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When to Start Treatment? A Systematic Approach to the Comparison of Dynamic Regimes Using Observational Data

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Author Info

  • Cain Lauren E.

    (Harvard School of Public Health)

  • Robins James M.

    (Harvard School of Public Health)

  • Lanoy Emilie

    (INSERM U943)

  • Logan Roger

    (Harvard School of Public Health)

  • Costagliola Dominique

    (INSERM U943 and Université Pierre et Marie Curie)

  • Hernán Miguel A.

    (Harvard School of Public Health and Harvard-MIT Division of Health Sciences and Technology)

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    Abstract

    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/mm3 or 350 cells/mm3. 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/mm3" 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.

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    Bibliographic Info

    Article provided by De Gruyter in its journal The International Journal of Biostatistics.

    Volume (Year): 6 (2010)
    Issue (Month): 2 (April)
    Pages: 1-26

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    Handle: RePEc:bpj:ijbist:v:6:y:2010:i:2:n:18

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    Web page: http://www.degruyter.com

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    Web: http://www.degruyter.com/view/j/ijb

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