These decision rules offer an effective vehicle for personalized management of chronic conditions, e.g. alcohol and drug abuse, cancer, diabetes, HIV infection, and mental illnesses, where a patient typically has to be treated at multiple stages, adapting the treatment (type, dosage, timing) at each stage to the evolving treatment and covariate history.
Full Answer
What is an example of a dynamic treatment regime?
For example in the addiction management study, the primary research question may be the comparison of two simple dynamic treatment regimes (regime A and B). Each regime specifies one initial treatment for all patients and assigns one treatment for initial treatment responders and another for non-responders.
What are the treatment options for different subgroups?
(11) Note that sometimes researchers may consider different treatment options for different subgroups of subjects. For example in the addiction management study, different secondary treatment options are offered each of the three subgroups: initial treatment responders (subgroup 1), NTX non-responders (subgroup 2) and CBI non-responders (subgroup 3).
What is the sequence of decision rules for dynamic treatment?
The sequence of decision rules (d∗ 1 ,d ∗ 2 ) is the optimal dynamic treatment regime. And µ (d∗ 1 ,d ∗ 2 is the optimal mean primary outcome. Note that the treatment options at each decision point may depend on a patient’s ongoing information and/or previous treatment.
Can dynamic regime marginal structural mean models estimate optimal dynamic treatment regimes?
Dynamic regime marginal structural mean models for estimation of optimal dynamic treatment regimes, part II: Proofs and additional results. The International Journal of Biostatistics. 2010b;6[PMC free article][PubMed] [Google Scholar]
History
Historically, medical research and the practice of medicine tended to rely on an acute care model for the treatment of all medical problems, including chronic illness ( Wagner et al. 2001 ). More recently the medical field has begun to look at long term care plans to treat patients with a chronic illness.
Notation and Formulation
For a series of decision time points, , define to be the treatment action taken at time point , and define to be all clinical observations taken at time , prior to treatment action . Then a dynamic treatment regime, consists of a set of rules for each time point for choosing treatment , based clinical observations .
Methods for developing dynamic treatment regimes
The development of dynamic treatment regimes that result in optimal clinical outcomes is a process which involves the consideration of many different issues. A brief review of some of this process is given below.
