There is by now a long tradition of using the EM algorithm to find maximum‐likelihood estimates (MLEs) when the data are incomplete in any of a wide range of ways, even when the observed‐data likelihood can easily be evaluated and numerical maximisation of that likelihood is available as a conceptually simple route to the MLEs. It is rare in the literature to see numerical maximisation employed if EM is possible. But with excellent general‐purpose numerical optimisers now available free, there is no longer any reason, as a matter of course, to avoid direct numerical maximisation of likelihood. In this tutorial, I present seven examples of models in which numerical maximisation of likelihood appears to have some advantages over the use of EM as a route to MLEs. The mathematical and coding effort is minimal, as there is no need to derive and code the E and M steps, only a likelihood evaluator. In all the examples, the unconstrained optimiser nlm available in R is used, and transformations are used to impose constraints on parameters. I suggest therefore that the following question be asked of proposed new applications of EM: Can the MLEs be found more simply and directly by using a general‐purpose numerical optimiser? 相似文献
Knee cartilage damage is a common cause of referral for orthopedic surgery. Treatment aims to reduce pain and symptoms by repairing cartilage. Microfracture, the current standard of care, yields good short-term clinical outcomes; however, treatment might fail after 2–3 years. A Chitosan-Beta glycerolphosphate-based medical device (BST-CarGel) is used as an adjunct to microfracture and demonstrates improvements in quantity and quality of repaired tissue, potentially reducing the risk of treatment failure. This study aimed to establish the economic value of BST-CarGel vs microfracture alone in knee cartilage repair from the societal perspective, using Germany as the reference market.
Methods:
A decision tree with a 20-year time-horizon was constructed, in which undesirable clinical events were inferred following initial surgery. These events consisted of pain management, surgery, and total knee replacement. Clinical outcomes were taken from the pivotal clinical trial, supplemented by other literature. Data and assumptions were validated by a Delphi panel. All relevant resource use and costs for procedures and events were considered.
Results:
In a group of patients with all lesion sizes, the model inferred that BST-CarGel yields a positive return on investment at year 4 (with 20-year cumulative cost savings of €6448). Reducing the incremental risk of treatment failure gap between the device and microfracture by 25–50% does not alter this conclusion. Cost savings are greatest for patients with large lesions; results for patients with small lesions are more modest.
Limitations:
Clinical evidence for microfracture and other interventions varies in quality. Comparative long-term data are lacking. The comparison is limited to microfracture and looks only at costs without considering quality-of-life.
Conclusion:
BST-CarGel potentially represents a cost-saving alternative for patients with knee cartilage injury by reducing the risk of clinical events through regeneration of chondral tissue with hyaline characteristics. Since the burden of this condition is high, both to the patient and society, an effective and economically viable alternative is of importance. 相似文献
This paper identifies determinants of compliance with various types of national numerical fiscal rules. Based on 51 fiscal rules in force in EU member states from 1995 to 2015, the analysis identifies determinants among specific rule characteristics and their fiscal frameworks, as well as their political, (socio-)economic and supranational environments. While the average compliance across all rules and countries is around 50%, compliance with rules constraining stock (rather than flow) variables, set out in coalitional agreements, as well as rules covering larger parts of general government finances is significantly higher. Furthermore, independent monitoring and enforcement bodies (issuing real-time alerts) turn out to be significantly associated with a higher probability of compliance. Several theories of the deficit bias of governments due to government fragmentation, decentralization and political budget cycles are also significant with regards to compliance with fiscal rules. However, neither the economic environment or business cycle, nor forecast errors (except for an unexpectedly higher primary balance) on average seem to play a significant role. 相似文献