Estimating the Causal Effect of Liver Allocation Policy Reflecting the Heterogeneity from Age and Geography

估计反映年龄和地理异质性的肝脏分配政策的因果效应

• 批准号: 10738502
• 负责人: Tomohiro Tanaka
• 金额: $ 14.72万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10738502
• 关键词: Estimating; Causal; Effect; Liver; Allocation

Project Summary / Abstract An optimal organ allocation policy for liver transplantation remains a critical yet unmet need. Fair and efficient organ allocation are often incompatible goals. Although the transplant community has made incremental changes to allocation policies over the years, disparities including, but not limited to, geographic region, age, and disease type persist. This is problematic, as organs represent severely limited resources (e.g., In 2020, median pretransplant mortality rate remained high [12.2 per 100 waiting list-years]) that are allocated in a life- and-death context. One major challenge in this arena is that randomized controlled trials are virtually impossible. Nevertheless, evidence-based policy making is necessary, making it difficult to accurately assess the causal effects of policies. Thus, it is essential to estimate the causal effects of these policies using observational data and rigorous methods that emulate the randomized trial. This Career Development Award aims to prepare the applicant for a career as a health policy/services researcher focusing on causal inference applied to chronic liver diseases / transplantation and whose work addresses a variety of health disparities. This will be strengthened by the applicant’s solid clinical domain expertise in chronic liver disease and liver transplantation. This goal will be accomplished within the infrastructure of the University of Iowa College of Medicine and College of Public Health through (a) specific graduate coursework, (b) a Mentorship Advisory Committee, (c) carefully selected conferences and workshops, and (d) a mentored research plan. The specific aims of the proposed studies are to estimate (1) the causal effects of the fundamental liver allocation policies (the Share-35 and the Acuity Circle policies), which designate different geographic boundaries and cutoffs for the criterion (Model of End-stage Liver Disease score; MELD) that is used to determine medical priority for allocation, (2) the causal effect of existing liver allocation priority rules in pediatric and adolescent candidates and (3) the potential causal impact of formulating a policy proposing to match the age of donors and recipients (donor-recipient age matching) and the cost-effectiveness of the potential policy implementation, all in the United States (U.S.). These estimates will be computed rigorously using natural- and quasi-experiments with an overlying causal inference framework, using a well-established nationwide observational transplant cohort. At the end of this Career Development Award, the candidate will be well-prepared to become an independent scientist with expertise in health policy, health services, epidemiology, and causal inference frameworks/econometrics focused on various disparities in healthcare (i.e., race, gender, age, geography, socioeconomic factors, and disease type), with specific expertise in chronic liver disease including liver transplantation. Our study findings will inform revisions to the current liver allocation policy in the U.S. and future studies designed to understand the causal effects of health policies guiding chronic liver disease/liver transplantation, which will form the foundation of the candidate's first R01 submission.

项目概要/摘要 肝移植的最佳器官分配政策仍然是一个关键但未得到满足的公平和有效的需求。 尽管移植界已经做出了渐进的目标，但器官分配往往是不相容的。 多年来分配政策的变化，差异包括但不限于地理区域、年龄、 和疾病类型持续存在，这是有问题的，因为器官代表的资源严重有限（例如，在 2020 年， 移植前死亡率中位数仍然很高[每 100 个等待名单年 12.2]） 这一领域的一个主要挑战是随机对照试验实际上是随机对照试验。 然而，基于证据的政策制定是必要的，因此很难准确评估。 因此，有必要利用这些政策的因果效应来估计。 模仿随机试验的观察数据和严格方法。 旨在帮助申请人为成为专注于因果推理的卫生政策/服务研究员的职业做好准备 应用于慢性肝病/移植，其工作解决了各种健康差异。 申请人在慢性肝病和肝脏方面扎实的临床领域专业知识将加强这一点 这一目标将在爱荷华大学学院的基础设施内实现。 医学和公共卫生学院通过（a）特定的研究生课程，（b）指导咨询 委员会，(c) 精心挑选的会议和研讨会，以及 (d) 指导研究计划。 拟议研究的目的是估计 (1) 基本肝脏分配政策的因果影响 （Share-35 和 Acuity Circle 政策），指定了不同的地理边界和界限 用于确定医疗优先级的标准（终末期肝病评分模型；MELD） 分配，（2）现有肝脏分配优先规则对儿童和青少年候选人的因果影响 (3) 制定建议匹配捐赠者和受赠者年龄的政策的潜在因果影响 （捐助者与受援者年龄匹配）以及潜在政策实施的成本效益，全部都在 美国（U.S.）。这些估计值将使用自然实验和准实验进行严格计算。 一个叠加的因果推理框架，使用完善的全国观察性移植队列。 在本次职业发展奖结束时，候选人将为成为一名独立人士做好充分准备 具有卫生政策、卫生服务、流行病学和因果推理专业知识的科学家 框架/计量经济学侧重于医疗保健方面的各种差异（即种族、性别、年龄、地理位置、 社会经济因素和疾病类型），在慢性肝病（包括肝病）方面具有特定的专业知识 我们的研究结果将为美国和美国现行肝脏分配政策的修订提供信息。 未来的研究旨在了解指导慢性肝病/肝脏的卫生政策的因果影响 移植，这将构成候选人首次提交 R01 的基础。