Time to event and drop-out model
Dear NM-users.
I am modeling the preventive effect of a drug by using a time-to-event approach
(time to get a new parasite infection after treatment). Patients were treated
once a month for 3 months, with a scheduled follow-up 1 month after the last
treatment (and again if they were symptomatic during 2 additional months of
follow-up) The PK has been modeled and fixed for the TTE-model. A constant
hazard with sigmoid Emax drug effect was used to explain the time-to-new
infection with a good RSEs and reasonable parameter estimates.
However, in this study, the dropout events are not randomly distributed. After
the third month (after last treatment), 30% of all patients dropped out and did
not come back for the 1st follow-up visit (the average dropout rate is about 2%
each month). Many of the patients (50%) that came back after the 1st follow-up
visit had acquired a new infection. I therefore believe that many of the
patients that were lost did not have an infection.
I am wondering if I need/how to model the drop-outs or in any way compensate
for the fact that only patients without infections dropped out?
I would also like to ask if anyone know how to diagnose TTE-models (except
VPCs)?
Your comments and help is most appreciated.
Thank you and Best Regards
Palang Chotsiri
PhD-student in Pharmacometrics
Mahidol-Oxford Tropical Medicine Research Unit, Bangkok 10400, THAILAND