The value of explicitly emulating a target trial when using real world evidence: an application to colorectal cancer screening

The value of explicitly emulating a target trial when using real world evidence: an application... Observational analyses for causal inference often rely on real world data collected for purposes other than research. A frequent goal of these observational analyses is to use the data to emulate a hypothetical randomized experiment, i.e., the target trial, that mimics the design features of a true experiment, including a clear definition of time zero with synchronization of treatment assignment and determination of eligibility. We review a recent observational analysis that explicitly emulated a target trial of screening colonoscopy using insurance claims from U.S. Medicare. We then compare this explicit emulation with alternative, simpler observational analyses that do not synchronize treatment assignment and eligibility determination at time zero and/or do not allow for repeated eligibility. This empirical comparison suggests that lack of an explicit emulation of the target trial leads to biased estimates, and shows that allowing for repeated eligibility increases the statistical efficiency of the estimates. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Epidemiology Springer Journals

The value of explicitly emulating a target trial when using real world evidence: an application to colorectal cancer screening

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Publisher
Springer Netherlands
Copyright
Copyright © 2017 by Springer Science+Business Media B.V.
Subject
Medicine & Public Health; Epidemiology; Public Health; Infectious Diseases; Cardiology; Oncology
ISSN
0393-2990
eISSN
1573-7284
D.O.I.
10.1007/s10654-017-0287-2
Publisher site
See Article on Publisher Site

Abstract

Observational analyses for causal inference often rely on real world data collected for purposes other than research. A frequent goal of these observational analyses is to use the data to emulate a hypothetical randomized experiment, i.e., the target trial, that mimics the design features of a true experiment, including a clear definition of time zero with synchronization of treatment assignment and determination of eligibility. We review a recent observational analysis that explicitly emulated a target trial of screening colonoscopy using insurance claims from U.S. Medicare. We then compare this explicit emulation with alternative, simpler observational analyses that do not synchronize treatment assignment and eligibility determination at time zero and/or do not allow for repeated eligibility. This empirical comparison suggests that lack of an explicit emulation of the target trial leads to biased estimates, and shows that allowing for repeated eligibility increases the statistical efficiency of the estimates.

Journal

European Journal of EpidemiologySpringer Journals

Published: Jul 26, 2017

References

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