More robust estimation of average treatment effects using kernel optimal matching in an observational study of spine surgical interventions

More robust estimation of average treatment effects using kernel optimal matching in an observational study of spine surgical interventions
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在脊柱手术干预的观察研究中使用内核最佳匹配更稳健地估计平均治疗效果

DOI:
10.1002/sim.8904
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发表时间:
2021
影响因子:
2
通讯作者:
Santacatterina, Michele
Santacatterina, Michele
中科院分区:
医学3区
文献类型:
--
作者:
Kallus, Nathan;Pennicooke, Brenton;Santacatterina, Michele

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治疗加权的逆概率(IPTW)已用于使用观察性数据估计平均治疗效应(ATE),它依赖于阳性假设和治疗分配模型的正确规范,这两者在许多观察性研究中都是有问题的假设。已经提出了各种方法来克服这些挑战,包括截断,协变量平衡倾向得分和稳定的平衡权重。出于对脊柱手术的观察性研究的动机,其中违反了积极性,真正的治疗分配模型是未知的,我们提出了使用核最优匹配(KOM)的最佳平衡来估计ATE。通过统一控制一类模型的加权估计的条件均方误差,KOM同时缓解了治疗分配模型可能的错误指定问题,并能够处理实际违反的积极性假设,如我们的模拟研究所示。使用来自临床登记的数据,我们应用KOM比较两种脊柱手术干预,并证明结果如何与IPTW估计虚假反驳的临床试验结论相匹配。
Inverse probability of treatment weighting (IPTW), which has been used to estimate average treatment effects (ATE) using observational data, tenuously relies on the positivity assumption and the correct specification of the treatment assignment model, both of which are problematic assumptions in many observational studies. Various methods have been proposed to overcome these challenges, including truncation, covariate‐balancing propensity scores, and stable balancing weights. Motivated by an observational study in spine surgery, in which positivity is violated and the true treatment assignment model is unknown, we present the use of optimal balancing by kernel optimal matching (KOM) to estimate ATE. By uniformly controlling the conditional mean squared error of a weighted estimator over a class of models, KOM simultaneously mitigates issues of possible misspecification of the treatment assignment model and is able to handle practical violations of the positivity assumption, as shown in our simulation study. Using data from a clinical registry, we apply KOM to compare two spine surgical interventions and demonstrate how the result matches the conclusions of clinical trials that IPTW estimates spuriously refute.
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