论文标题

在纵向研究中估计个性化治疗规则,以协变量驱动的观察时间

Estimating Individualized Treatment Rules in Longitudinal Studies with Covariate-Driven Observation Times

论文作者

Coulombe, Janie, Moodie, Erica E. M., Shortreed, Susan M., Renoux, Christel

论文摘要

医生为治疗慢性疾病做出的顺序治疗决定在统计文献中被形式化为动态治疗方案。迄今为止,在观察时间(即治疗和结果监测时间)由研究研究者确定的假设,即动态治疗方案的方法。在电子健康记录数据中,通常不满足该假设,其中结果,观察时间和治疗机制与患者的特征相关。治疗和观察过程可能会导致感兴趣的治疗与在动态治疗方案中进行优化的结果之间的虚假关联,即使在分析中未充分考虑。我们通过将两个是患者协变量的函数的逆权量结合到动态加权的普通最小二乘中来开发最佳的单阶段动态治疗方案(称为个性化治疗规则)来解决这些关联。我们从经验上表明,我们的方法学得出一致,多重稳定的估计器。在英国临床实践研究数据链接中的抗抑郁药的新用户中,该方法用于制定最佳治疗规则,该规则可以在两种抗抑郁药之间选择与体重指数变化有关的实用功能。

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, i.e., 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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