matching weights to simultaneously compare three treatment groups: a simulation study
TRANSCRIPT
Matching Weightsto Simultaneously Compare Three Treatment Groups:
a Simulation Study
Kazuki Yoshida, MD, MPH, MS*,
Sonia Hernandez-Dıaz, MD, DrPH, Daniel H. Solomon, MD, MPH,John W. Jackson, ScD, Joshua J. Gagne, PharmD, ScD,
Robert Glynn, PhD, Jessica M. Franklin, PhD
*Joint Doctor of Science StudentDepartments of Epidemiology & BiostatisticsHarvard T.H. Chan School of Public Health
677 Huntington Ave, Boston, MA 02115, USA
Last updated on June 22, 2016
Motivation
I Propensity score matching (Rosenbaum & Rubin 1983) is a wellestablished method, and is widely used in the two-group setting.
I In clinical practice, however, there are often 3+ comparator drugs tobe compared, e.g., antirheumatic drugs for rheumatoid arthritis.
I For non-binary treatment, generalized propensity score (Imbens2000) has been proposed, but its use has been limited.
I Recently developed software (Rassen et al 2013) allows 3-waysimultaneous matching on generalized PS, but further generalizationis complicated.
I Question: Is there an alternative that is similar to PS matching, butmore easily generalizes to 3+ groups?
I Hypothesis: Matching weights (Li & Greene 2013) may be a viablecandidate.
2 / 31
Matching weights definition
Li & Greene. A weighting analogue to pair matching in propensity scoreanalysis. Int J Biostat 2013;9:215-234.
MWi =min(ei , 1− ei )
Ziei + (1− Zi )(1− ei )
where ei is propensity score and Zi is binary treatment indicator
I AdvantagesI Asymptotic equivalence of estimand to 1:1 matchingI Efficiency gainI No tuning parameters (no algorithm, caliper scale or width)I Range (0,1) unlike non-stabilized IPTW (1,∞)
I DisadvantagesI Potential for common support violation
3 / 31
PS methods visualized (common treatment)
Original IPTW Matching
ATTW ATUW MW
0.0 0.5 1.0 0.0 0.5 1.0 0.0 0.5 1.0
0.0 0.5 1.0 0.0 0.5 1.0 0.0 0.5 1.0PS
Fre
quen
cy TreatmentTreated
Untreated
4 / 31
Comparing weighting methods
IPTWi =1
Ziei + (1− Zi )(1− ei )=
1
eifor Zi = 1
1
1− eifor Zi = 0
ATTWi =ei
Ziei + (1− Zi )(1− ei )=
1 for Zi = 1ei
1− eifor Zi = 0
ATUWi =1− ei
Ziei + (1− Zi )(1− ei )=
1− eiei
for Zi = 1
1 for Zi = 0
MWi =min(ei , 1− ei )
Ziei + (1− Zi )(1− ei )=
{ATTWi for ei ≤ 0.5
ATUWi for ei > 0.5
The denominator (IPTW) balances covariates, and the numeratorreshapes to the target population.
5 / 31
Extension of MW to K groupsI Define a propensity score (eki ) for each treatment category
(k ∈ {1, 2}) and redefine the treatment variable as Zi ∈ {1, 2}.
