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. 2020 Sep;19(5):626-635.
doi: 10.1002/pst.2019. Epub 2020 Mar 21.

The attributable estimand: A new approach to account for intercurrent events

Patrick Darken  1 , Jack Nyberg  1 , Shaila Ballal  1 , David Wright  2
Affiliations

The attributable estimand: A new approach to account for intercurrent events

Patrick Darken et al. Pharm Stat. 2020 Sep.

Abstract

The term "intercurrent events" has recently been used to describe events in clinical trials that may complicate the definition and calculation of the treatment effect estimand. This paper focuses on the use of an attributable estimand to address intercurrent events. Those events that are considered to be adversely related to randomized treatment (eg, discontinuation due to adverse events or lack of efficacy) are considered attributable and handled with a composite estimand strategy, while a hypothetical estimand strategy is used for intercurrent events not considered to be related to randomized treatment (eg, unrelated adverse events). We explore several options for how to implement this approach and compare them to hypothetical "efficacy" and treatment policy estimand strategies through a series of simulation studies whose design is inspired by recent trials in chronic obstructive pulmonary disease (COPD), and we illustrate through an analysis of a recently completed COPD trial.

Keywords: ICH E9; bootstrap; estimands; intercurrent events; missing data; multiple imputation.

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References

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