Decomposition analysis as a framework for understanding heterogeneity of treatment effects in n on‐randomized health care studies

2021 ◽  
Author(s):  
William H. Crown
Keyword(s):  
Health Care ◽  
Treatment Effects ◽  
Decomposition Analysis ◽  
Heterogeneity Of Treatment Effects

scholarly journals Demonstrating Heterogeneity of Treatment Effects Among Patients: An Overlooked but Important Step Toward Precision Medicine

2019 ◽  
Vol 106 (1) ◽  
pp. 204-210 ◽  
Author(s):  
Jennifer S. Gewandter ◽  
Michael P. McDermott ◽  
Hua He ◽  
Shan Gao ◽  
Xueya Cai ◽  
...  
Keyword(s):  
Precision Medicine ◽  
Treatment Effects ◽  
Heterogeneity Of Treatment Effects

scholarly journals Heterogeneity of treatment effects in malignant pleural mesothelioma – Authors' reply

The Lancet ◽  
2021 ◽  
Vol 398 (10297) ◽  
pp. 302
Author(s):  
Paul Baas ◽  
Arnaud Scherpereel ◽  
Anna K Nowak ◽  
Abderrahim Oukessou ◽  
Gerard Zalcman
Keyword(s):  
Malignant Pleural Mesothelioma ◽  
Treatment Effects ◽  
Pleural Mesothelioma ◽  
Heterogeneity Of Treatment Effects

Potential Genetic Causes of Heterogeneity of Treatment Effects

2007 ◽  
Vol 120 (4) ◽  
pp. S21-S25 ◽  
Author(s):  
David B. Goldstein ◽  
Anna C. Need ◽  
Rinki Singh ◽  
Sanjay M. Sisodiya
Keyword(s):  
Treatment Effects ◽  
Genetic Causes ◽  
Heterogeneity Of Treatment Effects

8. Heterogeneity of Treatment Effects

2017 ◽  
pp. 227-272
Author(s):  
Issa J. Dahabreh ◽  
Thomas A. Trikalinos ◽  
David M. Kent ◽  
Christopher H. Schmid
Keyword(s):  
Treatment Effects ◽  
Heterogeneity Of Treatment Effects

scholarly journals The Appalachia Mind Health Initiative (AMHI): A pragmatic clinical trial of adjunctive internet-based Cognitive Behavior Therapy for treating major depressive disorder among primary care patients

2021 ◽  
Author(s):  
Robert M. Bossarte ◽  
Ronald C. Kessler ◽  
Andrew A. Nierenberg ◽  
Pim Cuijpers ◽  
Angel Enrique ◽  
...  
Keyword(s):  
Treatment Effects ◽  
Remission Rate ◽  
Self Report ◽  
Cognitive Behavior ◽  
Major Depressive ◽  
Treatment Providers ◽  
Health Initiative ◽  
Heterogeneity Of Treatment Effects ◽  
Comparative Treatment

Abstract Background: Major Depressive Disorder (MDD) is a leading cause of disease morbidity. Combined treatment with antidepressant medication (ADM) plus psychotherapy yields a much higher MDD remission rate than ADM-only. But 77% of US MDD patients are nonetheless treated with ADM-only despite strong patient preferences for psychotherapy. This mismatch is due at least in part to a combination of cost considerations and limited availability of psychotherapists, although stigma and reluctance of PCPs to refer patients for psychotherapy are also involved. Internet-based Cognitive Behavior Therapy (i-CBT) addresses all of these problems. Methods: Enrolled patients (n=3,360) will be those who are beginning ADM-only treatment of MDD in primary care facilities throughout West Virginia, one of the poorest and most rural states in the country. Participating treatment providers and study staff at West Virginia University School of Medicine (WVU) will recruit patients and, after obtaining informed consent, administer a baseline self-report questionnaire (SRQ) and then randomize patients to 1 of 3 treatment arms with equal allocation: ADM-only, ADM + self-guided i-CBT, and ADM + guided i-CBT. Follow-up SRQs will be administered 2, 4, 8, 13, 16, 26, 39, and 52 weeks after randomization. The trial has two primary objectives: to evaluate aggregate comparative treatment effects across the 3 arms; and to estimate heterogeneity of treatment effects (HTE). The primary outcome will be episode remission based on a modified version of the patient-centered Remission from Depression Questionnaire (RDQ). The sample was powered to detect predictors of HTE that would increase the proportional remission rate by 20% by optimally assigning individuals as opposed to randomly assigning them into three treatment groups of equal size. Aggregate comparative treatment effects will be estimated using intent-to-treat analysis methods. Cumulative inverse probability weights will be used to deal with loss to follow-up. A wide range of self-report predictors of MDD heterogeneity of treatment effects based on previous studies will be included in the baseline SRQ. A state-of-the-art ensemble machine learning method will be used to estimate HTE.Discussion: The study is innovative in using a rich baseline assessment and in having a sample large enough to carry out a well-powered analysis of heterogeneity of treatment effects. We anticipate finding that self-guided and guided i-CBT will both improve outcomes compared to ADM-only. We also anticipate finding that the comparative advantages of adding i-CBT to ADM will vary significantly across patients. We hope to develop a stable individualized treatment rule that will allow patients and treatment providers to improve aggregate treatment outcomes by deciding collaboratively when ADM treatment should be augmented with i-CBT. Trial registration: The Appalachian Mind Health Initiative (AMHI; registry name) was prospectively registered on 10/9/19 (ClinicalTrials.gov Identifier: NCT04120285).

