Toward a practical handbook for choosing among causal inference methods in non-randomized studies with binary outcomes: A simulation study for applied researchers

Abstract

Applied researchers in biomedicine and related fields are often interested in estimating the causal effect of a treatment or intervention. Although randomized clinical trials are considered the gold standard for establishing causal effects, they are not always feasible, and real-world data may represent the only available source of evidence. In such settings, causal effects must be estimated using statistical methods applied to observational data. Over the last few decades, modern causal inference methods based on the potential outcomes framework have emerged as useful tools in this field. However, many such techniques exist, and their performance depends on factors such as sample size, the proportion of treated patients, the proportion of patients experiencing the outcome, the magnitude of the treatment effect, the target estimand, and potential violations of the fundamental assumptions of causal inference. Given the wide range of available methods, selecting an appropriate approach can be challenging for applied researchers. This study uses a large-scale simulation experiment to address this issue and provide researchers with a guide in the form of a handbook for a binary treatment and a binary outcome. Particularly, we test four popular statistical techniques: propensity score matching (full matching), inverse of the probability weighting, G-computation, and targeted maximum likelihood estimation. The proposed handbook is applied to two real-world datasets to assess its practical utility: one comprising vulnerable patients with mild COVID-19 (n=534 patients and more than 50% treated), and another of patients undergoing colorectal surgery (n=3635 patients and about 20% treated).