALSE)$events
|
||||||
|
expect_false(any(b1$pvi_elective %in% TRUE & b1$t_pvi < W))
|
||||||
|
b2 <- simulate_course(sw$pop, sw$par, policy("B2"), seed = 5L, record = FALSE)$events
|
||||||
|
expect_false(any(b2$pvi_elective %in% TRUE))
|
||||||
|
})
|
||||||
|
|
||||||
|
test_that("records carry no latent columns and person-months end at death", {
|
||||||
|
par <- load_params("W5", "harm", overrides = list(size = list(n_physicians = 100)))
|
||||||
|
rec <- simulate_records(par, rep = 1L, n = 2000)
|
||||||
|
expect_true(assert_no_hidden(rec$patients))
|
||||||
|
expect_true(assert_no_hidden(rec$pm))
|
||||||
|
last <- rec$pm[, .(tmax = max(t)), by = id]
|
||||||
|
dead <- rec$patients[!is.na(t_death), .(id, t_death)]
|
||||||
|
chk <- merge(last, dead, by = "id")
|
||||||
|
expect_true(all(chk$tmax == chk$t_death))
|
||||||
|
expect_true(all(is.finite(rec$pm$sev_obs)))
|
||||||
|
})
|
||||||
@@ -0,0 +1,80 @@
|
|||||||
|
# Calibrate each world's natural course to the Medicare targets (plan section 5.4).
|
||||||
|
#
|
||||||
|
# For every world, under the null scenario, solve one intercept per target, cycling
|
||||||
|
# until all targets hold. Every world gets the same targets, so worlds differ only in
|
||||||
|
# the threat they switch on, not in base rates.
|
||||||
|
#
|
||||||
|
# Usage: Rscript simulations/01_calibrate.R [n] [world ...]
|
||||||
|
# Writes simulations/config/calibrated.yml (merged over existing entries).
|
||||||
|
|
||||||
|
pkgload::load_all("pvisim", quiet = TRUE)
|
||||||
|
suppressPackageStartupMessages(library(data.table))
|
||||||
|
|
||||||
|
args <- commandArgs(TRUE)
|
||||||
|
n <- if (length(args) && grepl("^[0-9e.]+$", args[1])) as.numeric(args[1]) else 1e5
|
||||||
|
worlds <- setdiff(args, as.character(args[1]))
|
||||||
|
if (!length(worlds)) worlds <- names(yaml::read_yaml(default_params_path())$worlds)
|
||||||
|
H <- 53L # Sorber 2023 median follow-up, about 4.4 years
|
||||||
|
|
||||||
|
# Natural-course statistics that the targets are defined on.
|
||||||
|
stats_of <- function(par) {
|
||||||
|
pop <- make_population(par, n = n, seed = 20261027L)
|
||||||
|
ev <- simulate_course(pop, par, policy("natural"), seed = 20261028L, record = FALSE)$events
|
||||||
|
early <- ev$pvi_elective %in% TRUE & ev$t_pvi < par$size$window
|
||||||
|
late_early <- !is.na(ev$t_rr) & ev$t_rr < H
|
||||||
|
late_not <- !is.na(ev$t_pvi) & ev$t_pvi >= par$size$window & ev$t_pvi < H
|
||||||
|
list(early = mean(early),
|
||||||
|
late_not = mean(late_not[!early]),
|
||||||
|
late_early = mean(late_early[early]),
|
||||||
|
clti_not = mean((!is.na(ev$t_clti_code) & ev$t_clti_code < H)[!early]),
|
||||||
|
death = cum_inc(ev$t_death))
|
||||||
|
}
|
||||||
|
|
||||||
|
# target name -> parameter path and value (plan 5.4)
|
||||||
|
targets <- list(
|
||||||
|
early = list(path = c("treatment", "window", "intercept"), value = 0.032),
|
||||||
|
late_not = list(path = c("treatment", "deferred", "intercept"), value = 0.036),
|
||||||
|
late_early = list(path = c("outcomes", "repeat_revasc", "intercept"), value = 0.225),
|
||||||
|
clti_not = list(path = c("outcomes", "clti", "intercept"), value = 0.078),
|
||||||
|
death = list(path = c("outcomes", "death", "intercept"), value = 0.35)
|
||||||
|
)
|
||||||
|
|
||||||
|
set_path <- function(lst, path, value) {
|
||||||
|
if (length(path) == 1) { lst[[path]] <- value; return(lst) }
|
||||||
|
lst[[path[1]]] <- set_path(if (is.null(lst[[path[1]]])) list() else lst[[path[1]]], path[-1], value)
|
||||||
|
lst
|
||||||
|
}
|
||||||
|
get_path <- function(lst, path) Reduce(function(x, p) x[[p]], path, lst)
