A SMART data analysis method for constructing adaptive treatment strategies for substance use disorders

被引：37

作者：

Nahum-Shani, Inbal ^{[1
]}

Ertefaie, Ashkan ^{[2
]}

Lu, Xi ^{[3
]}

Lynch, Kevin G. ^{[4
,5
]}

McKay, James R. ^{[6
,7
]}

Oslin, David W. ^{[8
,9
]}

Almirall, Daniel ^{[1
]}

机构：

[1] Univ Michigan, Inst Social Res, 426 Thompson St, Ann Arbor, MI 48106 USA

[2] Univ Rochester, Dept Biostat & Computat Biol, Rochester, NY USA

[3] Univ Michigan, Dept Stat, Ann Arbor, MI 48109 USA

[4] Univ Penn, Dept Psychiat, Treatment Res Ctr, Philadelphia, PA 19104 USA

[5] Univ Penn, Dept Psychiat, Ctr Studies Addict, Philadelphia, PA 19104 USA

[6] Univ Penn, Dept Psychiat, Ctr Continuum Care Addict, Philadelphia, PA 19104 USA

[7] Univ Penn, Philadelphia Vet Adm Med Ctr, Philadelphia, PA 19104 USA

[8] Univ Penn, VISN MIRECC Cpl Michael J Crescenz VA Med Ctr 4, Philadelphia, PA 19104 USA

[9] Univ Penn, Dept Psychiat, Philadelphia, PA 19104 USA

来源：

ADDICTION | 2017年 / 112卷 / 05期

基金：

美国国家卫生研究院;

关键词：

Adaptive interventions; adaptive treatment strategies; alcohol dependence; Q-learning; Sequential Multiple Assignment Randomized Trial (SMART); stepped-care; DYNAMIC TREATMENT REGIMES; CONTINUING CARE; INDIVIDUALIZED TREATMENT; ALCOHOL DEPENDENCE; PERSONALIZED TREATMENT; RANDOMIZED-TRIAL; CHRONIC DISEASE; NALTREXONE; OUTCOMES; DESIGN;

D O I：

10.1111/add.13743

中图分类号：

R194 [卫生标准、卫生检查、医药管理];

学科分类号：

摘要：

AimsTo demonstrate how Q-learning, a novel data analysis method, can be used with data from a sequential, multiple assignment, randomized trial (SMART) to construct empirically an adaptive treatment strategy (ATS) that is more tailored than the ATSs already embedded in a SMART. MethodWe use Q-learning with data from the Extending Treatment Effectiveness of Naltrexone (ExTENd) SMART (N=250) to construct empirically an ATS employing naltrexone, behavioral intervention, and telephone disease management to reduce alcohol consumption over 24weeks in alcohol dependent individuals. ResultsQ-learning helped to identify a subset of individuals who, despite showing early signs of response to naltrexone, require additional treatment to maintain progress. ConclusionsQ-learning can inform the development of more cost-effective, adaptive treatment strategies for treating substance use disorders.

引用

页码：901 / 909

页数：9

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