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arXiv 2107.03441stat.ME
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用Q学习方法确定最佳成本效益动态治疗方案

Identifying optimally cost-effective dynamic treatment regimes with a Q-learning approach

Nicholas Illenberger, Andrew J. Spieker, Nandita Mitra

摘要:

关于患者治疗策略的卫生政策决定需要考虑治疗效果和成本。在有效性方面优化治疗规则可能导致过于昂贵的策略;另一方面,在成本方面优化可能导致患者预后不良。我们提出了一个两步的方法来确定一个最佳的成本效益和可解释的动态治疗方案。首先,我们开发了一个相结合的Q-学习和政策搜索的方法来估计一个最佳的列表为基础的制度下的预期治疗费用的约束。其次,我们提出了一个迭代的过程来选择一个最佳的成本效益的制度,从一组候选制度对应于不同的成本约束。我们的方法可以估计最佳的制度存在时变的混杂,审查和相关的结果。通过模拟研究,我们说明了估计的治疗方案的有效性,并检查灵活的建模方法下的操作特性。我们还应用我们的方法来评估最佳的成本效益的治疗策略分配辅助治疗子宫内膜癌患者。

英文摘要:

Health policy decisions regarding patient treatment strategies require consideration of both treatment effectiveness and cost. Optimizing treatment rules with respect to effectiveness may result in prohibitively expensive strategies; on the other hand, optimizing with respect to costs may result in poor patient outcomes. We propose a two-step approach for identifying an optimally cost-effective and interpretable dynamic treatment regime. First, we develop a combined Q-learning and policy-search approach to estimate an optimal list-based regime under a constraint on expected treatment costs. Second, we propose an iterative procedure to select an optimally cost-effective regime from a set of candidate regimes corresponding to different cost constraints. Our approach can estimate optimal regimes in the presence of time-varying confounding, censoring, and correlated outcomes. Through simulation studies, we illustrate the validity of estimated treatment regimes and examine operating characteristics under flexible modeling approaches. We also apply our methodology to evaluate optimally cost-effective treatment strategies for assigning adjuvant therapies to endometrial cancer patients.

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