论文标题
在持续治疗的比较有效性研究中的宽限期
Grace periods in comparative effectiveness studies of sustained treatments
论文作者
论文摘要
研究人员通常有兴趣估计持续使用治疗对健康结果的影响。但是，对严格治疗方案的遵守对实践中的个人可能具有挑战性，并且当预计不遵守性时，对持续使用效果的估计对于决策可能没有用。作为替代方案，在务实的随机试验和观察性研究中考虑了更轻松的治疗方案，该方案允许休假期（即宽限期）。在本文中，我们考虑了包括恩典时期在内的治疗策略的解释，识别和估计。我们将自然的宽限期策略进行了对比，这些策略使个人可以自然地接受治疗，并通过调查人员指定治疗利用分布的随机宽限期策略。我们估计噻嗪类利尿剂或血管紧张素转换酶抑制剂在包括宽限期在内的各种策略下的作用。
Researchers are often interested in estimating the effect of sustained use of a treatment on a health outcome. However, adherence to strict treatment protocols can be challenging for individuals in practice and, when non-adherence is expected, estimates of the effect of sustained use may not be useful for decision making. As an alternative, more relaxed treatment protocols which allow for periods of time off treatment (i.e. grace periods) have been considered in pragmatic randomized trials and observational studies. In this article, we consider the interpretation, identification, and estimation of treatment strategies which include grace periods. We contrast natural grace period strategies which allow individuals the flexibility to take treatment as they would naturally do, with stochastic grace period strategies in which the investigator specifies the distribution of treatment utilization. We estimate the effect of initiation of a thiazide diuretic or an angiotensin-converting enzyme inhibitor in hypertensive individuals under various strategies which include grace periods.