|
||||||
|
|
||||||
|
# Each target depends mainly on its own intercept, and for rare monthly events
|
||||||
|
# logit(rate) moves about one-for-one with the intercept. So update all intercepts
|
||||||
|
# together: b <- b - damp * (logit(stat) - logit(target)), until every target is within
|
||||||
|
# `tol` on the logit scale. Common random numbers make each evaluation deterministic.
|
||||||
|
calibrate_world <- function(world, max_iter = 25, tol = 0.02, damp = 0.9) {
|
||||||
|
base <- load_params(world, "null", calibrated = FALSE)
|
||||||
|
for (tg in names(base$calibration_targets)) targets[[tg]]$value <- base$calibration_targets[[tg]]
|
||||||
|
ov <- list()
|
||||||
|
for (tg in names(targets)) ov <- set_path(ov, targets[[tg]]$path, get_path(base, targets[[tg]]$path))
|
||||||
|
for (it in seq_len(max_iter)) {
|
||||||
|
s <- stats_of(load_params(world, "null", overrides = ov, calibrated = FALSE))
|
||||||
|
gap <- sapply(names(targets), function(tg) qlogis(s[[tg]]) - qlogis(targets[[tg]]$value))
|
||||||
|
cat(sprintf("%s iter %2d: %s\n", world, it,
|
||||||
|
paste(sprintf("%s %.3f", names(s), unlist(s)), collapse = " ")))
|
||||||
|
if (all(abs(gap) < tol)) break
|
||||||
|
for (tg in names(targets)) {
|
||||||
|
b <- get_path(ov, targets[[tg]]$path)
|
||||||
|
ov <- set_path(ov, targets[[tg]]$path, round(b - damp * gap[[tg]], 4))
|
||||||
|
}
|
||||||
|
}
|
||||||
|
if (any(abs(gap) >= tol)) warning(world, ": not converged; largest logit gap ", round(max(abs(gap)), 3))
|
||||||
|
ov
|
||||||
|
}
|
||||||
|
|
||||||
|
out_path <- "simulations/config/calibrated.yml"
|
||||||
|
cal <- if (file.exists(out_path)) yaml::read_yaml(out_path) else list()
|
||||||
|
for (w in worlds) {
|
||||||
|
t0 <- Sys.time()
|
||||||
|
cal[[w]] <- calibrate_world(w)
|
||||||
|
cat(sprintf("%s done in %.1f min\n", w, as.numeric(Sys.time() - t0, units = "mins")))
|
||||||
|
yaml::write_yaml(cal, out_path)
|
||||||
|
}
|
||||||
@@ -0,0 +1,104 @@
|
|||||||
|
W0:
|
||||||
|
treatment:
|
||||||
|
window:
|
||||||
|
intercept: -6.3552
|
||||||
|
deferred:
|
||||||
|
intercept: -7.7172
|
||||||
|
outcomes:
|
||||||
|
repeat_revasc:
|
||||||
|
intercept: -5.6375
|
||||||
|
clti:
|
||||||
|
intercept: -7.4903
|
||||||
|
death:
|
||||||
|
intercept: -5.6504
|
||||||
|
W4:
|
||||||
|
treatment:
|
||||||
|
window:
|
||||||
|
intercept: -6.3535
|
||||||
|
deferred:
|
||||||
|
intercept: -6.7744
|
||||||
|
outcomes:
|
||||||
|
repeat_revasc:
|
||||||
|
intercept: -5.6429
|
||||||
|
clti:
|
||||||
|
intercept: -7.4903
|
||||||
|
death:
|
||||||
|
intercept: -5.6542
|
||||||
|
W1:
|
||||||
|
treatment:
|
||||||
|
window:
|
||||||
|
intercept: -6.3552
|
||||||
|
deferred:
|
||||||
|
intercept: -7.7172
|
||||||
|
outcomes:
|
||||||
|
repeat_revasc:
|
||||||
|
intercept: -5.7951
|
||||||
|
clti:
|
||||||
|
intercept: -7.4903
|
||||||
|
death:
|
||||||
|
intercept: -5.6504
|
||||||
|
W1_rho0:
|
||||||
|
treatment:
|
||||||
|
window:
|
||||||
|
intercept: -6.3552
|
||||||
|
deferred:
|
||||||
|
intercept: -7.7172
|
||||||
|
outcomes:
|
||||||
|
repeat_revasc:
|
||||||
|
intercept: -5.7187
|
||||||
|
clti:
|
||||||
|
intercept: -7.4903
|
||||||
|
death:
|
||||||
|
intercept: -5.6504
|
||||||
|
W2:
|
||||||
|
treatment:
|
||||||
|
window:
|
||||||
|
intercept: -7.3097
|
||||||
|
deferred:
|
||||||
|
intercept: -8.5615
|