MWi =min(e1i , e2i )2∑
k=1
I (Zi = k)eki
=Smallest PS
PS of assigned treatment
I Use multinomial logistic regression for PS modelI Each subject has K propensity scores {e1i , e2i , ..., eKi}I K propensity scores sum to 1I Generalize the weights as
MWi =min(e1i , . . . , eKi )K∑
k=1
I (Zi = k)eki
6 / 31
Simulation study
Ti
Xi
Yi
Outcome modelβT1, βT2 (main effects)
for treatment effectsβXT1, βXT2 (interactions)
for additional treatment effects in subset
Treatment modelα10, α20 (intercepts)
for treatment prevalenceα1X ,α2X (covariate association)
for covariate overlap level
Outcome modelβ0 (intercept)
for baseline risk of diseaseβX (covariate association)for strength of risk factors
I Exposure distribution: {(33 : 33 : 33), (10 : 45 : 45), (10 : 10 : 80)}I Levels of covariate overlap: small, substantialI Baseline risk of disease: {0.05, 0.20}I Presence of treatment effect: absent, presentI Presence of treatment effect heterogeneity: absent, present
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Good overlap Poor overlap
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pExpo 33:33:33 10:45:45 10:10:80
Sample Sizes
X1 X4 X7
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pExpo 33:33:33 10:45:45 10:10:80
Average Standardized Mean Differences
Modification (−)
1v0
Modification (−)
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Modification (−)
2v1
Modification (+)
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2v1
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Null m
ain effectsN
ull main effects
Non−
null main effects
Non−
null main effects
Good overlap
Poor overlap
Good overlap
Poor overlap
U M Mw Ip U M Mw Ip U M Mw Ip U M Mw Ip U M Mw Ip U M Mw Ip
pExpo 33:33:33 10:45:45 10:10:80
pDis 0.05 0.2
Bias (Estimated Risk Ratio / True Risk Ratio)
Modification (−)
1v0
Modification (−)
2v0
Modification (−)
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Modification (+)
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Modification (+)
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Null m
ain effectsN
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Good overlap
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Good overlap
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U M Mw Ip U M Mw Ip U M Mw Ip U M Mw Ip U M Mw Ip U M Mw Ip
pExpo 33:33:33 10:45:45 10:10:80
pDis ● 0.05 0.2
Mean Squared Error
Simulation: Summary results
Comparing matching weights to three-way matching and IPTW, wefound:
I Similar sample sizes for MW and matching, but not IPTW
I Best covariate balance
I Similarly small bias compared to matching
I Smaller MSE compared to matching in all scenarios
I More robust to rare events, unequally sized groups, and poorcovariate overlap
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Conclusion
I MW has been suggested as a more efficient alternative to 1:1pairwise matching with a similar estimand (Li & Greene 2013).
I In the three treatment group setting, MW demonstrated similar bias,but smaller MSE compared to 1:1:1 three-way matching in asimulation study.
I Efficiency gain compared to 1:1:1 three-way matching was morenoticeable in scenarios in which the outcome events were rare,treatment groups were unequally sized, or covariate overlap waspoor.
I Compared to IPTW, MW was more stable in the poor covariateoverlap setting.
13 / 31
Acknowledgment
KY currently receives tuition support jointly from Japan StudentServices Organization (JASSO) and Harvard T. H. Chan School ofPublic Health (partially supported by training grants from Pfizer,Takeda, Bayer and PhRMA).
14 / 31
PS methods visualized (rare treatment)
Original IPTW Matching
ATTW ATUW MW
0.0 0.5 1.0 0.0 0.5 1.0 0.0 0.5 1.0
0.0 0.5 1.0 0.0 0.5 1.0 0.0 0.5 1.0PS
Fre
quen
cy TreatmentTreated
Untreated
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Simulation: Covariate generating model
I Based on Franklin et al. Metrics for covariate balance in cohortstudies of causal effects. Stat Med. 2014;33:1685.
Variable Generation ProcessX1i Normal(0, 12)X2i Log-Normal(0, 0.52)X3i Normal(0, 102)X4i Bernoulli(pi = e2X1i/(1 + e2X1i )) where E [pi ] = 0.5X5i Bernoulli(p = 0.2)X6i Multinomial(p = (0.5, 0.3, 0.1, 0.05, 0.05)T )X7i sin(X1i )X8i X 2
2i
X9i X3i × X4i
X10i X4i × X5i
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Simulation: Treatment generating model
ηT1i = log
(P(Ti = 1|Xi = xi )
P(Ti = 0|Xi = xi )
)= α10 + αT
1Xxi
ηT2i = log
(P(Ti = 2|Xi = xi )
P(Ti = 0|Xi = xi )
)= α20 + αT
2Xxi
where
α10, α20 determine treatment prevalence
α1X ,α2X determine covariate-treatment association
e0i = P(Ti = 0|Xi = xi ) =1
qi
e1i = P(Ti = 1|Xi = xi ) =exp(ηT1i )
qi
e2i = P(Ti = 2|Xi = xi ) =exp(ηT2i )
qi
where qi = 1 + exp(ηT1i ) + exp(ηT2i )
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Simulation: Outcome generating model
ηYi = log(P(Yi = 1|Ti = ti ,Xi = xi ))
= β0 + βTX xi + βT1I (ti = 1) + βT2I (ti = 2)+
βXT1x4i I (ti = 1) + βXT2x4i I (ti = 2)
where
β0 = Intercept determining baseline disease risk
βX = Effects of ten covariates (risk factors) on disease risk
βT1 = Main effect of Treatment 1 compared to Treatment 0
βT2 = Main effect of Treatment 2 compared to Treatment 0
βXT1 = Additional effect for Treatment 1 vs 0 among X4i = 1
βXT2 = Additional effect for Treatment 2 vs 0 among X4i = 1
Counterfactual disease probabilities
P(Yi = 1|Ti = 0,Xi = xi )
P(Yi = 1|Ti = 1,Xi = xi )
P(Yi = 1|Ti = 2,Xi = xi )
Yi ∼ Bernoulli (pYi = P(Yi = 1|Ti = ti ,Xi = xi ))19 / 31
Simulation: Analyses
I All computation except 3-way matching was performed in R
I Multinomial logistic regression with all covariates as the propensityscore model.
