Counterpoint: The Treatment Decision Design
Counterpoint: The Treatment Decision Design
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DOI：
10.1093/aje/kwv214
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发表时间：
2015-11-15
影响因子：
5
通讯作者：
Brookhart, M. Alan
中科院分区：
文献类型：
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作者：
Brookhart, M. Alan
比较新用户设计是一种原则性方法，用于了解在没有研究治疗使用史的患者中开始不同治疗的相对风险和获益。Vandenbroucke和皮尔斯讨论了事件暴露设计中固有的一些问题，并认为流行病学可能会受到严格要求的损害，即随访只能在第一次暴露时开始。在目前的对位文章，药物流行病学的一系列问题，并不一定要求观察开始在第一次接触进行了讨论。例如，在过去或现在使用某种药物的患者中，我们可能想知道是否应该增加治疗，转换，重新开始或停止治疗。为了回答这些问题，概括的新用户的设计，治疗决策设计，确定队列锚定的时候，正在作出治疗决定，如实验室参数的评价，进行了讨论。该设计旨在提供与医生和患者直接相关的估计，帮助他们更好地了解他们正在考虑的不同治疗选择的风险和益处。
The comparative new-user design is a principled approach to learning about the relative risks and benefits of starting different treatments in patients who have no history of use of the treatments being studied. Vandenbroucke and Pearce discuss some problems inherent in incident exposure designs and argue that epidemiology may be harmed by a rigid requirement that follow-up can only begin at first exposure. In the present counterpoint article, a range of problems in pharmacoepidemiology that do not necessarily require that observation begin at first exposure are discussed. For example, among patients who are past or current users of a medication, we might want to know whether treatment should be augmented, switched, restarted, or discontinued. To answer these questions, a generalization of the new-user design, the treatment decision design, which identifies cohorts anchored at times when treatment decisions are being made, such as the evaluation of laboratory parameters, is discussed. The design aims to provide estimates that are directly relevant to physicians and patients, helping them to better understand the risks and benefits of the different treatment choices that they are considering.