Econometrics in outcomes research: the use of instrumental variables

Annu Rev Public Health. 1998:19:17-34. doi: 10.1146/annurev.publhealth.19.1.17.


We describe an econometric technique, instrumental variables, that can be useful in estimating the effectiveness of clinical treatments in situations when a controlled trial has not or cannot be done. This technique relies upon the existence of one or more variables that induce substantial variation in the treatment variable but have no direct effect on the outcome variable of interest. We illustrate the use of the technique with an application to aggressive treatment of acute myocardial infarction in the elderly.

Publication types

  • Review

MeSH terms

  • Aged
  • Health Services Research / methods*
  • Humans
  • Models, Econometric*
  • Myocardial Infarction / therapy
  • Outcome Assessment, Health Care / economics
  • Outcome Assessment, Health Care / methods*
  • United States