Patients with end-stage kidney disease can expect to wait for several years before they receive a transplant, all the while their health deteriorates. How would the survival change if we managed to reduce these waiting times? To provide an answer, we present a continuous-time marginal structural model (MSM) of hypothetical scenarios in which the time until treatment is changed. In these scenarios, the treatment process is defined on a hypothetical time scale where time passes at a different rate compared to the time actually observed. Changing the time of the treatment process corresponds to changing the joint probability distribution, thereby making it possible to identify and estimate hypothetical parameters from observational data using previously developed methodology. We demonstrate this treatment-accelerated MSM using observational data from a Norwegian cohort of elderly patients with kidney failure. This model can potentially be useful to health authorities looking to assess the impacts of reducing the waiting times for organ transplantation in a given patient population.
翻译:肾脏末期疾病患者在接受移植前预计会等待几年,而他们的健康状况则会恶化。如果我们设法减少这些等待时间,生存会如何变化?为了提供答案,我们提出了一个连续时间边缘结构模型(MSM)的假设假设假设情景,在这种假设情景中,治疗期到治疗前的时间变化。在这些假设情景中,治疗过程的定义是假设时间尺度,时间间隔与实际观察到的时间间隔不同。改变治疗过程的时间与改变共同概率分布相对应,从而有可能利用以前开发的方法从观察数据中查明和估计假设参数。我们用挪威肾衰竭老年病人群的观察数据来证明这种治疗加速的MMMM。这一模型可能有益于卫生当局评估在特定病人人口中减少器官移植等待时间的影响。