Reply to Comparison of hospitalization risk and associated costs among patients receiving sargramostim, filgrastim, and pegfilgrastim for chemotherapy‐induced neutropenia
Notice bibliographique
Résumé
We appreciate the concerns raised by Weycker and Barron regarding our study of the effects of sargramostim, filgrastim, and pegfilgrastim on hospitalization risks associated with chemotherapy-induced neutropenia,1 but believe that their criticisms do not call into question the study's conclusions. We agree that the risk of febrile neutropenia (FN) varies across multiple chemotherapy cycles, so we focused our study design on the use of colony-stimulating factors (CSFs) during the first few chemotherapy cycles, thereby capturing the period with the highest incident risk of FN. Our methodology also took into account the use of CSFs for treatment versus prophylaxis because the adjusted hospitalization incidence rates controlled for the occurrence of a neutropenia diagnosis on the date of CSF initiation, reflecting CSF use for treatment rather than prophylaxis. The results found that pegfilgrastim indeed appears to be used more frequently for prophylaxis than sargramostim and filgrastim, and this potential confounding factor was accounted for in the regression model. Moreover, it is unlikely from a clinical perspective that sargramostim and filgrastim would be used differentially for treatment versus prophylaxis, thereby reducing the likelihood of biased estimates. With regard to the duration of follow-up across the CSFs, Weycker and Baron appear to imply that the longer observation period penalizes pegfilgrastim (ie, assigns a higher incidence rate of hospitalization to pegfilgrastim). We believe that the longer therapeutic duration of pegfilgrastim compared with sargramostim and filgrastim necessitates a longer observation period and chose 19 days as the average real-life interval between pegfilgrastim administrations. Moreover, the use of patient-years of observation as the denominator for the incidence rate accounts for the longer therapeutic duration. The matched cohort design was challenged because it excludes the majority of filgrastim and pegfilgrastim patients. Although there are many ways to control for potential confounders, matched cohorts are a well-established research design.2, 3 Indeed, when considering all, rather than matched pairs of CSF patients in the claims data, we found that filgrastim and pegfilgrastim patients tend to be younger (unpublished data). Matching thus reduced the likelihood of confounding due to differences in the age and gender distribution and permitted a better comparison. We agree that further study of this important topic is warranted, but we believe that our analysis and methodology appropriately considered real-world practice and experience. Mark L. Heaney MD, PhD*, Edmond L. Toy PhD , Francis Vekeman MA , * Department of Medicine Memorial Sloan-Kettering Cancer Center New York, New York, Analysis Group, Inc Lakewood, Colorado, Analysis Group, Inc Montreal, Quebec, Canada.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».