Background: When using observational data to compare the effectiveness of medications, it is essential to account parsimoniously for patients' longitudinal characteristics that lead to changes in treatments over time.
Objectives: We developed a method of estimating effects of longitudinal treatments that uses subclassification on a longitudinal propensity score to compare outcomes between a new drug (exenatide) and established drugs (insulin and oral medications) assuming knowledge of the variables influencing the treatment assignment. RESEARCH DESIGN/SUBJECTS: We assembled a retrospective cohort of patients with diabetes mellitus from among a population of employed persons and their dependents.
Methods: The data, from i3Innovus, includes claims for utilization of medications and inpatient and outpatient services. We estimated a model for the longitudinal propensity score process of receiving a medication of interest. We used our methods to estimate the effect of the new versus established drugs on total health care charges and hospitalization.
Results: We had data from 131,714 patients with diabetes filling prescriptions from June through December 2005. Within propensity score quintiles, the explanatory covariates were well-balanced. We estimated that the total health care charges per month that would have occurred if all patients had been continually on exenatide compared with if the same patients had been on insulin were minimally higher, with a mean monthly difference of $397 [95% confidence interval (CI), $218-$1054]. The odds of hospitalization were also comparable (relative odds, 1.02; 95% CI, 0.33-1.98).
Conclusions: We used subclassification of a longitudinal propensity score for reducing the multidimensionality of observational data, including treatments changing over time. In our example, evaluating a new diabetes drug, there were no demonstrable differences in outcomes relative to existing therapies.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/MLR.0b013e31804ffd6d | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Comparative Effectiveness of Individual Sodium-Glucose Cotransporter 2 Inhibitors.
JAMA Intern Med
January 2025
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Importance: Evidence on cardiovascular benefits and safety of sodium-glucose cotransporter 2 (SGLT-2) inhibitors is mainly from placebo-controlled trials. Therefore, the comparative effectiveness and safety of individual SGLT-2 inhibitors remain unknown.
Objective: To compare the use of canagliflozin or dapagliflozin with empagliflozin for a composite outcome (myocardial infarction [MI] or stroke), heart failure hospitalization, MI, stroke, all-cause death, and safety outcomes, including diabetic ketoacidosis (DKA), lower-limb amputation, bone fracture, severe urinary tract infection (UTI), and genital infection and whether effects differed by dosage or cardiovascular disease (CVD) history.
Efficacy of prophylactic laxatives against opioid-induced constipation: retrospective propensity score matching analysis.
Support Care Cancer
January 2025
Department of Anesthesiology, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama-Shi, 641-8509, Japan.
Purpose: Opioid-induced constipation (OIC) is problematic for patients with cancer receiving opioid therapy. Some guidelines recommend initiating regular laxatives at the same time as opioid analgesics. However, the effectiveness of prophylactic laxatives on OIC has not been widely demonstrated.
View Article and Find Full Text PDFComparative outcomes of ultrasound-guided radiofrequency ablation vs. microwave ablation for patients with T1N0M0 papillary thyroid carcinoma: a retrospective cohort study.
Eur Radiol
January 2025
Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.
Objective: To compare the clinical outcomes between radiofrequency ablation (RFA) and microwave ablation (MWA) for the treatment of T1N0M0 papillary thyroid carcinoma (PTC) in a large cohort.
Materials And Methods: This retrospective study included 1111 patients with solitary T1N0M0 PTC treated with RFA (n = 894) or MWA (n = 215) by experienced physicians. A propensity score matching was used to compare disease progression, including lymph node metastases (LNM), recurrent tumors and persistent tumors, recurrence-free survival (RFS), volume reduction ratio (VRR), and complications between the RFA and MWA groups.
Extracorporeal membrane oxygenation is associated with decreased mortality in non-acute respiratory distress syndrome patients following severe blunt thoracic trauma.
J Trauma Acute Care Surg
January 2025
From the Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY.
Background: Extracorporeal membrane oxygenation (ECMO) has emerged as a critical intervention in the management of patients with trauma-induced cardiorespiratory failure. This study aims to compare outcomes in patients with severe thoracic injuries with and without venovenous extracorporeal membrane oxygenation (VV-ECMO).
Methods: We performed a retrospective cohort study on Trauma Quality Improvement Program (2017-2021) and included all patients with isolated blunt thoracic injuries with Abbreviated Injury Scale score of ≥4 who required intubation.
An introduction to propensity score analysis in acute care surgery research: Methodology and pitfalls.
J Trauma Acute Care Surg
January 2025
From the Department of Surgery (T.G.) and Department of Biostatistics and Epidemiology (T.G.), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and Comparative Effectiveness and Clinical Outcomes Center (CECORC) (Z.L.B.), Riverside University Health Systems, Moreno Valley, CA.
Observational studies assessing causal effects of interventions are subject to indication (selection) bias, which may be difficult to eliminate using traditional multivariable techniques. When properly specified, propensity score-adjusted analysis may offer an advantage traditional regression by ensuring that investigators explicitly assess comparability of baseline prognostic factors between the treated and untreated. However, it is important to note that the effectiveness of a propensity score-adjusted analysis depends on the variables selected for the model and the analytic approach.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!