Fahmida Homayra, Benjamin Enns, Jeong Eun Min, Megan Kurz, Paxton Bach, Julie Bruneau, Sander Greenland, Paul Gustafson, Mohammad Ehsanul Karim, P Todd Korthuis, Thomas Loughin, Malcolm MacLure, Lawrence McCandless, Robert William Platt, Kevin Schnepel, Hitoshi Shigeoka, Uwe Siebert, Eugenia Socias, Evan Wood, Bohdan Nosyk
{"title":"丁丙诺啡/纳洛酮或美沙酮治疗阿片类药物使用障碍的工具变量比较分析。","authors":"Fahmida Homayra, Benjamin Enns, Jeong Eun Min, Megan Kurz, Paxton Bach, Julie Bruneau, Sander Greenland, Paul Gustafson, Mohammad Ehsanul Karim, P Todd Korthuis, Thomas Loughin, Malcolm MacLure, Lawrence McCandless, Robert William Platt, Kevin Schnepel, Hitoshi Shigeoka, Uwe Siebert, Eugenia Socias, Evan Wood, Bohdan Nosyk","doi":"10.1097/EDE.0000000000001697","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Instrumental variable (IV) analysis provides an alternative set of identification assumptions in the presence of uncontrolled confounding when attempting to estimate causal effects. Our objective was to evaluate the suitability of measures of prescriber preference and calendar time as potential IVs to evaluate the comparative effectiveness of buprenorphine/naloxone versus methadone for treatment of opioid use disorder (OUD).</p><p><strong>Methods: </strong>Using linked population-level health administrative data, we constructed five IVs: prescribing preference at the individual, facility, and region levels (continuous and categorical variables), calendar time, and a binary prescriber's preference IV in analyzing the treatment assignment-treatment discontinuation association using both incident-user and prevalent-new-user designs. Using published guidelines, we assessed and compared each IV according to the four assumptions for IVs, employing both empirical assessment and content expertise. We evaluated the robustness of results using sensitivity analyses.</p><p><strong>Results: </strong>The study sample included 35,904 incident users (43.3% on buprenorphine/naloxone) initiated on opioid agonist treatment by 1585 prescribers during the study period. While all candidate IVs were strong (A1) according to conventional criteria, by expert opinion, we found no evidence against assumptions of exclusion (A2), independence (A3), monotonicity (A4a), and homogeneity (A4b) for prescribing preference-based IV. Some criteria were violated for the calendar time-based IV. We determined that preference in provider-level prescribing, measured on a continuous scale, was the most suitable IV for comparative effectiveness of buprenorphine/naloxone and methadone for the treatment of OUD.</p><p><strong>Conclusions: </strong>Our results suggest that prescriber's preference measures are suitable IVs in comparative effectiveness studies of treatment for OUD.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":"35 2","pages":"218-231"},"PeriodicalIF":4.7000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10833049/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparative Analysis of Instrumental Variables on the Assignment of Buprenorphine/Naloxone or Methadone for the Treatment of Opioid Use Disorder.\",\"authors\":\"Fahmida Homayra, Benjamin Enns, Jeong Eun Min, Megan Kurz, Paxton Bach, Julie Bruneau, Sander Greenland, Paul Gustafson, Mohammad Ehsanul Karim, P Todd Korthuis, Thomas Loughin, Malcolm MacLure, Lawrence McCandless, Robert William Platt, Kevin Schnepel, Hitoshi Shigeoka, Uwe Siebert, Eugenia Socias, Evan Wood, Bohdan Nosyk\",\"doi\":\"10.1097/EDE.0000000000001697\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Instrumental variable (IV) analysis provides an alternative set of identification assumptions in the presence of uncontrolled confounding when attempting to estimate causal effects. Our objective was to evaluate the suitability of measures of prescriber preference and calendar time as potential IVs to evaluate the comparative effectiveness of buprenorphine/naloxone versus methadone for treatment of opioid use disorder (OUD).</p><p><strong>Methods: </strong>Using linked population-level health administrative data, we constructed five IVs: prescribing preference at the individual, facility, and region levels (continuous and categorical variables), calendar time, and a binary prescriber's preference IV in analyzing the treatment assignment-treatment discontinuation association using both incident-user and prevalent-new-user designs. Using published guidelines, we assessed and compared each IV according to the four assumptions for IVs, employing both empirical assessment and content expertise. We evaluated the robustness of results using sensitivity analyses.