Abstract

Observational longitudinal data on treatments and covariates are increasingly used to investigate treatment effects, but are often subject to time-dependent confounding. Marginal structural models (MSMs), estimated using inverse probability of treatment weighting or the g-formula, are popular for handling this problem. With increasing development of advanced causal inference methods, it is important to be able to assess their performance in different scenarios to guide their application. Simulation studies are a key tool for this, but their use to evaluate causal inference methods has been limited. This paper focuses on the use of simulations for evaluations involving MSMs in studies with a time-to-event outcome. In a simulation, it is important to be able to generate the data in such a way that the correct forms of any models to be fitted to those data are known. However, this is not straightforward in the longitudinal setting because it is natural for data to be generated in a sequential conditional manner, whereas MSMs involve fitting marginal rather than conditional hazard models. We provide general results that enable the form of the correctly specified MSM to be derived based on a conditional data generating procedure, and show how the results can be applied when the conditional hazard model is an Aalen additive hazard or Cox model. Using conditional additive hazard models is advantageous because they imply additive MSMs that can be fitted using standard software. We describe and illustrate a simulation algorithm. Our results will help researchers to effectively evaluate causal inference methods via simulation.

Highlights

  • Observational longitudinal data are increasingly used to investigate the effects of treatments and exposures on health outcomes

  • We provide general results that enable the form of the correctly specified Marginal structural models (MSMs) for estimating causal treatment effects to be derived from an underlying conditional hazard model used in the data simulation procedure, and show how the results can be applied when the conditional hazard model is an additive hazard model (Aalen, 1989; Aalen et al, 2008) or a Cox model (Cox, 1972)

  • When the conditional hazard model λ(t|Ā ⌊t⌋, L ⌊t⌋, U) is additive, we have shown that the MSM λTa0 (t) is additive

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Summary

Introduction

Observational longitudinal data are increasingly used to investigate the effects of treatments and exposures on health outcomes. To estimate treatment effects from observational data we must account for confounding of the treatment-outcome association, sometimes referred to as ‘confounding by indication’, and recent years have seen huge developments in statistical and epidemiological methods for this task. We focus on the setting of estimating the joint effects of treatment across time-points on a time-to-event outcome using longitudinal data on treatment use and covariates, where time-dependent confounding is a specific challenge. When there is time-dependent confounding, standard analysis methods, such as Cox regression with adjustment for baseline or time-updated covariates, do not in general enable estimation of the causal effects of interest (Daniel et al, 2013). Several methods have been described for estimating the causal effects of longitudinal treatment regimes on time-toevent outcomes. A recent review (Clare et al, 2018) found that among these, the Cox MSM approach is by far the most commonly used method in practice

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