When to Start Treatment? A Systematic Approach to the Comparison of Dynamic Regimes Using Observational Data
When to Start Treatment? A Systematic Approach to the Comparison of Dynamic Regimes Using Observational Data
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DOI：
10.2202/1557-4679.1212
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发表时间：
2010-01-01
影响因子：
1.2
通讯作者：
Hernan, Miguel A.
中科院分区：
文献类型：
--
作者：
Cain, Lauren E.;Robins, James M.;Hernan, Miguel A.
动态治疗方案是临床实践中最常用的方案类型。例如，医生可能会开始联合抗逆转录病毒治疗时，第一次个人的记录CD 4细胞计数下降到低于500个细胞/mm（3）或350个细胞/mm（3）。本文描述了一种使用观察数据来模拟随机临床试验的方法，该方法比较了“在某个时间段内开始治疗”的形式的动态方案，该时间段内的某个时变协变量首次越过特定阈值。“我们将这种方法应用于法国医院HIV数据库（FHDH-ANRS CO 4）的数据，这是一项针对HIV感染患者的观察性研究，目的是比较“在记录的CD 4细胞计数首次降至x细胞/mm（3）以下后m个月内开始治疗”的动态方案，其中x取200至500的值，增量为10，m取0或3。我们在这个例子的上下文中描述了该方法，并讨论了使用观察数据模拟随机实验时出现的一些并发症。
Dynamic treatment regimes are the type of regime most commonly used in clinical practice. For example, physicians may initiate combined antiretroviral therapy the first time an individual's recorded CD4 cell count drops below either 500 cells/mm(3) or 350 cells/mm(3). This paper describes an approach for using observational data to emulate randomized clinical trials that compare dynamic regimes of the form "initiate treatment within a certain time period of some time-varying covariate first crossing a particular threshold." We applied this method to data from the French Hospital database on HIV (FHDH-ANRS CO4), an observational study of HIV-infected patients, in order to compare dynamic regimes of the form "initiate treatment within m months after the recorded CD4 cell count first drops below x cells/mm(3)" where x takes values from 200 to 500 in increments of 10 and m takes values 0 or 3. We describe the method in the context of this example and discuss some complications that arise in emulating a randomized experiment using observational data.