Bayesian propensity score analysis for observational data

In the analysis of observational data, stratifying patients on the estimated propensity scores reduces confounding from measured variables.  Confidence intervals for the treatment effect are typically calculated without acknowledging uncertainty in the estimated propensity scores, and intuitively this may yield inferences, which are falsely precise.

In this paper, we describe a Bayesian method that models the propensity score as a latent variable.  The authors consider observational studies with a dichotomous treatment, dichotomous outcome, and measured confounders where the log odds ratio is the measure of effect.  Markov chain Monte Carlo is used for posterior simulation.  They study the impact of modeling uncertainty in the propensity scores in a case study investigating the effect of statin therapy on mortality in Ontario patients discharged from hospital following acute myocardial infarction.  Their analysis reveals that the Bayesian credible interval for the treatment effect is 10 per cent wider compared with a conventional propensity score analysis.  Using simulations, they show that when the association between treatment and confounders is weak, then this increases uncertainty in the estimated propensity scores.  Bayesian interval estimates for the treatment effect are longer on average, though there is little improvement in coverage probability.

A novel feature of the proposed method is that it fits models for the treatment and outcome simultaneously rather than one at a time.  The method uses the outcome variable to inform the fit of the propensity model.  The authors explore the performance of the estimated propensity scores using cross-validation.