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

Cain Lauren E., Robins James M., Lanoy Emilie, Logan Roger, Costagliola Dominique and Hernán Miguel A.
Additional contact information
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

The International Journal of Biostatistics, 2010, vol. 6, issue 2, 26

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.

Keywords: dynamic treatment regimes; marginal structural models; HIV infection; antiretroviral therapy (search for similar items in EconPapers)
Date: 2010
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (11)

Downloads: (external link)
https://doi.org/10.2202/1557-4679.1212 (text/html)
For access to full text, subscription to the journal or payment for the individual article is required.

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:bpj:ijbist:v:6:y:2010:i:2:n:18

Ordering information: This journal article can be ordered from
https://www.degruyter.com/journal/key/ijb/html

DOI: 10.2202/1557-4679.1212

Access Statistics for this article

The International Journal of Biostatistics is currently edited by Antoine Chambaz, Alan E. Hubbard and Mark J. van der Laan

More articles in The International Journal of Biostatistics from De Gruyter
Bibliographic data for series maintained by Peter Golla ().