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Activity Number: 67
Type: Topic Contributed
Date/Time: Sunday, August 9, 2015 : 4:00 PM to 5:50 PM
Sponsor: Section on Statistics in Epidemiology
Abstract #316311 View Presentation
Title: Comparison of a Targeted Maximum Likelihood Estimator to Other Estimation Techniques for the One-Year Risk of Recurrent MI Among New Users of High vs. Low Potency Statins
Author(s): Jonathan Todd* and Michele Jonsson Funk and Alan Brookhart
Companies: The University of North Carolina Gillings School of Global Public Health and The University of North Carolina Gillings School of Global Public Health and The University of North Carolina at Chapel Hill
Keywords: TMLE ; Augmented IPTW ; statins ; MI ; claims
Abstract:

The PROVE IT-TIMI 22 randomized controlled trial found that the use of higher potency statins had a protective effect (HR: 0.85) on a combined endpoint of major cardiovascular events or death. We estimate the effect of high vs. low statin potency on the outcome of a major cardiovascular event or death within one year, in a cohort of new users of statins within 20 days of a first myocardial infarction, in the Truven MarketScan database. We compare results from different estimation techniques, including targeted maximum likelihood estimation (TMLE) and augmented inverse probability of treatment weighting (A-IPTW). 21,624 individuals with a new statin prescription within 20 days of an initial MI were identified. Patient characteristics were well balanced in the cohort. Incidence of a major cardiovascular event was 44% among high potency statin users, and 40% among low potency statin users. Adjustment via all modeling strategies resulted in very similar risk ratios just below the null (RR: 0.95-0.98). The relative efficiency for TMLE was slightly improved compared to all other models. A-IPTW and TMLE performed similarly, with the TMLE modeling having a very slight precision advantage.


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