Propensity Score Weighting and Trimming Strategies for Reducing Variance and Bias of Treatment Effect Estimates: A Simulation Study

AbstractTo extend previous simulations on the performance of propensity score (PS) weighting and trimming methods to settings without and with unmeasured confounding, Poisson outcomes, and various strengths of treatment prediction (PSc statistic), we simulated studies with a binary intended treatmentT as a function of 4 measured covariates. We mimicked treatment withheld and last-resort treatment by adding 2 “unmeasured” dichotomous factors that directed treatment to change for some patients in both tails of the PS distribution. The number of outcomesY was simulated as a Poisson function ofT and confounders. We estimated the PS as a function of measured covariates and trimmed the tails of the PS distribution using 3 strategies ( “Crump,” “Stürmer,” and “Walker”). After trimming and reestimation, we used alternative PS weights to estimate the treatment effect (rate ratio): inverse probability of treatment weighting, standardized mortality ratio (SMR)-treated, SMR-untreated, the average treatment effect in the ov erlap population (ATO), matching, and entropy. With no unmeasured confounding, the ATO (123%) and “Crump” trimming (112%) improved relative efficiency compared with untrimmed inverse probability of treatment weighting. With unmeasured confounding, untrimmed estimates were biased irrespective of weighting method, and only Stürmer and Walker trimming consistently reduced bias. In settings where unmeasured confounding (e.g., frailty) may lead physici...
Source: American Journal of Epidemiology - Category: Epidemiology Source Type: research