Statistical models for longitudinal biomarkers of disease onset.

We consider the analysis of serial biomarkers to screen and monitor individuals in a given population for onset of a specific disease of interest. The biomarker readings are subject to error. We survey some of the existing literature and concentrate on two recently proposed models. The first is a fully Bayesian hierarchical structure for a mixed effects segmented regression model. Posterior estimates of the changepoint (onset time) distribution are obtained by Gibbs sampling. The second is a hidden changepoint model in which the onset time distribution is estimated by maximum likelihood using the EM algorithm. Both methods lead to a dynamic index that represents a strength of evidence that onset has occurred by the current time in an individual subject. The methods are applied to some large data sets concerning prostate specific antigen (PSA) as a serial marker for prostate cancer. Rules based on the indices are compared to standard diagnostic criteria through the use of ROC curves adapted for longitudinal data. Copyright 2000 John Wiley & Sons, Ltd.