scholarly journals A 15-Year Trend of Catastrophic Health Payment and its Inequality in China: Evidence from Longitudinal Data

2021 ◽  
Author(s):  
Yongjian Xu ◽  
Yiting Zhou ◽  
Andi Pramono
Keyword(s):  
Health Care ◽  
Decomposition Analysis ◽  
Medical Insurance ◽  
Catastrophic Health Expenditure ◽  
Chinese Government ◽  
Nutrition Survey ◽  
Basic Medical Insurance ◽  
Poor Households ◽  
Health Payment ◽  
Basic Medical

Abstract Background：The Chinese health care system has gone through two major cycles of reform since the 1980s. This study aims to comprehensively track the trends in the occurrence of catastrophic health payment and its inequality in the past 15 years, which may help better understand the influence of health system reforms on catastrophic health payment and its inequality. Methods：The study employed the subset of data from China Health and Nutrition Survey conducted from 1991 to 2015. Concentration index and decomposition analysis were used to measure the magnitude of income-related inequality in catastrophic health payment and decompose it into determinants respectively. Results: The incidence of catastrophic health expenditure in China increased from 3.10% in 1993 to 8.90% in 2004, and still maintained at a high level in the following years. The incidence gap of catastrophic health payment between the richest and poorest became increasingly wider over year. Moreover, the adjusted concentration indexes were all negative in each year, decreasing from -0.202 in 1991 to -0.613 in 2015. The basic medical insurance didn’t decrease the incidence of catastrophic health payment and showed the second largest contribution on the inequality in catastrophic health payment before 2004. However, this contribution began to decline after 2006. Conclusions: After the New Health Care Reform, although the Chinese government has taken many measures to protect poor households from catastrophic health payment, the incidence gap between the rich and poor has widened. China has nearly achieved universal coverage in recent years, however, the basic medical insurance in China was not enough to protect households from catastrophic health payment. Our study suggests that improving the generosity of existing basic medical insurance, and reforming the medical insurance payment system would be helpful to reduce the incidence of catastrophic health payment. The use of big data tools and techniques to effectively screen the poor households, and strengthening the social medical aid system would be helpful to decrease the pro-rich inequality in catastrophic health payment.

scholarly journals Understanding the Improvement in Full Childhood Vaccination Coverage in Ethiopia Using Oaxaca–Blinder Decomposition Analysis

Vaccines ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 505
Author(s):  
Abrham Wondimu ◽  
Qi Cao ◽  
Derek Asuman ◽  
Josué Almansa ◽  
Maarten J. Postma ◽  
...  
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Care Utilization ◽  
Vaccination Coverage ◽  
Decomposition Analysis ◽  
Maternal Health Care ◽  
Childhood Vaccination ◽  
Care Utilization ◽  
Explanatory Variables ◽  
Maternal Health Care Utilization

In Ethiopia, full vaccination coverage among children aged 12–23 months has improved in recent decades. This study aimed to investigate drivers of the improvement in the vaccination coverage. The Oaxaca–Blinder decomposition technique was applied to identify the drivers using data from Ethiopian Demographic and Health Survey conducted in 2000 and 2016. The vaccination coverage rose from 14.3% in 2000 to 38.5% in 2016. The decomposition analysis showed that most of the rise in vaccination coverage (73.7%) resulted from the change in the effect of explanatory variables over time and other unmeasured characteristics. Muslim religion had a counteracting effect on the observed increase in vaccination coverage. The remaining 26.3% of the increase was attributed to the change in the composition of the explanatory variables between 2000 and 2016, with maternal educational level and maternal health care utilization as significant contributors. The findings highlight the need for further improvements in maternal health care utilization and educational status to maintain the momentum towards universal coverage of childhood vaccination. Targeted intervention among Muslim-dominated communities is also needed to improve the current situation. Besides which, future studies need to be conducted to identify additional potential modifiable factors.

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