Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Pharmacoepidemiol Drug Saf. 2012 May;21 Suppl 2:90-8. doi: 10.1002/pds.3250.

Confronting "confounding by health system use" in Medicare Part D: comparative effectiveness of propensity score approaches to confounding adjustment.

Author information

  • 1Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA. jpolinski@partners.org

Abstract

PURPOSE:

Under Medicare Part D, patient characteristics influence plan choice, which in turn influences Part D coverage gap entry. We compared predefined propensity score (PS) and high-dimensional propensity score (hdPS) approaches to address such "confounding by health system use" in assessing whether coverage gap entry is associated with cardiovascular events or death.

METHODS:

We followed 243,079 Medicare patients aged 65+ years with linked prescription, medical, and plan-specific data in 2005-2007. Patients reached the coverage gap and were followed until an event or year's end. Exposed patients were responsible for drug costs in the gap; unexposed patients (patients with non-Part D drug insurance and Part D patients receiving a low-income subsidy) received financial assistance. Exposed patients were 1:1 PS-matched or hdPS-matched to unexposed patients. The PS model included 52 predefined covariates; the hdPS model added 400 empirically identified covariates. Hazard ratios for death and any of five cardiovascular outcomes were compared. In sensitivity analyses, we explored residual confounding using only low-income subsidy patients in the unexposed group.

RESULTS:

In unadjusted analyses, exposed patients had no greater hazard of death (HR = 1.00; 95%CI, 0.84-1.20) or other outcomes. PS-matched (HR = 1.29; 0.99-1.66) and hdPS-matched (HR = 1.11; 0.86-1.42) analyses showed elevated but non-significant hazards of death. In sensitivity analyses, the PS analysis showed a protective effect (HR = 0.78; 0.61-0.98), whereas the hdPS analysis (HR = 1.06; 0.82-1.37) confirmed the main hdPS findings.

CONCLUSION:

Although the PS-matched analysis suggested elevated but non-significant hazards of death among patients with no financial assistance during the gap, the hdPS analysis produced lower estimates that were stable across sensitivity analyses.

Copyright © 2012 John Wiley & Sons, Ltd.

PMID:
22552984
[PubMed - indexed for MEDLINE]
PMCID:
PMC3367305
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for John Wiley & Sons, Inc. Icon for PubMed Central
    Loading ...
    Write to the Help Desk