||||||
|
outcomes:
|
||||||
|
repeat_revasc:
|
||||||
|
intercept: -5.5855
|
||||||
|
clti:
|
||||||
|
intercept: -7.4913
|
||||||
|
death:
|
||||||
|
intercept: -5.6505
|
||||||
|
W3:
|
||||||
|
treatment:
|
||||||
|
window:
|
||||||
|
intercept: -7.3134
|
||||||
|
deferred:
|
||||||
|
intercept: -8.5848
|
||||||
|
outcomes:
|
||||||
|
repeat_revasc:
|
||||||
|
intercept: -6.4032
|
||||||
|
clti:
|
||||||
|
intercept: -7.5232
|
||||||
|
death:
|
||||||
|
intercept: -5.649
|
||||||
|
W5:
|
||||||
|
treatment:
|
||||||
|
window:
|
||||||
|
intercept: -6.3552
|
||||||
|
deferred:
|
||||||
|
intercept: -7.7172
|
||||||
|
outcomes:
|
||||||
|
repeat_revasc:
|
||||||
|
intercept: -5.6375
|
||||||
|
clti:
|
||||||
|
intercept: -7.4903
|
||||||
|
death:
|
||||||
|
intercept: -5.6504
|
||||||
|
WR:
|
||||||
|
treatment:
|
||||||
|
window:
|
||||||
|
intercept: -7.3131
|
||||||
|
deferred:
|
||||||
|
intercept: -9.598
|
||||||
|
outcomes:
|
||||||
|
repeat_revasc:
|
||||||
|
intercept: -6.8121
|
||||||
|
clti:
|
||||||
|
intercept: -7.5233
|
||||||
|
death:
|
||||||
|
intercept: -5.6489
|
||||||
@@ -0,0 +1,26 @@
|
|||||||
|
# Quick look: the natural course of each world against the calibration targets (plan 5.4).
|
||||||
|
pkgload::load_all("pvisim", quiet = TRUE)
|
||||||
|
library(data.table)
|
||||||
|
args <- commandArgs(TRUE); worlds <- if (length(args)) args else c("W0", "WR")
|
||||||
|
for (w in worlds) {
|
||||||
|
par <- load_params(w, "harm")
|
||||||
|
t0 <- Sys.time()
|
||||||
|
pop <- make_population(par, seed = 1L)
|
||||||
|
ev <- simulate_course(pop, par, policy("natural"), seed = 2L, record = FALSE)$events
|
||||||
|
ev <- merge(ev, pop$pat[, .(id, phys_id)], by = "id")
|
||||||
|
early <- !is.na(ev$t_pvi) & ev$t_pvi < 6 & ev$pvi_elective %in% TRUE
|
||||||
|
h <- 53 # Sorber median follow-up about 4.4 years
|
||||||
|
late <- !is.na(ev$t_pvi) & ev$t_pvi >= 6 | !is.na(ev$t_rr) & ev$t_rr >= 6
|
||||||
|
late <- late & pmin(ev$t_pvi * NA^(ev$t_pvi < 6), ifelse(!is.na(ev$t_rr) & ev$t_rr >= 6, ev$t_rr, NA), na.rm = TRUE) < h
|
||||||
|
clti <- !is.na(ev$t_clti_code) & ev$t_clti_code < h
|
||||||
|
phys <- ev[, .(n = .N, rate = mean(!is.na(t_pvi) & t_pvi < 6 & pvi_elective %in% TRUE)), by = phys_id]
|
||||||
|
sdr <- sd(phys$rate); out <- mean(phys$rate >= mean(phys$rate) + 2 * sdr)
|
||||||
|
cat(sprintf("\n%s (%.0fs)\n early PVI %.1f%% (target 3.2)\n physician rate: median %.1f%%, max %.0f%%, >=2SD outliers %.1f%% (0, 58, 5.6)\n",
|
||||||
|
w, as.numeric(Sys.time() - t0, units = "secs"), 100 * mean(early),
|
||||||
|
100 * median(phys$rate), 100 * max(phys$rate), 100 * out))
|
||||||
|
cat(sprintf(" late PVI by 4.4y: early %.1f%% vs not %.1f%% (22.5 vs 3.6)\n", 100 * mean(late[early]), 100 * mean(late[!early])))
|
||||||
|
cat(sprintf(" coded CLTI by 4.4y: early %.1f%% vs not %.1f%% (16.4 vs 7.8)\n", 100 * mean(clti[early]), 100 * mean(clti[!early])))
|
||||||
|
cat(sprintf(" death by 5y %.1f%% (about 35) MALE by 5y %.1f%% amputation %.2f%% disease composite %.1f%%\n",
|
||||||
|
100 * cum_inc(ev$t_death), 100 * cum_inc(ev$t_male), 100 * cum_inc(ev$t_amp), 100 * cum_inc(ev$t_disease)))
|
||||||
|
cat(sprintf(" NCO1 %.1f%% NCO2 %.1f%% NCE %.1f%%\n", 100 * cum_inc(ev$t_nco1), 100 * cum_inc(ev$t_nco2), 100 * cum_inc(ev$t_nce)))
|
||||||
|
}
|
||||||
Reference in New Issue
Block a user