Regression based quasi-experimental approach when randomisation is not an option: interrupted time series analysis

Kontopantelis, Evangelos; Doran, Tim; Springate, David A.; Buchan, Iain; Reeves, David

doi:10.1136/bmj.h2750

Cited by 730 publications

(618 citation statements)

References 15 publications

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“…(16) Our use of an interrupted time series approach that controls for baseline level and trend is considered a strong quasi-experimental modeling strategy, allowing for "real world" estimation of longitudinal effects when an RCT is unfeasible. (10,12) The reverse of this ecological correlation has also been previously demonstrated, ie, recent increases in hip fracture incidence alongside a reduction in bisphosphonate use, (17) itself likely due to reports of atypical femoral fractures associated with long-term bisphosphonate use. The large number of primary hip fractures and the generalizability of the CPRD cohort to the general UK population (9) are further strengths of the analysis.…”

Section: Discussionmentioning

confidence: 64%

Anti-Osteoporosis Medication Prescriptions and Incidence of Subsequent Fracture Among Primary Hip Fracture Patients in England and Wales: An Interrupted Time-Series Analysis

Hawley

Leal

Delmestri

et al. 2016

Journal of Bone and Mineral Research

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In January 2005, the National Institute for Health and Care Excellence (NICE) in England and Wales provided new guidance on the use of antiosteoporosis therapies for the secondary prevention of osteoporotic fractures. This was shortly followed in the same year by market authorization of a generic form of alendronic acid within the UK. We here set out to estimate the actual practice impact of these events among hip fracture patients in terms of antiosteoporosis medication prescribing and subsequent fracture incidence using primary care data (Clinical Practice Research Datalink) from 1999 to 2013. Changes in level and trend of prescribing and subsequent fracture following publication of NICE guidance and availability of generic alendronic acid were estimated using an interrupted time series analysis. Both events were considered in combination within a 1-year "intervention period." We identified 10,873 primary hip fracture patients between April 1999 and Sept 2012. Taking into account prior trend, the intervention period was associated with an immediate absolute increase of 14.9% (95% CI, 10.9 to 18.9) for incident antiosteoporosis prescriptions and a significant and clinically important reduction in subsequent major and subsequent hip fracture: -0.19% (95% CI, -0.28 to -0.09) and -0.17% (95% CI, -0.26 to -0.09) per 6 months, respectively. This equated to an approximate 14% (major) and 22% (hip) reduction at 3 years postintervention relative to expected values based solely on preintervention level and trend. We conclude that among hip fracture patients, publication of NICE guidance and availability of generic alendronic acid was temporally associated with increased prescribing and a significant decline in subsequent fractures.

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Section: Discussionmentioning

confidence: 64%

Anti-Osteoporosis Medication Prescriptions and Incidence of Subsequent Fracture Among Primary Hip Fracture Patients in England and Wales: An Interrupted Time-Series Analysis

Hawley

Leal

Delmestri

et al. 2016

Journal of Bone and Mineral Research

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“…The presence of seasonal and long-term trends complicates interrupted time series designs, but accounting for such factors in the pre-intervention period is the crucial assumption for the validity of any interrupted time series analysis [36,37,44,45]. We used an algorithm [41] to select the most parsimonious model based on pre-recession trends in each demographic group, and it seems plausible that our results differ from prior studies because the pre-intervention trends differ substantially by demographic group.…”

Section: Discussionmentioning

confidence: 99%

The Great Recession and suicide

Harper¹

2017

Preprint

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“…It is therefore able to provide more precise estimates than can be done using averaged or standardized temperatures. This can be done either with or without a control group that did not receive the intervention (Kontopantelis, Doran, Springate, Buchan, & Reeves, 2015). Known time-varying confounders (e.g.…”

Section: Present Studymentioning

confidence: 99%

Impacts of energy-efficiency investments on internal conditions in low-income households

Poortinga

Jiang

Grey

et al. 2017

Building Research & Information

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Living in cold conditions poses a risk to health, in particular to low-income, fuel-poor households. Improving the energy efficiency of the housing stock may bring multiple positive health gains through improved indoor temperatures and reduced fuel consumption. This study used a multilevel interrupted time-series approach to evaluate a policy-led energy-performance investment programme. Long-term monitoring data were collected for intervention and control households at baseline (n = 99) and follow-up (n = 88), creating a dataset with 15,771 data points for a series of daily-averaged hydrothermal outcome variables. The study found that the intervention raised indoor air temperature by on average 0.84 K as compared with control households, thereby bringing the majority of indoor temperature measurements within the 'healthy' comfort zone of 18-24°C, while average daily gas usage dropped by 37%. External wall insulation was the most effective measure to increase indoor air temperature. The greatest increases were found in the evening and at night, in the bedroom, and in British steel-framed buildings. No evidence was found that the intervention substantially increased indoor relative humidity levels when accompanied by mechanical ventilation. The study concludes that the multilevel interrupted time-series approach offers a useful model for evaluating housing improvement programmes.

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Regression based quasi-experimental approach when randomisation is not an option: interrupted time series analysis

Abstract: Interrupted time series analysis is a quasi-experimental design that can evaluate an intervention effect, using longitudinal data. The advantages, disadvantages, and underlying assumptions of various modelling approaches are discussed using published examples

Cited by 730 publications

References 15 publications

Anti-Osteoporosis Medication Prescriptions and Incidence of Subsequent Fracture Among Primary Hip Fracture Patients in England and Wales: An Interrupted Time-Series Analysis

Anti-Osteoporosis Medication Prescriptions and Incidence of Subsequent Fracture Among Primary Hip Fracture Patients in England and Wales: An Interrupted Time-Series Analysis

The Great Recession and suicide

Impacts of energy-efficiency investments on internal conditions in low-income households

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