Antimicrobial Treatment of Mild Mycobacterium Avium Complex-pulmonary Disease Predicted to Increase Survival and Quality Adjusted Life Years: A Microsimulation Decision Analysis Model
Notice bibliographique
Résumé
Abstract RATIONALE: Treatment for Mycobacterium avium complex-pulmonary disease (MAC-PD) requires many months of multiple antibiotics, which carry with them the risk for drug toxicity. For patients with mild MAC-PD, it is challenging to decide whether to pursue treatment or active observation. We conducted a patient-centered microsimulation to compare the quality adjusted life years (QALY) and life expectancy associated with treatment or observation. METHODS: We simulated 10,000 individuals using monthly cycles, with the base case of a 65-year-old Canadian individual with macrolide-susceptible nodular-bronchiectatic MAC-PD with preserved lung function, following individuals for 40 years. Individuals started in either the observation or treatment state and followed attached diagram. Treatment followed the ATS/IDSA/ERS/ESCMID guidelines and was continued between 13-24 months depending on when culture conversion occurred. Treatment toxicity was simulated as a transient decrease in utility based on common toxicities associated with each medication. Model outcomes were QALY and life-expectancy. Probabilities and utilities were obtained from the literature. The hazard ratio of early culture conversion (≤3 months’ treatment) arose from Samsung Medical Center data. Deterministic sensitivity analyses were performed on each variable by varying across likely ranges, and five two-way sensitivity analyses were carried out based on clinical relevance. A probabilistic sensitivity analysis was done by simulating 1000 parameter values from each parent distribution and measuring mean and 95% credible interval (CrI). RESULTS: In the base case, utility was greater in the treatment than with observation, with 16.2 QALYs in treatment as compared to 14.5 with observation. Similarly, life-expectancy was 22.4 years in treatment and 19.9 with observation. Treatment was superior to observation in all deterministic one-way or two-way analyses when measuring utilities. Life-expectancy was greater with treatment than observation in all scenarios except for when the hazard ratio of early culture conversion was 1, in which case observation was superior. In the probabilistic sensitivity analysis, treatment led to greater utility with mean 15.3 QALYs (95% CrI 8.33-18.9) compared to 13.9 QALYs with observation (95% CrI 8.66-17.2). Life expectancy was also greater with treatment (21.1 years, 95% CrI 18.1-24.4) compared to observation (19.3 years, 95% CrI 17.2-21.8). CONCLUSION: In microsimulation, treatment for MAC-PD leads to prolonged survival with greater expected utility. Findings were robust across multiple sensitivity analyses. Our findings can help guide patients and clinicians in deciding on potential treatment options.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 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 source (Gemma direct ou Codex distillé), 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 ».