Estimating individualized treatment rules in longitudinal studies with covariate-driven observation times.
Estimating individualized treatment rules in longitudinal studies with covariate-driven observation times.
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DOI：
10.1177/09622802231158733
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发表时间：
2023-05
影响因子：
2.3
通讯作者：
Renoux, Christel
中科院分区：
文献类型：
--
作者：
Coulombe, Janie;Moodie, Erica E. M.;Shortreed, Susan M.;Renoux, Christel
关键词：
医生治疗慢性病的顺序治疗决策在统计文献中被正式确定为动态治疗方案。迄今为止，动态治疗方案的方法已经在假设观察时间（即治疗和结果监测时间）由研究者确定的情况下开发。在电子健康记录数据中，结果、观察时间和治疗机制与患者的特征相关联，这一假设通常不满足。如果在分析中没有充分考虑，治疗和观察过程可能导致感兴趣的治疗与动态治疗方案下待优化的结果之间的虚假关联。我们解决这些关联，将两个反权重，是一个病人的协变量的函数到动态加权普通最小二乘法开发最佳的单阶段动态治疗方案，被称为个性化的治疗规则。我们的经验表明，我们的方法产生一致的，多个强大的估计。在英国临床实践研究数据链的抗抑郁药物的新用户队列中，所提出的方法用于开发最佳治疗规则，该规则在两种抗抑郁药物之间进行选择，以优化与体重指数变化相关的效用函数。
The sequential treatment decisions made by physicians to treat chronic diseases are formalized in the statistical literature as dynamic treatment regimes. To date, methods for dynamic treatment regimes have been developed under the assumption that observation times, that is, treatment and outcome monitoring times, are determined by study investigators. That assumption is often not satisfied in electronic health records data in which the outcome, the observation times, and the treatment mechanism are associated with patients’ characteristics. The treatment and observation processes can lead to spurious associations between the treatment of interest and the outcome to be optimized under the dynamic treatment regime if not adequately considered in the analysis. We address these associations by incorporating two inverse weights that are functions of a patient’s covariates into dynamic weighted ordinary least squares to develop optimal single stage dynamic treatment regimes, known as individualized treatment rules. We show empirically that our methodology yields consistent, multiply robust estimators. In a cohort of new users of antidepressant drugs from the United Kingdom’s Clinical Practice Research Datalink, the proposed method is used to develop an optimal treatment rule that chooses between two antidepressants to optimize a utility function related to the change in body mass index.
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