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2017 ; 8
(ä): 15-30
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An evaluation of exact matching and propensity score methods as applied in a
comparative effectiveness study of inhaled corticosteroids in asthma
#MMPMID28356782
Burden A
; Roche N
; Miglio C
; Hillyer EV
; Postma DS
; Herings RM
; Overbeek JA
; Khalid JM
; van Eickels D
; Price DB
Pragmat Obs Res
2017[]; 8
(ä): 15-30
PMID28356782
show ga
BACKGROUND: Cohort matching and regression modeling are used in observational
studies to control for confounding factors when estimating treatment effects. Our
objective was to evaluate exact matching and propensity score methods by applying
them in a 1-year pre-post historical database study to investigate asthma-related
outcomes by treatment. METHODS: We drew on longitudinal medical record data in
the PHARMO database for asthma patients prescribed the treatments to be compared
(ciclesonide and fine-particle inhaled corticosteroid [ICS]). Propensity score
methods that we evaluated were propensity score matching (PSM) using two
different algorithms, the inverse probability of treatment weighting (IPTW),
covariate adjustment using the propensity score, and propensity score
stratification. We defined balance, using standardized differences, as
differences of <10% between cohorts. RESULTS: Of 4064 eligible patients, 1382
(34%) were prescribed ciclesonide and 2682 (66%) fine-particle ICS. The IPTW and
propensity score-based methods retained more patients (96%-100%) than exact
matching (90%); exact matching selected less severe patients. Standardized
differences were >10% for four variables in the exact-matched dataset and <10%
for both PSM algorithms and the weighted pseudo-dataset used in the IPTW method.
With all methods, ciclesonide was associated with better 1-year asthma-related
outcomes, at one-third the prescribed dose, than fine-particle ICS; results
varied slightly by method, but direction and statistical significance remained
the same. CONCLUSION: We found that each method has its particular strengths, and
we recommend at least two methods be applied for each matched cohort study to
evaluate the robustness of the findings. Balance diagnostics should be applied
with all methods to check the balance of confounders between treatment cohorts.
If exact matching is used, the calculation of a propensity score could be useful
to identify variables that require balancing, thereby informing the choice of
matching criteria together with clinical considerations.