A Marginal Structural Modeling Approach to Assess the Cumulative Effect of Drug Treatment on the Later Drug Use Abstinence.

Abstract

In this article, we applied a marginal structural model (MSM) to estimate the effect on later drug use of drug treatments occurring over 10 years following first use of the primary drug. The study was based on the longitudinal data that were collected in three projects among 421 subjects and covered 15 years since first use of their primary drug. The cumulative treatment effect was estimated by the inverse-probability of treatment weighted estimators of MSM as well as the traditional regression analysis. Contrary to the traditional regression analysis, results of the MSM showed that the cumulative treatment occurring over the 10 years significantly increased the likelihood of drug use abstinence in the subsequent 5-year period. From both the statistical and empirical point of view, MSM is a better approach to assessing cumulative treatment effects, considering its advantage of controlling for self-selection bias over time.