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首页> 美国卫生研究院文献>American Journal of Epidemiology >Editors choice: The Choice of Analytical Strategies in Inverse-Probability-of-Treatment–Weighted Analysis: A Simulation Study
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Editors choice: The Choice of Analytical Strategies in Inverse-Probability-of-Treatment–Weighted Analysis: A Simulation Study

机译：编辑的选择：治疗逆概率分析中加权分析的策略选择：模拟研究

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We sought to explore the impact of intention to treat and complex treatment use assumptions made during weight construction on the validity and precision of estimates derived from inverse-probability-of-treatment–weighted analysis. We simulated data assuming a nonexperimental design that attempted to quantify the effect of statin on lowering low-density lipoprotein cholesterol. We created 324 scenarios by varying parameter values (effect size, sample size, adherence level, probability of treatment initiation, associations between low-density lipoprotein cholesterol and treatment initiation and continuation). Four analytical approaches were used: 1) assuming intention to treat; 2) assuming complex mechanisms of treatment use; 3) assuming a simple mechanism of treatment use; and 4) assuming invariant confounders. With a continuous outcome, estimates assuming intention to treat were biased toward the null when there were nonnull treatment effect and nonadherence after treatment initiation. For each 1% decrease in the proportion of patients staying on treatment after initiation, the bias in estimated average treatment effect increased by 1%. Inverse-probability-of-treatment–weighted analyses that took into account the complex mechanisms of treatment use generated approximately unbiased estimates. Studies estimating the actual effect of a time-varying treatment need to consider the complex mechanisms of treatment use during weight construction.
机译：我们试图探讨在权重构建过程中要进行治疗的意图和复杂的治疗使用假设，对治疗逆概率加权分析得出的估计值的有效性和准确性的影响。我们模拟的数据假设采用非实验设计，试图量化他汀类药物对降低低密度脂蛋白胆固醇的作用。我们通过改变参数值（效应量，样本量，依从性水平，治疗开始的可能性，低密度脂蛋白胆固醇与治疗开始和持续之间的关联）创建了324种方案。使用了四种分析方法：1）假定要治疗； 2）假定使用复杂的治疗机制； 3）假设使用简单的治疗机制； 4）假设不变的混杂因素。结果连续，当治疗开始后存在非无效治疗效果和不依从性时，假定有治疗意向的估计偏向无效。启动后继续治疗的患者比例每下降1％，估计平均治疗效果的偏差就会增加1％。考虑到使用治疗的复杂机制的治疗逆概率加权分析产生了近似无偏估计。估计随时间变化的治疗的实际效果的研究需要考虑体重增加过程中使用治疗的复杂机制。

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