Sean Hennessy1, Charles E Leonard2, Cristin M Palumbo2, Xiaoli Shi2, Thomas R Ten Have2. 1. Center for Clinical Epidemiology & Biostatistics, Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. Electronic address: hennessy@mail.med.upenn.edu. 2. Center for Clinical Epidemiology & Biostatistics, Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Abstract
OBJECTIVE: Prescriber preference has been used as an instrumental variable (IV) in a prior study of nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) vs. selective cyclooxygenase-2 (COX-2) inhibitors, with preference expressed as the drug constituting the immediately preceding prescription by the same prescriber (instantaneous preference). We sought to compare the correlations between different IV measures with exposure. STUDY DESIGN AND SETTING: In an ambulatory electronic medical record database of university-based physicians, we compared correlations with exposure among three measures of prescriber preference: instantaneous preference, and the proportion of that prescriber's prescriptions in the past 3 and 6 months that were for an NSAID. RESULTS: We identified 37,934 initial NSAID/COX-2 prescriptions. The correlation with exposure was 0.283 (95% confidence interval 0.274-0.292) for instantaneous preference, 0.197 (0.187-0.206) for 3-month preference, and 0.170 (0.160-0.180) for 6-month preference. CONCLUSION: Instantaneous NSAID/COX-2 prescribing preference was most strongly correlated, and therefore the strongest IV. Future research should focus on the robustness of IV methods to violations of underlying assumptions, extension of IV methods to more than two groups, ratio measures of association, second and subsequent prescriptions per person, and time-varying exposures.
OBJECTIVE: Prescriber preference has been used as an instrumental variable (IV) in a prior study of nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) vs. selective cyclooxygenase-2 (COX-2) inhibitors, with preference expressed as the drug constituting the immediately preceding prescription by the same prescriber (instantaneous preference). We sought to compare the correlations between different IV measures with exposure. STUDY DESIGN AND SETTING: In an ambulatory electronic medical record database of university-based physicians, we compared correlations with exposure among three measures of prescriber preference: instantaneous preference, and the proportion of that prescriber's prescriptions in the past 3 and 6 months that were for an NSAID. RESULTS: We identified 37,934 initial NSAID/COX-2 prescriptions. The correlation with exposure was 0.283 (95% confidence interval 0.274-0.292) for instantaneous preference, 0.197 (0.187-0.206) for 3-month preference, and 0.170 (0.160-0.180) for 6-month preference. CONCLUSION: Instantaneous NSAID/COX-2 prescribing preference was most strongly correlated, and therefore the strongest IV. Future research should focus on the robustness of IV methods to violations of underlying assumptions, extension of IV methods to more than two groups, ratio measures of association, second and subsequent prescriptions per person, and time-varying exposures.
Authors: Neil M Davies; David Gunnell; Kyla H Thomas; Chris Metcalfe; Frank Windmeijer; Richard M Martin Journal: J Clin Epidemiol Date: 2013-09-24 Impact factor: 6.437