I Matched analyses:I Three-way nearest neighbor algorithm implemented in the
pharmacoepi toolbox by Rassen et al generated matched “trios”.I Caliper for the matched trio triangle perimeter was defined as
0.6
√τ21+τ2
2+τ23
3where τ 2j = Var(e1|T=j)+Var(e2|T=j)
2.
I OLS linear regression was conducted in the matched dataset.
I Weighted analysis:I MW and stabilized IPTWI survey package was used to appropriately account for weighting in
the outcome log linear model.
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Simulation: Assessment metrics
I Matched/weighted sample size
I Covariate standardized mean difference (SMD) averaged acrossthree contrasts
I bias in risk ratio
I Simulation and estimated variance of estimators
I Mean squared error of estimators
I False positive rates in null scenarios
I Coverage probability of estimated confidence intervals
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Modification (−)
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Modification (+)
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Null m
ain effectsN
ull main effects
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Poor overlap
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Poor overlap
U M Mw Ip U M Mw Ip U M Mw Ip U M Mw Ip U M Mw Ip U M Mw Ip
pExpo 33:33:33 10:45:45 10:10:80
True Risk Ratios (Estimands)
Modification (−)
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pExpo 33:33:33 10:45:45 10:10:80
pDis ● 0.05 0.2
True Variance
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pExpo 33:33:33 10:45:45 10:10:80
pDis ● 0.05 0.2
Mean Estimated Variance
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Est. True Boot. Est. True Boot. Est. True Boot. Est. True Boot. Est. True Boot. Est. True Boot.
pExpo 33:33:33 10:45:45 10:10:80
pDis ● 0.05 0.2
Variance Comparison
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pExpo 33:33:33 10:45:45 10:10:80
pDis ● 0.05 0.2
Observed Type I Error Rates (Null Scenarios)
Modification (−)
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Null m
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ull main effects
Non−
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Poor overlap
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Poor overlap
U M Mw Ip U M Mw Ip U M Mw Ip U M Mw Ip U M Mw Ip U M Mw Ip
pExpo 33:33:33 10:45:45 10:10:80
pDis ● 0.05 0.2
Coverage of 95% Confidence Intervals
Empirical example: Methods
I Solomon et al. Arch Intern Med 2010;170:1968.
I Medicare Beneficiary dataset from PA and NJ (1999-2005)
I Groups: Opioids (12,601) vs COX2 inhibitors (6,172) vs nsNSAIDs(4,874) new users
I Outcomes: Death (794), fractures (706), GI bleed (230), andcardiovascular events (1,204)
I Confounders: 35 pre-treatment variables including 5 continuous
I PS model: Quadratic terms for continuous variables; no interaction
I Analyzed using MW and three-way matching to see agreement
I MW sample size 4,618.7-4,635.71 per group; matched sample size4,611 per group; stablized IPTW sample size 4,926.6-12,585.0
I Best balance was achieved by MW in 24 covariates, by matching in6, and by IPTW in 5.
