A novel high dimensional approach to assess heterogeneous treatment effect in claims data

We tested a novel high-dimensional approach (using 1 ordinal variable per code with up to four levels: zero, occurred once, sporadically, or frequent) against the standard high-dimensional propensity score (hdPS) method (up to 3 binary variables per code) for detecting heterogeneous treatment effects (HTE). Using the iterative causal forest (iCF) subgrouping algorithm, we analyzed a new-user cohort of 8075 sodium-glucose cotransporter-2 inhibitors and 7313 glucagon-like peptide-1 receptor agonists from a 20% random Medicare sample (2015-2019) with ≥1-year parts A/B/D enrollment and without severe renal disease. We extracted the top 200 prevalent codes across diagnoses, procedures, and prescriptions during the 1-year baseline. Subgroup-specific conditional average treatment effects (CATEs) were assessed for 2-year risk differences (aRD) in hospitalized heart failure using inverse-probability treatment weighting. The overall population exhibited an aRD of -0.4% (95% CI, -1.1% to 0.2%). Our high-dimensional setting identified patients with ≥2 loop diuretic prescriptions (aRD, -2.6%, 95% CI, -5.0% to -0.2%) as the subgroup with the largest CATE. In contrast, the high-dimensional setting from hdPS identified patients with chronic kidney disease (aRD, -1.7%, 95% CI, -3.6% to 0.2%). Across various sensitivity analyses, our high-dimensional approach more accurately identified expected subgroups with HTE that aligns with prior clinical evidence.