Project ECHO Revisited: Propensity Score Analysis And HCV Treatment Outcomes

IF 2.6 Q2 GASTROENTEROLOGY & HEPATOLOGY
K. Page, F. Qeadan, C. Qualls, K. Thornton, Sanjeev Arora
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引用次数: 4

Abstract

Abstract Propensity score analysis is a statistical approach to reduce bias often present in non-randomized observational studies. In this paper we use this method to re-analyze data from a study that assessed whether patients receiving HCV treatment from providers in Project ECHO had different clinical outcomes than patients treated by specialists from an academic medical center (UNM HCV clinic) but in which treatment assignment was not randomized. We modeled the best estimated probability of treatment assignment, and then assess differences overall SVR and SVR in patients with genotype 1 infection by treatment arm using Stabilized Inverse Probability of Treatment Weights (SIPTW). Results show that after adjustment for SIPTW, HCV treatment outcomes were significantly better for the ECHO patients compared to the UNM HCV clinic patients. Higher proportions of patients treated by primary care providers achieved SVR and SVR with genotype 1 compared to those treated at UNM HCV clinic with 15.1% and 16.3% absolute differences, respectively. These results indicate that previously published results (showing no differences) were biased, and resulted in an underestimation of the treatment effect of ECHO on HCV treatment.
项目ECHO重访:倾向评分分析和HCV治疗结果
倾向评分分析是一种减少非随机观察性研究中经常出现的偏倚的统计方法。在本文中,我们使用这种方法重新分析了一项研究的数据,该研究评估了接受ECHO项目提供者治疗的HCV患者与接受学术医疗中心(UNM HCV诊所)专家治疗的患者的临床结果是否不同,但治疗分配不是随机的。我们建立了治疗分配的最佳估计概率模型,然后使用稳定的治疗权重逆概率(SIPTW)评估治疗组基因1型感染患者的总体SVR和SVR的差异。结果显示,经SIPTW校正后,ECHO患者的HCV治疗结果明显优于UNM HCV临床患者。与UNM HCV诊所治疗的患者相比,初级保健提供者治疗的患者达到基因型1的SVR和SVR的比例更高,绝对差异分别为15.1%和16.3%。这些结果表明,先前发表的结果(没有显示差异)是有偏差的,并且导致低估了ECHO对HCV治疗的治疗效果。
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来源期刊
Hepatic Medicine : Evidence and Research
Hepatic Medicine : Evidence and Research GASTROENTEROLOGY & HEPATOLOGY-
自引率
0.00%
发文量
15
审稿时长
16 weeks
期刊介绍: Hepatic Medicine: Evidence and Research is an international, peer-reviewed, open access, online journal. Publishing original research, reports, editorials, reviews and commentaries on all aspects of adult and pediatric hepatology in the clinic and laboratory including the following topics: Pathology, pathophysiology of hepatic disease Investigation and treatment of hepatic disease Pharmacology of drugs used for the treatment of hepatic disease Although the main focus of the journal is to publish research and clinical results in humans; preclinical, animal and in vitro studies will be published where they will shed light on disease processes and potential new therapies. Issues of patient safety and quality of care will also be considered. As of 1st April 2019, Hepatic Medicine: Evidence and Research will no longer consider meta-analyses for publication.
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