Assessment of evidence against homogeneity in exhaustive subgroup treatment effect plots

Abstract

Exhaustive subgroup treatment effect plots are constructed by displaying all subgroup treatment effects of interest against subgroup sample size, providing a useful overview of the observed treatment effect heterogeneity in a clinical trial. As in any exploratory subgroup analysis, however, the observed estimates suffer from small sample sizes and multiplicity issues. To facilitate more interpretable exploratory assessments, this paper introduces a computationally efficient method to generate homogeneity regions within exhaustive subgroup treatment effect plots. Using the Doubly Robust (DR) learner, pseudo-outcomes are used to estimate subgroup effects and derive reference distributions, quantifying how surprising observed heterogeneity is under a homogeneous effects model. Explicit formulas are derived for the homogeneity region and different methods for calculation of the critical values are compared. The method is illustrated with a cardiovascular trial and evaluated via simulation, showing well-calibrated inference and improved performance over standard approaches using simple differences of observed group means.