Analytical strategies for characterizing chemotherapy diffusion with patient-level population-based data.
Analytical strategies for characterizing chemotherapy diffusion with patient-level population-based data.
复制标题
利用基于患者水平的人群数据来表征化疗扩散的分析策略。
DOI：
10.1007/bf03256164
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发表时间：
2010
影响因子：
3.6
通讯作者：
Schrag,Deborah
中科院分区：
文献类型：
--
作者：
Sima,CamiS;Panageas,KatherineS;Heller,Glenn;Schrag,Deborah
为了给癌症护理质量的评估提供信息，我们描述了分析方法来表征化疗药物在美国FDA批准后的扩散趋势。经济学和医学文献为研究创新扩散提供了两套截然不同的经验方法：聚合模型，它使用市场渗透率水平作为扩散的估计器；非聚集模型，它根据不同的个体单位采用创新所需的时间来评估扩散。当患者水平的基于人群的数据可用时，分解方法最大限度地利用可用信息。我们提出了一种方法，它使用时间到事件技术来描述在癌症诊断后的特定时间范围内使用药物的可能性。通过绘制这一概率与患者诊断的日历时间之间的关系，我们可以评估扩散的趋势。我们的方法解释了对死亡的依赖审查，以及医生内部患者的聚集。所提出的方法使用了监测、流行病学和最终结果(SEER)--医疗保险数据应用于两个案例研究：吉西他滨，被批准用于III/IV期胰腺癌；以及伊立替康，被批准为IV期结直肠癌的二线疗法。
To inform assessments of the quality of cancer care, we describe analytical approaches to characterizing trends in diffusion of chemotherapy drugs subsequent to their US FDA approval. The economics and medical literature provide two distinct sets of empirical methods for investigating diffusion of innovations: aggregate models, which use the level of market penetration as an estimator of diffusion; and disaggregate models, which evaluate diffusion based on the time required for different individual units to adopt innovations. When patient-level population-based data are available, disaggregate methods make the best use of the available information. We propose a method that employs time-to-event techniques to describe the probability of utilization of a drug within a specified timeframe subsequent to the diagnosis of cancer. By mapping the relationship between this probability and calendar time of a patient’s diagnosis, we can assess trends in diffusion. Our approach accounts for the dependent censoring for death, as well as for the clustering of patients within physicians. The method proposed is illustrated using Surveillance, Epidemiology, and End Results (SEER)-Medicare data applied to two case studies: gemcitabine, approved for stage III/IV pancreatic cancer; and irinotecan, approved as a second-line therapy for stage IV colorectal cancer.