A theoretical exploration of therapeutic monomania as a physician‐based instrumental variable

Purpose To explore the utility of physician prescribing preference as an instrumental variable. Methods Expert (non‐systematic) review of relevant literature on the appropriate selection of instrumental variables and theoretical exploration of individual physician and physician group prescriber pref...

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Bibliographic Details
Published in:Pharmacoepidemiology and drug safety 2020-01, Vol.29 (S1), p.45-52
Main Authors: Potter, Brian J., Dormuth, Colin, Le Lorier, Jacques
Format: Article
Language:English
Subjects:
Confounding Factors, Epidemiologic
Economic models
Humans
instrumental variable
Original Research
Pharmacoepidemiology
Practice Patterns, Physicians' - statistics & numerical data
prescribing preference
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Summary:Purpose To explore the utility of physician prescribing preference as an instrumental variable. Methods Expert (non‐systematic) review of relevant literature on the appropriate selection of instrumental variables and theoretical exploration of individual physician and physician group prescriber preference. Results An instrumental variable must satisfy three criteria: (1) It must predict the treatment received (strength of the instrument); (2) it cannot influence the outcome other that through the treatment received (exclusion restriction); and (3) it cannot be influenced by any factor that also influences the outcome (independence assumption). Arguments in favor of prescriber preference as an instrumental variable and suggestions for how to approach specific scenarios that may be encountered are offered. Conclusions Prescriber preference, be it of individual physicians or groups of physicians, may, under the right conditions, be powerful instrumental variables. Empiric experimental data are required to determine the appropriateness of combining propensity matching and instrumental variable analysis.
ISSN:1053-8569
1099-1557
DOI:10.1002/pds.4757