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【學術演講】2017/3/6(一) 12:10 鄭浩民醫師─Make Evidence-based Medicine Individualized
時間:106年3月6日 (一) 12:10 – 13:00 鄭浩民醫師
題目:Make Evidence-based Medicine Individualized
Many researchers have recognized the importance of assigning distinct weights to individual adverse events in a composite end point. However, an adequate weighting approach have not been developed for the application on trial data. Here we develop an approach by utilizing two metrics, the disability-adjusted life-years (DALYs) developed by WHO Global Burden of Disease Project (GBDP) and the lifetime cost of medical care reimbursed by Taiwan's National Health Insurance, separately as the weighting values. We provided an example of the approach by integrating five clinical outcomes, myocardial infarction, ischemic stroke, intracranial hemorrhage, gastrointestinal bleeding, and all-cause death, into the composite in previous clinical trials on novel oral anticoagulation; and to evaluate the overall effect on a composite end point by performing a meta-analysis. The aggregative data from randomized controlled trials comparing non-VKA oral anticoagulants (NOACs) with vitamin K antagonists (VKAs) in patients with nonvalvular atrial fibrillation was used in this practice. The age-standardized DALYs or lifetime medical cost was incorporated into individual end points by multiplying the number of events in each outcome by the relative DALY value or cost value, and then summing over all weighted events. We did a meta-analysis on this integrated weighting data with Mantel-Haenszel fixed-effects model or DerSimonian and Laird random-effects model to pool the estimates. The relative risk (RR) and 95% confidence interval (CI) were calculated. Considering uncertainty in assignment of preference weights, pooled estimates were further summarized after conducting aggregative analyses on the more numerous integrated data based on 1000 resampling weights derived from an appropriate distribution. Our results demonstrate that differential weighting of clinical end points is indeed required, which would correctly reflect the impacts of a particular therapy on the integrated and clinically weighted composite end point for patients or health policy.
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