Prescription Sequence Symmetry Analysis – Methodological considerations
Description
Prescription Sequence Symmetry Analysis (PSSA) is a pharmacoepidemiological method used to identify potential prescribing cascades using routinely collected medication data. The method compares the number of patients who initiate an index medication before versus after the initiation of a marker medication. A clear asymmetry may indicate the presence of a prescribing cascade.
Although PSSA is being applied increasingly often, important methodological choices have not yet been standardised. Examples include the method used to define dosage levels (for example, based on categories or tertiles), which prescriptions are used to determine dosage (first, last, average or cumulative dose), and whether exposure is analysed at the substance level or the therapeutic class level. These differences limit the comparability of studies.
The aim of this study is to investigate how such methodological choices influence the estimation of prescribing cascades. Specifically, the study examines the impact of dose definitions and the choice between substance-level and class-level analyses in two potential prescribing cascades: ACE inhibitors leading to the use of antitussives and calcium channel blockers leading to the use of diuretics.
Who is the principal investigator?
Dr. Fatma Karapinar
Team
Dr. Veerle van Hulten
Dr. Annemariek Driessen
Prof. Dr. Petra Denig
Contact for internship or collaboration
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Contact for general questions
Dr. Veerle van Hulten (veerle.van.hulten@mumc.nl)