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      International Journal of COPD (submit here)

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      Clinical and economic outcomes in an observational study of COPD maintenance therapies: multivariable regression versus propensity score matching

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          Abstract

          Purpose

          To investigate equivalency of results from multivariable regression (MR) and propensity score matching (PSM) models, observational research methods used to mitigate bias stemming from non-randomization (and consequently unbalanced groups at baseline), using, as an example, a large study of chronic obstructive pulmonary disease (COPD) initial maintenance therapy.

          Methods

          Patients were 32,338 health plan members, age ≥40 years, with COPD initially treated with fluticasone propionate/salmeterol combination (FSC), tiotropium (TIO), or ipratropium (IPR) alone or in combination with albuterol. Using MR and PSM methods, the proportion of patients with COPD-related health care utilization, mean costs, odds ratios (ORs), and incidence rate ratios (IRRs) for utilization events were calculated for the 12 months following therapy initiation.

          Results

          Of 12,595 FSC, 9126 TIO, and 10,617 IPR patients meeting MR inclusion criteria, 89.1% (8135) of TIO and 80.2% (8514) of IPR patients were matched to FSC patients for the PSM analysis. Methods produced substantially similar findings for mean cost comparisons, ORs, and IRRs for most utilization events. In contrast to MR, for TIO compared to FSC, PSM did not produce statistically significant ORs for hospitalization or outpatient visit with antibiotic or significant IRRs for hospitalization or outpatient visit with oral corticosteroid. As in the MR analysis, compared to FSC, ORs and IRRs for all other utilization events, as well as mean costs, were less favorable for IPR and TIO.

          Conclusion

          In this example of an observational study of maintenance therapy for COPD, more than 80% of the original treatment groups used in the MR analysis were matched to comparison treatment groups for the PSM analysis. While some sample size was lost in the PSM analysis, results from both methods were similar in direction and statistical significance, suggesting that MR and PSM were equivalent methods for mitigating bias.

          Author and article information

          Journal
          Int J Chron Obstruct Pulmon Dis
          Int J Chron Obstruct Pulmon Dis
          International Journal of COPD
          International Journal of Chronic Obstructive Pulmonary Disease
          Dove Medical Press
          1176-9106
          1178-2005
          2012
          2012
          22 March 2012
          : 7
          : 221-233
          Affiliations
          [1 ]Lovelace Clinic Foundation, (Lovelace Respiratory Research Institute at the time of the study), Albuquerque, NM
          [2 ]US Health Outcomes, GlaxoSmithKline, Durham, NC, USA
          Author notes
          Correspondence: Melissa H Roberts, LCF Research, 2309 Renard Place SE, Suite 103, Albuquerque, NM 87106, USA, Tel +1 505 938 9922, Fax +1 505 938 9940, Email melissa.roberts@ 123456lcfresearch.org
          Article
          copd-7-221
          10.2147/COPD.S27569
          3324998
          22500122
          a3639dbc-176d-4072-82f0-47a13db092cd
          © 2012 Roberts and Dalal, publisher and licensee Dove Medical Press Ltd.

          This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

          History
          Categories
          Methodology

          Respiratory medicine
          multivariate analysis,pulmonary disease,statistical bias,outcomes research,statistical models,propensity score,chronic obstructive

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