Generalizing causal inferences from individuals in randomized trials to all trial-eligible individuals

Biometrics. 2019 Jun;75(2):685-694. doi: 10.1111/biom.13009. Epub 2019 Jun 21.

Abstract

We consider methods for causal inference in randomized trials nested within cohorts of trial-eligible individuals, including those who are not randomized. We show how baseline covariate data from the entire cohort, and treatment and outcome data only from randomized individuals, can be used to identify potential (counterfactual) outcome means and average treatment effects in the target population of all eligible individuals. We review identifiability conditions, propose estimators, and assess the estimators' finite-sample performance in simulation studies. As an illustration, we apply the estimators in a trial nested within a cohort of trial-eligible individuals to compare coronary artery bypass grafting surgery plus medical therapy vs. medical therapy alone for chronic coronary artery disease.

Keywords: causal inference; clinical trials; double robustness; generalizability; observational studies; transportability.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Causality*
  • Chronic Disease
  • Computer Simulation
  • Coronary Artery Bypass / statistics & numerical data
  • Coronary Artery Disease / drug therapy
  • Coronary Artery Disease / surgery
  • Humans
  • Patient Selection*
  • Randomized Controlled Trials as Topic / statistics & numerical data*
  • Treatment Outcome