Toward evaluation of disseminated effects of medications for opioid use disorder within provider-based clusters using routinely-collected health data

Abstract

Routinely-collected health data can be employed to emulate a target trial when randomized trial data are not available. Patients within provider-based clusters likely exert and share influence on each other's treatment preferences and subsequent health outcomes and this is known as dissemination or spillover. Extending a framework to replicate an idealized two-stage randomized trial using routinely-collected health data, an evaluation of disseminated effects within provider-based clusters is possible. In this article, we propose a novel application of causal inference methods for dissemination to retrospective cohort studies in administrative claims data and evaluate the impact of the normality of the random effects distribution for the cluster-level propensity score on estimation of the causal parameters. An extensive simulation study was conducted to study the robustness of the methods under different distributions of the random effects. We applied these methods to evaluate baseline prescription for medications for opioid use disorder among a cohort of patients diagnosed with opioid use disorder and adjust for baseline confounders using information obtained from an administrative claims database. We discuss future research directions in this setting to better address unmeasured confounding in the presence of disseminated effects.

Keywords: dissemination; health data; interference; medication for opioid use disorder; mixed effects models; opioid use disorder.

FIGURE 1

Schematic diagram of the subsets of data used for each estimator (direct, disseminated, composite, and overall) based on a format provided in Halloran and Struchiner

FIGURE 2

Schematic diagram of retrospective cohort study of medications for opioid use disorder (MOUD) on the two-year risk of opioid overdose among patients diagnosed with opioid use disorder (OUD) in Optum’s de-identified Clinformatics® Data Mart Database, 2010-2017, United States