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Activity Number: 503
Type: Invited
Date/Time: Wednesday, August 7, 2013 : 10:30 AM to 12:20 PM
Sponsor: Business and Economic Statistics Section
Abstract - #307013
Title: The Regression Discontinuity Design in Epidemiology: An Application to Statins
Author(s): Sara Geneletti and Gianluca Baio*+
Companies: London School of Economics and Political Science and University College London
Keywords: causality ; local average treatment effect ; statins
Abstract:

It is important to determine if a drug is being prescribed at the point in disease progression where it will be most beneficial to patients. Determining prescription guidelines falls to expert clinicians. The regression discontinuity (RD) design provides a principled way of evaluating whether a particular prescription rule is successful. Many drugs are prescribed according to guidelines, e.g. statins, a class of cholesterol-lowering drugs. In the UK, the NHS recommends that patients are prescribed statins when their risk of developing CVD in the subsequent 10 years, as calculated by a risk calculator, exceeds 20%. We exploit this guideline to estimate the effect of the treatment around the threshold. We apply the RD to statin prescription in THIN, a UK database which contains a representative sample of anonymised patient records. A number of Bayesian models are explored, ranging from simple regressions to cubic penalized splines. We compare results to those obtained from clinical trials of statins and consider the underlying assumptions in the context of the data. Of particular interest is the issue of "weak instruments" as doctors do not always follow prescription guidelines.


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