The proportion of all previous patients was a potential instrument for patients' actual prescriptions of nonsteroidal anti-inflammatory drugs

Journal of Clinical Epidemiology
Bianca KollhorstIris Pigeot

Abstract

To investigate whether physician's prescribing preference is a valid instrumental variable (IV) for patients' actual prescription of selective cyclooxygenase-2 (COX-2) inhibitors in the German Pharmacoepidemiological Research Database (GePaRD). We compared the effect of COX-2 inhibitors vs. traditional nonsteroidal anti-inflammatory drugs (tNSAIDs) on the risk of gastrointestinal complications using physician's preference as IV. We used different definitions of physician's preference for COX-2 inhibitors. A retrospective cohort of new users was built which was further restricted to subcohorts. We compared IV-based risk difference estimates, using a two-stage approach, to estimates from conventional multivariate models. We observed only a small proportion of COX-inhibitor users (3.2%) in our study. All instruments, in the full cohort and in the subcohorts, reduced the imbalance in most of the covariates. However, the IV treatment effect estimates had a highly inflated variance. Compared to the most recent prescription, the proportion of previous patients was a stronger instrument and reduced the variance of the estimates. The proportion of all previous patients is a potential IV for comparing COX-2 inhibitors vs. tNSAIDs in GePa...Continue Reading

References

Nov 23, 2000·The New England Journal of Medicine·C BombardierUNKNOWN VIGOR Study Group
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Apr 18, 2006·Epidemiology·Edwin P MartensOlaf H Klungel
Aug 24, 2007·Statistical Methods in Medical Research·Vanessa Didelez, Nuala Sheehan
May 23, 2008·Journal of Clinical Epidemiology·Sean HennessyThomas R Ten Have
May 14, 2009·Pharmacoepidemiology and Drug Safety·Raluca Ionescu-IttuMichal Abrahamowicz
Jul 19, 2011·American Journal of Epidemiology·Michal AbrahamowiczLouise Pilote
Mar 19, 2015·Epidemiology·Sonja A SwansonMiguel A Hernán

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Citations

Apr 12, 2017·International Journal of Epidemiology·Neil M DaviesFrank Windmeijer
Oct 26, 2021·Das Gesundheitswesen·Iris PigeotVanessa Didelez

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