Estimating the Causal Effect of Liver Allocation Policy Reflecting the Heterogeneity from Age and Geography

估计反映年龄和地理异质性的肝脏分配政策的因果效应

• 批准号: 10738502
• 负责人: Tomohiro Tanaka
• 金额: $ 14.72万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10738502
• 关键词: Estimating; Causal; Effect; Liver; Allocation

Project Summary / Abstract An optimal organ allocation policy for liver transplantation remains a critical yet unmet need. Fair and efficient organ allocation are often incompatible goals. Although the transplant community has made incremental changes to allocation policies over the years, disparities including, but not limited to, geographic region, age, and disease type persist. This is problematic, as organs represent severely limited resources (e.g., In 2020, median pretransplant mortality rate remained high [12.2 per 100 waiting list-years]) that are allocated in a life- and-death context. One major challenge in this arena is that randomized controlled trials are virtually impossible. Nevertheless, evidence-based policy making is necessary, making it difficult to accurately assess the causal effects of policies. Thus, it is essential to estimate the causal effects of these policies using observational data and rigorous methods that emulate the randomized trial. This Career Development Award aims to prepare the applicant for a career as a health policy/services researcher focusing on causal inference applied to chronic liver diseases / transplantation and whose work addresses a variety of health disparities. This will be strengthened by the applicant’s solid clinical domain expertise in chronic liver disease and liver transplantation. This goal will be accomplished within the infrastructure of the University of Iowa College of Medicine and College of Public Health through (a) specific graduate coursework, (b) a Mentorship Advisory Committee, (c) carefully selected conferences and workshops, and (d) a mentored research plan. The specific aims of the proposed studies are to estimate (1) the causal effects of the fundamental liver allocation policies (the Share-35 and the Acuity Circle policies), which designate different geographic boundaries and cutoffs for the criterion (Model of End-stage Liver Disease score; MELD) that is used to determine medical priority for allocation, (2) the causal effect of existing liver allocation priority rules in pediatric and adolescent candidates and (3) the potential causal impact of formulating a policy proposing to match the age of donors and recipients (donor-recipient age matching) and the cost-effectiveness of the potential policy implementation, all in the United States (U.S.). These estimates will be computed rigorously using natural- and quasi-experiments with an overlying causal inference framework, using a well-established nationwide observational transplant cohort. At the end of this Career Development Award, the candidate will be well-prepared to become an independent scientist with expertise in health policy, health services, epidemiology, and causal inference frameworks/econometrics focused on various disparities in healthcare (i.e., race, gender, age, geography, socioeconomic factors, and disease type), with specific expertise in chronic liver disease including liver transplantation. Our study findings will inform revisions to the current liver allocation policy in the U.S. and future studies designed to understand the causal effects of health policies guiding chronic liver disease/liver transplantation, which will form the foundation of the candidate's first R01 submission.

项目摘要 /摘要 肝脏移植的最佳器官分配政策仍然是至关重要但未满足的需求。公平有效 器官分配通常是不兼容的目标。尽管移植社区已经增量 多年来分配政策的变化，包括但不限于地理区域，年龄，包括但不限于 和疾病类型持续存在。这是有问题的，因为器官代表了严重有限的资源（例如，在2020年， 移植前死亡率中位数仍然很高[每100名等待名单的12.2]），分配在生命中 - 和死亡的上下文。在这个领域的一个主要挑战是随机对照试验实际上是 不可能的。但是，必须制​​定基于证据的政策，因此难以准确评估 政策的因果影响。这是必须使用 模拟随机试验的观察数据和严格方法。这个职业发展奖 旨在为申请人做好准备，成为关注因果推理的健康政策/服务研究人员 应用于慢性肝病 /移植，其工作涉及各种健康分布。 申请人在慢性肝病和肝脏中的固体临床领域专业知识将加强这一点 移植。这个目标将在爱荷华大学的基础设施中实现 医学和公共卫生学院通过（a）特定的研究生课程，（b）指导咨询 委员会（c）精心选择的会议和讲习班，以及（d）指导的研究计划。具体 拟议研究的目的是估计（1）基本肝分配政策的因果关系 （Share-35和Acuity Circle策略），指定不同的地理边界和截止 用于确定医学优先级的标准（终末期肝病评分；梅尔德） 分配，（2）小儿和青少年候选人中现有肝分配优先规则的因果效应 （3）制定政策提案以符合捐助者和接收者年龄的潜在因果影响 （捐助者的年龄匹配）以及潜在政策实施的成本效益 美国（美国）。这些估计将使用具有自然和准表现的严格计算 使用公认的国家观察移植队列的上覆的因果推理框架。 在该职业发展奖的结尾，候选人将有充分的准备成为独立的 具有卫生政策，卫生服务，流行病学和因果推论的专业知识的科学家 框架/计量经济学的重点是医疗保健的各种差异（即种族，性别，年龄，地理，地理， 社会经济因素和疾病类型），在慢性肝病（包括肝脏）中具有特定的专业知识 移植。我们的研究结果将为美国当前的肝分配政策和 未来的研究旨在了解指导慢性肝病/肝的健康政策的因果关系 移植，这将构成候选人的第一个R01提交的基础。