Target Trials

Lucy D’Agostino McGowan

Randomized trials

Randomization

  • Purpose of Randomization: Solves key issues in causal inference
    • Consistency
    • Positivity
    • Does not address interference

Ideal vs Realizstic Randomized Trials

  • Ideal Randomized Trials
    • Achieve exchangeability
  • Realistic Randomized Trials
    • May violate exchangeability with non-adherence / dropout

Assumption Ideal Randomized Trial Realistic Randomized Trial Observational Study
Consistency (Well defined exposure) 😄 😄 🤷
Consistency (No interference) 🤷 🤷 🤷
Positivity 😄 😄 🤷
Exchangeability 😄 🤷 🤷

Study Protocol

  1. Eligibility criteria
  2. Exposure definition
  3. Assignment procedures
  4. Follow-up period
  5. Outcome definition
  6. Causal contrast of interest
  7. Analysis plan

Protcol elements mapped to assumptions

Assumption Eligibility Criteria Exposure Definition Assignment Procedures Follow-up Period Outcome Definition Causal contrast Analysis Plan
Consistency (Well defined exposure) ✔️
Consistency (No interference) ✔️ ✔️ ✔️ ✔️
Positivity ✔️ ✔️ ✔️
Exchangeability ✔️ ✔️ ✔️ ✔️

Mapped to diagraming causal claims

Target Trials

Target Trials

  • There are many reasons why randomization may not be possible
    • it might not be ethical to randomly assign people to a particular exposure
    • there may not be funding available
    • there might not be enough time to conduct a full trial

Target Trial

  • In these situations, we rely on observational data to help us answer causal questions by implementing a target trial
  • A target trial answers: What experiment would you design if you could?

Let’s try a simple example

# A tibble: 10,000 × 3
   confounder exposure outcome
        <int>    <int>   <dbl>
 1          0        0 -0.804 
 2          0        0 -1.06  
 3          1        1 -0.0354
 4          1        1 -0.186 
 5          0        0 -0.500 
 6          1        1  0.475 
 7          1        0  0.698 
 8          1        0  1.47  
 9          1        0  0.752 
10          0        0  1.26  
# ℹ 9,990 more rows

Let’s try a simple example

  1. Eligibility criteria: everyone
  2. Exposure definition: exposed = 1 vs exposed = 0
  3. Assignment procedures: people who have confounder = 1 are more likely to be exposed
  4. Follow-up period: (until outcome observed)
  5. Outcome definition: outcome
  6. Causal contrast of interest: \(\textrm{E}[Y(1) - Y(0)]\)
  7. Analysis plan: stratified analysis

Let’s try a simple example

  1. Eligibility criteria: everyone
  2. Exposure definition: exposed = 1 vs exposed = 0
  3. Assignment procedures: people who have confounder = 1 are more likely to be exposed
  4. Follow-up period: (until outcome observed)
  5. Outcome definition: outcome
  6. Causal contrast of interest: \(\textrm{E}[Y(1) - Y(0)]\)
  7. Analysis plan: stratified analysis

Causal Diagram

Application Exercise

Find your starter repo on sta-779-s23 that starts with appex-02

  1. Run the sim code chunk to run the simulation
  2. What is the probability that exposure = 1 given confounder = 1?
  3. What is the probability that exposure = 0 given confounder = 1
  4. What is the difference in the average outcome between exposure groups?
10:00

Application Exercise

  1. Stratify by confounder and calculate the average difference between exposure group within each stratum
  2. Compare this to the “Truth” from the simulation
05:00

Demo