The Comparison of Matching Methods Using Different Measures of Balance: Benefits and Risks Exemplified within a Study to Evaluate the Effects of German Disease Management Programs on Long-Term Outcomes of Patients with Type 2 Diabetes

Health Serv Res. 2016 Oct;51(5):1960-80. doi: 10.1111/1475-6773.12452. Epub 2016 Feb 3.


Objective: To present a case study on how to compare various matching methods applying different measures of balance and to point out some pitfalls involved in relying on such measures.

Data sources: Administrative claims data from a German statutory health insurance fund covering the years 2004-2008.

Study design: We applied three different covariance balance diagnostics to a choice of 12 different matching methods used to evaluate the effectiveness of the German disease management program for type 2 diabetes (DMPDM2). We further compared the effect estimates resulting from applying these different matching techniques in the evaluation of the DMPDM2.

Principal findings: The choice of balance measure leads to different results on the performance of the applied matching methods. Exact matching methods performed well across all measures of balance, but resulted in the exclusion of many observations, leading to a change of the baseline characteristics of the study sample and also the effect estimate of the DMPDM2. All PS-based methods showed similar effect estimates. Applying a higher matching ratio and using a larger variable set generally resulted in better balance. Using a generalized boosted instead of a logistic regression model showed slightly better performance for balance diagnostics taking into account imbalances at higher moments.

Conclusion: Best practice should include the application of several matching methods and thorough balance diagnostics. Applying matching techniques can provide a useful preprocessing step to reveal areas of the data that lack common support. The use of different balance diagnostics can be helpful for the interpretation of different effect estimates found with different matching methods.

Keywords: Disease management; chronic care; diabetes; matching; measures of balance; propensity scores.

Publication types

  • Comparative Study

MeSH terms

  • Administrative Claims, Healthcare
  • Case-Control Studies
  • Chronic Disease
  • Comparative Effectiveness Research
  • Diabetes Mellitus, Type 2 / therapy*
  • Disease Management*
  • Germany
  • Humans
  • Insurance, Health / organization & administration*
  • Models, Statistical*
  • Organizational Case Studies
  • Outcome Assessment, Health Care / methods
  • Propensity Score
  • Risk Assessment