</p><p><strong>Results: </strong>The study sample included 35,904 incident users (43.3% on buprenorphine/naloxone) initiated on opioid agonist treatment by 1585 prescribers during the study period. While all candidate IVs were strong (A1) according to conventional criteria, by expert opinion, we found no evidence against assumptions of exclusion (A2), independence (A3), monotonicity (A4a), and homogeneity (A4b) for prescribing preference-based IV. Some criteria were violated for the calendar time-based IV. We determined that preference in provider-level prescribing, measured on a continuous scale, was the most suitable IV for comparative effectiveness of buprenorphine/naloxone and methadone for the treatment of OUD.</p><p><strong>Conclusions: </strong>Our results suggest that prescriber's preference measures are suitable IVs in comparative effectiveness studies of treatment for OUD.</p>\",\"PeriodicalId\":11779,\"journal\":{\"name\":\"Epidemiology\",\"volume\":\"35 2\",\"pages\":\"218-231\"},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2024-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10833049/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Epidemiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/EDE.0000000000001697\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/1/30 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Epidemiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/EDE.0000000000001697","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/1/30 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
摘要
背景：在试图估算因果效应时，如果存在不受控制的混杂因素，工具变量（IV）分析提供了另一套识别假设。我们的目标是评估处方者偏好和日历时间的测量值是否适合作为潜在的工具变量来评估丁丙诺啡/纳洛酮与美沙酮治疗阿片类药物使用障碍（OUD）的比较效果：利用关联的人口级健康管理数据，我们构建了五个IV：个人、机构和地区层面的处方偏好（连续变量和分类变量）、日历时间和二元处方偏好IV，利用事件-用户和普遍-新用户设计分析治疗分配与治疗中止之间的关联。根据已公布的指南，我们采用经验评估和内容专业知识，按照 IV 的四个假设对每种 IV 进行了评估和比较。我们利用敏感性分析评估了结果的稳健性：研究样本包括在研究期间由 1585 名处方者开具的接受阿片类激动剂治疗的 35904 名事件使用者（43.3% 使用丁丙诺啡/纳洛酮）。虽然根据传统标准，所有候选静脉注射都很强（A1），但根据专家意见，我们发现没有证据表明基于偏好的静脉注射处方违反了排除性假设（A2）、独立性假设（A3）、单调性假设（A4a）和同质性假设（A4b）。而基于日历时间的 IV 则违反了某些标准。我们认为，以连续量表衡量的医疗服务提供者层面的处方偏好是最适合丁丙诺啡/纳洛酮和美沙酮治疗 OUD 疗效比较的 IV：我们的研究结果表明，在对 OUD 治疗进行比较有效性研究时，处方提供者的偏好度量是最合适的四维量表。
Comparative Analysis of Instrumental Variables on the Assignment of Buprenorphine/Naloxone or Methadone for the Treatment of Opioid Use Disorder.
Background: Instrumental variable (IV) analysis provides an alternative set of identification assumptions in the presence of uncontrolled confounding when attempting to estimate causal effects. Our objective was to evaluate the suitability of measures of prescriber preference and calendar time as potential IVs to evaluate the comparative effectiveness of buprenorphine/naloxone versus methadone for treatment of opioid use disorder (OUD).
Methods: Using linked population-level health administrative data, we constructed five IVs: prescribing preference at the individual, facility, and region levels (continuous and categorical variables), calendar time, and a binary prescriber's preference IV in analyzing the treatment assignment-treatment discontinuation association using both incident-user and prevalent-new-user designs. Using published guidelines, we assessed and compared each IV according to the four assumptions for IVs, employing both empirical assessment and content expertise. We evaluated the robustness of results using sensitivity analyses.
Results: The study sample included 35,904 incident users (43.3% on buprenorphine/naloxone) initiated on opioid agonist treatment by 1585 prescribers during the study period. While all candidate IVs were strong (A1) according to conventional criteria, by expert opinion, we found no evidence against assumptions of exclusion (A2), independence (A3), monotonicity (A4a), and homogeneity (A4b) for prescribing preference-based IV. Some criteria were violated for the calendar time-based IV. We determined that preference in provider-level prescribing, measured on a continuous scale, was the most suitable IV for comparative effectiveness of buprenorphine/naloxone and methadone for the treatment of OUD.
Conclusions: Our results suggest that prescriber's preference measures are suitable IVs in comparative effectiveness studies of treatment for OUD.
期刊介绍：
Epidemiology publishes original research from all fields of epidemiology. The journal also welcomes review articles and meta-analyses, novel hypotheses, descriptions and applications of new methods, and discussions of research theory or public health policy. We give special consideration to papers from developing countries.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
