Use of the landmark method to address immortal person-time bias in comparative effectiveness research: a simulation study

Xiaojuan Mi, Bradley G. Hammill, Lesley H. Curtis, Edward Chia Cheng Lai, Soko Setoguchi

研究成果: Article同行評審

33 引文 斯高帕斯(Scopus)

摘要

Observational comparative effectiveness and safety studies are often subject to immortal person-time, a period of follow-up during which outcomes cannot occur because of the treatment definition. Common approaches, like excluding immortal time from the analysis or naïvely including immortal time in the analysis, are known to result in biased estimates of treatment effect. Other approaches, such as the Mantel–Byar and landmark methods, have been proposed to handle immortal time. Little is known about the performance of the landmark method in different scenarios. We conducted extensive Monte Carlo simulations to assess the performance of the landmark method compared with other methods in settings that reflect realistic scenarios. We considered four landmark times for the landmark method. We found that the Mantel–Byar method provided unbiased estimates in all scenarios, whereas the exclusion and naïve methods resulted in substantial bias when the hazard of the event was constant or decreased over time. The landmark method performed well in correcting immortal person-time bias in all scenarios when the treatment effect was small, and provided unbiased estimates when there was no treatment effect. The bias associated with the landmark method tended to be small when the treatment rate was higher in the early follow-up period than it was later. These findings were confirmed in a case study of chronic obstructive pulmonary disease.

原文English
頁(從 - 到)4824-4836
頁數13
期刊Statistics in Medicine
35
發行號26
DOIs
出版狀態Published - 2016 十一月 20

All Science Journal Classification (ASJC) codes

  • 流行病學
  • 統計與概率

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