High-dimensional versus conventional propensity scores in a comparative effectiveness study of coxibs and reduced upper gastrointestinal complications

Garbe, Edeltraut; Kloss, Sebastian; Suling, Marc; Pigeot, Iris; Schneeweiß, Sebastian

doi:10.1007/s00228-012-1334-2

Cited by 58 publications

(52 citation statements)

References 31 publications

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“…To do so would require the existence of a “gold standard”, providing the nature and magnitude of the “true” association, to which we could compare our results [2–5]. Despite this fact, we consider that the quality of the match is a good marker of the performance of the hdPS method within this study since only this approach could illustrate that the hdPS method truly adjusted for the seven hidden confounders [7, 17–21].…”

Section: Discussionmentioning

confidence: 99%

Performance of the high-dimensional propensity score in adjusting for unmeasured confounders

Guertin

Rahme

LeLorier

2016

Eur J Clin Pharmacol

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PurposeHigh-dimensional propensity scores (hdPS) can adjust for measured confounders, but it remains unclear how well it can adjust for unmeasured confounders. Our goal was to identify if the hdPS method could adjust for confounders which were hidden to the hdPS algorithm.MethodThe hdPS algorithm was used to estimate two hdPS; the first version (hdPS-1) was estimated using data provided by 6 data dimensions and the second version (hdPS-2) was estimated using data provided from only two of the 6 data dimensions. Two matched sub-cohorts were created by matching one patient initiated on a high-dose statin to one patient initiated on a low-dose statin based on either hdPS-1 (Matched hdPS Full Info Sub-Cohort) or hdPS-2 (Matched hdPS Hidden Info Sub-Cohort). Performances of both hdPS were compared by means of the absolute standardized differences (ASDD) regarding 18 characteristics (data on seven of the 18 characteristics were hidden to the hdPS algorithm when estimating the hdPS-2).ResultsEight out of the 18 characteristics were shown to be unbalanced within the unmatched cohort. Matching on either hdPS achieved adequate balance (i.e., ASDD <0.1) on all 18 characteristics.ConclusionOur results indicate that the hdPS method was able to adjust for hidden confounders supporting the claim that the hdPS method can adjust for at least some unmeasured confounders.

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Section: Discussionmentioning

confidence: 99%

Performance of the high-dimensional propensity score in adjusting for unmeasured confounders

Guertin

Rahme

LeLorier

2016

Eur J Clin Pharmacol

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“…Use of a fixed baseline period is standard in studies utilizing hdPS methods. [34] Persons entered the cohort without regard to the initiation order of warfarin and the antihyperlipidemic ( Figure 1 ). [35]…”

Section: Methodsmentioning

confidence: 99%

Gastrointestinal bleeding and intracranial hemorrhage in concomitant users of warfarin and antihyperlipidemics

Leonard

Brensinger

Bilker

et al. 2017

International Journal of Cardiology

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Background Drug interactions, particularly those involving warfarin, are a major clinical and public health problem. Minimizing serious bleeding caused by anticoagulants is a recent major focus of the United States (US) Department of Health and Human Services. This study quantified the risk of gastrointestinal bleeding (GIB) and intracranial hemorrhage (ICH) among concomitant users of warfarin and individual antihyperlipidemics. Methods The authors conducted a high-dimensional propensity score-adjusted cohort study of new concomitant users of warfarin and an antihyperlipidemic, among US Medicaid beneficiaries from five states during 1999–2011. Exposure was defined by concomitant use of warfarin plus one of eight antihyperlipidemics. The primary outcome measure was a composite of GIB/ICH within the first 30 days of concomitant use. As a secondary outcome measure, GIB/ICH was examined within the first 180 days of concomitant use. Results Among 236,691 persons newly-exposed to warfarin and an antihyperlipidemic, the crude incidence of GIB/ICH was 13.2 (95% confidence interval 12.7 to 13.8) per 100 person-years. Users were predominantly older, female, and Caucasian. Adjusted hazard ratios (aHRs) for warfarin and individual statins were consistent with no association. Warfarin + gemfibrozil was associated with an 80% increased risk of GIB/ICH within the first month of concomitant use (aHR = 1.8, 1.4 to 2.4). Warfarin + fenofibrate was associated with a similar increased risk (aHR = 1.8, 1.2 to 2.7), yet with an onset during the second month of concomitant use. Conclusions Among warfarin-treated persons, the use of fibrates—but not statins—increases the risk of hospital presentation for GIB/ICH.

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“…33 This methodology has been shown to approximate point estimates of risk from randomized clinical trials substantially better than standard propensity scoring or regression methodologies. 33, 34 Each digoxin user was matched to a maximum of three non-digoxin users (without replacement) based on age (+/− one year), gender and high-dimensional propensity score for the initiation of digoxin (caliper width of +/− 0.01) on the calendar date of the first digoxin prescription (model c statistic =0.68).…”

Section: Methodsmentioning

confidence: 99%

Digoxin and Risk of Death in Adults With Atrial Fibrillation

Freeman

Reynolds

Fang

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background Digoxin remains commonly used for rate control in atrial fibrillation, but very limited data exist supporting this practice and some studies have shown an association with adverse outcomes. We examined the independent association between digoxin and risks of death and hospitalization in adults with incident atrial fibrillation and no heart failure. Methods and Results We performed a retrospective cohort study of 14,787 age, gender and high-dimensional propensity score-matched adults with incident atrial fibrillation and no prior heart failure or digoxin use in the AnTicoagulation and Risk factors In Atrial fibrillation-Cardiovascular Research Network (ATRIA-CVRN) Study within Kaiser Permanente Northern and Southern California. We examined the independent association between newly initiated digoxin and the risks of death and hospitalization using extended Cox regression. During a median 1.17 (interquartile range 0.49–1.97) years of follow-up among matched patients with atrial fibrillation, incident digoxin use was associated with higher rates of death (8.3 vs. 4.9 per 100 person-years, P<0.001) and hospitalization (60.1 vs. 37.2 per 100 person-years, P<0.001). Incident digoxin use was independently associated with a 71% higher risk of death (hazard ratio [HR] 1.71, 95%CI:1.52–1.93) and a 63% higher risk of hospitalization (HR 1.63, 95%CI:1.56–1.71). Results were consistent in subgroups of age and gender and when using “intent-to-treat” or “on-treatment” analytic approaches. Conclusions In adults with atrial fibrillation, digoxin use was independently associated with higher risks of death and hospitalization. Given other available rate control options, digoxin should be used with caution in the management of atrial fibrillation.

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High-dimensional versus conventional propensity scores in a comparative effectiveness study of coxibs and reduced upper gastrointestinal complications

Abstract: A comparison of hd-PS matching versus conventional PS matching resulted in improved point estimates for studying an intended treatment effect of coxibs versus tNSAIDs when benchmarked against results from randomized controlled trials.

Cited by 58 publications

References 31 publications

Performance of the high-dimensional propensity score in adjusting for unmeasured confounders

Performance of the high-dimensional propensity score in adjusting for unmeasured confounders

Gastrointestinal bleeding and intracranial hemorrhage in concomitant users of warfarin and antihyperlipidemics

Digoxin and Risk of Death in Adults With Atrial Fibrillation

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