arXiv subjects

Issa Dahabreh

Publications and source records attributed to Issa Dahabreh.

5 recordsLinked to original sources

arXiv2026

Considerations for the Integration of Randomized Controlled Trials and Real-World Data

As clinical decision-making increasingly moves toward individualized and context-specific treatment recommendations, reliance on any single evidence source, randomized or observational, may be insufficient. Principled integration of randomized controlled trials and real-world data, grounded in explicit causal frameworks, offers a path toward evidence that is both internally credible and externally relevant. In this article, we describe distinct objectives for the integration of randomized controlled trials and real-world data and discuss how these objectives shape key design and analytic considerations, illustrating the resulting choices through example estimands. We highlight practical issues that commonly arise in applied settings, including data relevance and curation, cross-source comparability, estimand specification, and sensitivity analysis. We aim for this article to help readers evaluate and implement principled approaches to integrating randomized controlled trials and real-world data in ways that can support more reliable treatment recommendations while maintaining regulatory-grade evidentiary standards.

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arXiv2024

Efficient estimation of subgroup treatment effects using multi-source data

Investigators often use multi-source data (e.g., multi-center trials, meta-analyses of randomized trials, pooled analyses of observational cohorts) to learn about the effects of interventions in subgroups of some well-defined target population. Such a target population can correspond to one of the data sources of the multi-source data or an external population in which the treatment and outcome information may not be available. We develop and evaluate methods for using multi-source data to estimate subgroup potential outcome means and treatment effects in a target population. We consider identifiability conditions and propose doubly robust estimators that, under mild conditions, are non-parametrically efficient and allow for nuisance functions to be estimated using flexible data-adaptive methods (e.g., machine learning techniques). We also show how to construct confidence intervals and simultaneous confidence bands for the estimated subgroup treatment effects. We examine the properties of the proposed estimators in simulation studies and compare performance against alternative estimators. We also conclude that our methods work well when the sample size of the target population is much larger than the sample size of the multi-source data. We illustrate the proposed methods in a meta-analysis of randomized trials for schizophrenia.

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arXiv2024

Causal inference under transportability assumptions for conditional relative effect measures

When extending inferences from a randomized trial to a new target population, the transportability condition for conditional difference effect measures is invoked to identify the marginal causal mean difference in the target population. However, many clinical investigators believe that conditional relative effect measures are more likely to be "transportable" between populations. Here, we examine the identification and estimation of the marginal counterfactual mean difference and ratio under the transportability condition for conditional relative effect measures. We obtain identification results for two scenarios that often arise in practice when individuals in the target population (1) only have access to the control treatment, and (2) have access to the control and other treatments but not necessarily the experimental treatment evaluated in the trial. We then propose model and rate multiply robust and nonparametric efficient estimators that allow for the use of data-adaptive methods to model the nuisance functions. We examine the performance of the methods in simulation studies and illustrate their use with data from two trials of paliperidone for patients with schizophrenia. We conclude that the proposed methods are attractive when background knowledge suggests that the transportability condition for conditional relative effect measures is more plausible than alternative conditions.

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arXiv2023

A Causal Roadmap for Generating High-Quality Real-World Evidence

Increasing emphasis on the use of real-world evidence (RWE) to support clinical policy and regulatory decision-making has led to a proliferation of guidance, advice, and frameworks from regulatory agencies, academia, professional societies, and industry. A broad spectrum of studies use real-world data (RWD) to produce RWE, ranging from randomized controlled trials with outcomes assessed using RWD to fully observational studies. Yet many RWE study proposals lack sufficient detail to evaluate adequacy, and many analyses of RWD suffer from implausible assumptions, other methodological flaws, or inappropriate interpretations. The Causal Roadmap is an explicit, itemized, iterative process that guides investigators to pre-specify analytic study designs; it addresses a wide range of guidance within a single framework. By requiring transparent evaluation of causal assumptions and facilitating objective comparisons of design and analysis choices based on pre-specified criteria, the Roadmap can help investigators to evaluate the quality of evidence that a given study is likely to produce, specify a study to generate high-quality RWE, and communicate effectively with regulatory agencies and other stakeholders. This paper aims to disseminate and extend the Causal Roadmap framework for use by clinical and translational researchers, with companion papers demonstrating application of the Causal Roadmap for specific use cases.

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arXiv2019

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

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.

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