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Physician's Prescribing Preference as an Instrumental Variable: Exploring Assumptions Using Survey Data.

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Summary
This summary is machine-generated.

Physician preference significantly influences treatment decisions, impacting instrumental variable studies. While deterministic monotonicity is often implausible, stochastic monotonicity may be viable for physician preference as an instrument.

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Area of Science:

  • Pharmacoeconomics
  • Medical Research Methodology
  • Health Services Research

Background:

  • Physician prescribing preference is a key instrumental variable in therapeutic effect studies.
  • Variations in prescribing patterns may stem from physician preferences or patient case-mix differences.
  • Assumptions for using physician preference as an instrument are debated.

Purpose of the Study:

  • To investigate the observability and determinants of physician preference variation in prescribing levothyroxine.
  • To assess the compatibility of observed prescription patterns with deterministic and stochastic monotonicity assumptions.

Main Methods:

  • Survey distributed to general practitioners (GPs) across six countries (Netherlands, UK, New Zealand, Ireland, Switzerland, Germany).
  • GPs evaluated prescribing levothyroxine for eight hypothetical subclinical hypothyroidism cases.
  • Analysis of prescription variation and its relation to GP characteristics and patient populations.

Main Results:

  • Substantial variation in levothyroxine prescriptions observed among 526 responding GPs.
  • Between-GP variance in prescriptions was significant, even after accounting for country and GP characteristics.
  • Prescription patterns falsified deterministic monotonicity but were compatible with stochastic monotonicity.

Conclusions:

  • Physician preference is a significant factor in treatment decisions.
  • Deterministic monotonicity is generally not plausible for physician preference as an instrumental variable.
  • Stochastic monotonicity may be plausible depending on the instrument's definition.