Evaluating short-term drug effects using a physician-specific prescribing preference as an instrumental variable.

Epidemiology
M Alan BrookhartSebastian Schneeweiss

Abstract

Postmarketing observational studies of the safety and effectiveness of prescription medications are critically important but fraught with methodological problems. The data sources available for such research often lack information on indications and other important confounders for the drug exposure under study. Instrumental variable methods have been proposed as a potential approach to control confounding by indication in nonexperimental studies of treatment effects; however, good instruments are hard to find. We propose an instrument for use in pharmacoepidemiology that is based on a time-varying estimate of the prescribing physician's preference for one drug relative to a competing therapy. The use of this instrument is illustrated in a study comparing the effect of exposure to COX-2 inhibitors with nonselective, nonsteroidal antiinflammatory medications on gastrointestinal complications. Using conventional multivariable regression adjusting for 17 potential confounders, we found no protective effect due to COX-2 use within 120 days from the initial exposure (risk difference = -0.06 per 100 patients; 95% confidence interval = -0.26 to 0.14). However, the proposed instrumental variable method attributed a protective effect to ...Continue Reading

References

Mar 3, 1977·The New England Journal of Medicine·H Jick
Feb 1, 1992·American Journal of Public Health·E S FisherD C Hsia
Apr 1, 1991·Statistics in Medicine·H Petri, J Urquhart
Oct 1, 1984·The American Journal of Medicine·B L StromK L Melmon
Apr 1, 1983·Statistics in Medicine·O S Miettinen
Sep 21, 1994·JAMA : the Journal of the American Medical Association·M McClellanJ P Newhouse
Aug 24, 1996·Lancet·A M Walker, M J Stampfer
Jun 5, 1998·Annual Review of Public Health·J P Newhouse, M McClellan
Feb 11, 1999·Journal of Clinical Epidemiology·S W Wen, M S Kramer
Aug 3, 2000·International Journal of Epidemiology·S Greenland
Nov 9, 2000·British Journal of Clinical Pharmacology·A D McMahon, T M MacDonald
Nov 23, 2000·The New England Journal of Medicine·C BombardierUNKNOWN VIGOR Study Group
Oct 9, 2002·American Journal of Epidemiology·S Claiborne JohnstonMark van der Laan
Jun 10, 2003·Arthritis and Rheumatism·Fausto G PatinoKenneth G Saag
Feb 7, 2004·Pharmacoepidemiology and Drug Safety·UNKNOWN Centers for Education and Research on Therapeutics Risk Assessment Workshop
May 3, 2005·Journal of Clinical Epidemiology·Sebastian Schneeweiss, Jerry Avorn
Nov 26, 2008·Pharmacoepidemiology and Drug Safety·M M Joffe

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Citations

Jan 5, 2011·Journal of General Internal Medicine·William H ShrankM Alan Brookhart
Feb 22, 2008·The New England Journal of Medicine·Sebastian SchneeweissAlexander M Walker
May 7, 2009·Journal of Palliative Medicine·Joan D PenrodPartha Deb
May 24, 2011·American Journal of Epidemiology·Jeremy A RassenSebastian Schneeweiss
Nov 26, 2008·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Francesca TentoriFriedrich K Port
May 16, 2009·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Antonio Alberto LopesEric W Young
Apr 16, 2010·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Francesca TentoriBruce M Robinson
Feb 5, 2008·Spine·Daniel H SolomonM Alan Brookhart
May 15, 2008·Journal of Epidemiology and Community Health·M M GlymourL F Berkman
Aug 29, 2012·International Journal of Surgical Oncology·John M BrooksNancy L Keating
Feb 28, 2007·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Sebastian SchneeweissPhilip S Wang
Apr 10, 2009·Journal of the American Society of Nephrology : JASN·Sylvia P B RamirezFriedrich K Port
Sep 19, 2009·American Journal of Public Health·Charles C BranasDouglas J Wiebe
Jan 1, 2007·The International Journal of Biostatistics·M Alan Brookhart, Sebastian Schneeweiss
Nov 19, 2013·Journal of Comparative Effectiveness Research·Nancy A Dreyer
Jun 28, 2013·Annals of the American Thoracic Society·Rhonda D VanDykeMichael Seid
Jun 5, 2010·Biostatistics·Paul S Clarke, Frank Windmeijer
May 18, 2010·Medical Care·M Alan BrookhartSebastian Schneeweiss
Nov 27, 2008·American Journal of Epidemiology·Jeremy A RassenM Alan Brookhart
Jul 19, 2011·American Journal of Epidemiology·Michal AbrahamowiczLouise Pilote
Sep 7, 2013·American Journal of Epidemiology·M Maria GlymourDavid H Rehkopf
Jun 7, 2006·Epidemiology·Miguel A Hernán, James M Robins
Jul 1, 2006·Epidemiology·M Alan BrookhartSebastian Schneeweiss
Nov 16, 2007·Journal of Clinical Psychopharmacology·Philip S WangM Alan Brookhart

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