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Empirical example: Covariate balance
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Hepatic diseaseGender
ARB useAlzheimer disease
OsteoporosisHypertension
Parkinson's diseaseThiazide use
Bone meneral density testACE inhibitor useAntiepileptic use
DiabetesUpper gastrointestinal disease
HyperlipidemiaGout
Benzodiazepine useBeta blocker use
Back painSSRI use
AnginaH2 blocker use
Corticosteroid useFalls
PPI useStroke
Myocardial infarctionNo. physician visits
AgeLoop diuretic use
FractureWhite race
No. days in hospitalNo. prescription drugs
Antithrombotic useCharlson score
0.00 0.05 0.10 0.15 0.20Absolute Standardized Mean Difference
Methods● Unmatched
Matched
MW
IPTW
Unmatched
Matched
MW
IPTW
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Empirical example: Outcome regression
Yoshida K et al. Matching Weights for Three-category Exposure 2/9/2016
- 1 -
Table 1. Comparison of hazard ratios for coxibs and opioids (nonselective NSAIDs as the reference)
by different methods and outcomes.
Coxibs vs nsNSAIDs
Opioids vs nsNSAIDs
HR [95% CI] p
HR [95% CI] p
Death
Unmatched 1.702 [1.293, 2.240] <0.001 2.821 [2.185, 3.642] <0.001 Matched 1.415 [1.060, 1.889] 0.018 1.997 [1.492, 2.671] <0.001 MW 1.393 [1.056, 1.837] 0.019 1.973 [1.517, 2.566] <0.001 IPTW 1.385 [1.024, 1.873] 0.035 1.962 [1.480, 2.601] <0.001
Fracture
Unmatched 1.181 [0.799, 1.746] 0.405 5.825 [4.195, 8.089] <0.001 Matched 0.947 [0.618, 1.453] 0.804 4.708 [3.308, 6.702] <0.001 MW 1.013 [0.684, 1.502] 0.948 4.733 [3.396, 6.595] <0.001 IPTW 0.887 [0.576, 1.365] 0.585 4.068 [2.814, 5.882] <0.001
GI bleed
Unmatched 0.933 [0.605, 1.439] 0.753 1.529 [1.034, 2.262] 0.033 Matched 0.932 [0.587, 1.480] 0.766 1.005 [0.615, 1.643] 0.984 MW 0.857 [0.551, 1.335] 0.496 1.108 [0.737, 1.668] 0.622 IPTW 0.916 [0.575, 1.459] 0.713 1.196 [0.793, 1.804] 0.394
Cardiovascular
Unmatched 1.603 [1.298, 1.979] <0.001 2.294 [1.882, 2.797] <0.001 Matched 1.419 [1.135, 1.775] 0.002 1.585 [1.255, 2.003] <0.001 MW 1.355 [1.096, 1.675] 0.005 1.626 [1.326, 1.995] <0.001 IPTW 1.268 [0.979, 1.642] 0.072 1.445 [1.125, 1.856] 0.004
Abbreviations: MW: matching weights; IPTW: inverse probability of treatment weights; Matched:
three-way matching; Coxibs: COX-2 selective inhibitors; nsNSAIDs: non-selective non-steroidal
anti-inflammatory drugs; HR: hazard ratio; CI: confidence interval.
Table 1
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Outline of proof that estimands are equivalentA complete common support and exact propensity score matching areassumed. Sk is the set of matched individuals in treatment group k. Wi
is the matching weights min(e1i ,...,eKi )∑Kk=1 I (Zi=k)eki
. The estimators for the group
mean have the same estimand.
Matching
1n
∑ni=1 Yi I (i ∈ Sk)
1n
∑ni=1 I (i ∈ Sk)
=1n
∑ni=1 Yki I (i ∈ Sk)
1n
∑ni=1 I (i ∈ Sk)
→ E [Yki I (i ∈ Sk)]
E [I (i ∈ Sk)]
. . .
=E [E [Yki |Xi ]min(e1i , ..., eKi )]
E [min(e1i , ..., eKi )]
Weighting
1n
∑ni=1 Yi I (Zi = k)Wi
1n
∑ni=1 I (Zi = k)Wi
=1n
∑ni=1 Yki I (Zi = k)Wi
1n
∑ni=1 I (Zi = k)Wi
→E [∑n
i=1 Yki I (Zi = k)Wi ]
E [∑n
i=1 I (Zi = k)Wi ]
. . .
=E [E [Yki |Xi ]min(e1i , ..., eKi )]
E [min(e1i , ..., eKi )] 31 / 31