Strong instrumental variables biased propensity scores in comparative effectiveness research: A case study in oncology.

Autor: Thurin NH; University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France. Electronic address: nicolas.thurin@u-bordeaux.fr., Jové J; University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France., Lassalle R; University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France., Rouyer M; University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France., Lamarque S; University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France., Bosco-Levy P; University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France., Segalas C; University of Paris Cité, Centre of Epidemiology and Statistics (CRESS) INSERM, Paris, France., Schneeweiss S; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Blin P; University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France., Droz-Perroteau C; University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France.
Jazyk: angličtina
Zdroj: Journal of clinical epidemiology [J Clin Epidemiol] 2023 Mar; Vol. 155, pp. 31-38. Date of Electronic Publication: 2023 Jan 16.
DOI: 10.1016/j.jclinepi.2023.01.002
Abstrakt: Background and Objectives: Some medications require specific medical procedures in the weeks before their start. Such procedures may meet the definition of instrumental variables (IVs). We examined how they may influence treatment effect estimation in propensity score (PS)-adjusted comparative studies, and how to remedy.
Study Design and Setting: Different covariate assessment periods (CAPs) did and did not include the month preceding treatment start were used to compute PS in the French claims database (Sytème National des Données de Santé-SNDS), and 1:1 match patients with metastatic castration resistant prostate cancer initiating abiraterone acetate or docetaxel. The 36-month survival was assessed.
Results: Among 1, 213 docetaxel and 2, 442 abiraterone initiators, the PS distribution resulting from the CAP [-12; 0 months] distinctly separated populations (c = 0.93; 273 matched pairs). The CAPs [-12;-1 months] identified 765 pairs (c = 0.81). Strong docetaxel treatment predictors during the month before treatment start were implantable delivery systems (1% vs. 59%), which fulfilled IV conditions. The 36-month survival was not meaningfully different under the [-12; 0 months] CAP but differed by 10% points (38% vs. 28%) after excluding month -1.
Conclusion: In the setting of highly predictive pretreatment procedures, excluding the immediate pre-exposure time from the CAP will reduce the risk of including potential IVs in PS models and may reduce bias.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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