A Viable Alternative When Propensity Scores Fail: Evaluation of Inverse Propensity Weighting and Sequential G-Estimation in a Two-Wave Mediation Model.

Two methods from the potential outcomes framework - inverse propensity weighting (IPW) and sequential G-estimation - were evaluated and compared to linear regression for estimating the mediated effect in a two-wave design with a randomized intervention and continuous mediator and outcome. Baseline measures of the mediator and outcome can be considered confounders of the follow-up mediator - outcome relation for which adjustment is necessary to eliminate bias. To adjust for baseline measures of the mediator and outcome, IPW uses stabilized inverse propensity weights whereas sequential G-estimation uses regression adjustment. Theoretical differences between the models are described, and Monte Carlo simulations compared the performance of linear regression; IPW without weight truncation; IPW with weights truncated at the 1st/99th, 5th/95th, and 10th/90th percentiles; and sequential G-estimation. Sequential G-estimation performed similarly to linear regression, but IPW provided a biased estimate of the mediated effect, lower power, lower confidence interval coverage, and higher mean squared error. Simulation results show that IPW failed to fully adjust the follow-up mediator - outcome relation for confounding due to the baseline measures. We then compared the mediated effect estimates using data from a randomized experiment evaluating a steroid prevention program for high school athletes. Implications and future directions are discussed.