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Selecting an appropriate caliper can be essential for achieving good balance with propensity score matching.

ABSTRACT: Matching on the propensity score is widely used to estimate the effect of an exposure in observational studies. However, the quality of the matches can be affected by decisions made during the matching process, particularly the order in which subjects are selected for matching and the maximum permitted difference between matched subjects (the "caliper"). This study used simulations to explore the effects of these decisions on both the imbalance of covariates and the closeness of matching, while allowing the numbers of potential matches and strengths of association between the confounding variable and the exposure to vary. It was found that, without a caliper, substantial bias was possible, particularly with a relatively small reservoir of potential matches and strong confounder-exposure association. Use of the recommended caliper reduced the bias considerably, but bias remained if subjects were selected by increasing or decreasing propensity score. A tighter caliper led to greatly reduced bias and closer matches, although some subjects could not be matched. This study suggests that a narrow caliper can improve the performance of propensity score matching. In situations where it is impossible to find appropriate matches for all exposed subjects, it is better to select subjects in order of the best available matches, rather than increasing or decreasing the propensity score.

SUBMITTER: Lunt M

PROVIDER: S-EPMC3873103 | biostudies-literature | 2014 Jan

REPOSITORIES: biostudies-literature

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Selecting an appropriate caliper can be essential for achieving good balance with propensity score matching.

Lunt Mark M

American journal of epidemiology 20131010 2

Matching on the propensity score is widely used to estimate the effect of an exposure in observational studies. However, the quality of the matches can be affected by decisions made during the matching process, particularly the order in which subjects are selected for matching and the maximum permitted difference between matched subjects (the "caliper"). This study used simulations to explore the effects of these decisions on both the imbalance of covariates and the closeness of matching, while ...[more]

PMID: 24114655

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Project description:BackgroundThe diagnostic process is a key element of medicine but it is complex and prone to errors. Infectious diseases are one of the three categories of diseases in which diagnostic errors can be most harmful to patients. In this study we aimed to estimate the effect of initial misdiagnosis of the source of infection in patients with bacteraemia on 14 day mortality using propensity score methods to adjust for confounding.MethodsData from a previously described longitudinal cohort of patients diagnosed with monobacterial bloodstream infection (BSI) at the Leiden University Medical Centre (LUMC) between 2013 and 2015 were used. Propensity score matching and inversed probability of treatment weighting (IPTW) were applied to correct for confounding. The average treatment effect on the treated (ATT), which in this study was the average effect of initial misdiagnosis on the misdiagnosed (AEMM), was estimated. Methodological issues that were encountered when applying propensity score methods were addressed by performing additional sensitivity analyses. Sensitivity analyses consisted of varying caliper in propensity score matching and using different truncated weights in inversed probability of treatment weighting.ResultsData of 887 patients were included in the study. Propensity scores ranged between 0.015 and 0.999 and 80 patients (9.9%) had a propensity score > 0.95. In the matched analyses, 35 of the 171 misdiagnosed patients died within 14 days (20.5%), versus 10 of the 171 correctly diagnosed patients (5.8%), yielding a difference of 14.6% (7.6%; 21.6%). In the total group of patients, the observed percentage of patients with an incorrect initial diagnosis that died within 14 days was 19.8% while propensity score reweighting estimated that their probability of dying would have been 6.5%, if they had been correctly diagnosed (difference 13.3% (95% CI 6.9%;19.6%)). After adjustment for all variables that showed disbalance in the propensity score a difference of 13.7% (7.4%; 19.9%) was estimated. Sensitivity analyses yielded similar results. However, performing weighted analyses without truncation yielded unstable results.ConclusionThus, we observed a substantial increase of 14 day mortality in initially misdiagnosed patients. Furthermore, several patients received propensity scores extremely close to one and were almost sure to be initially misdiagnosed.

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Selecting an appropriate caliper can be essential for achieving good balance with propensity score matching.

Publications

Selecting an appropriate caliper can be essential for achieving good balance with propensity score matching.

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