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In observational studies, unbalanced observed covariates between treatment groups often cause biased inferences on the estimation of treatment effects. Recently, generalized propensity score (GPS) has been proposed to overcome this problem; however, a practical technique to apply the GPS is lacking. This study demonstrates how clustering algorithms can be used to group similar subjects based on transformed GPS. We compare four popular clustering algorithms:k-means clustering (KMC), model-based clustering, fuzzyc-means clustering and partitioning around medoids based on the following three criteria: average dissimilarity between subjects within clusters, average Dunn index and average silhouette width under four various covariate scenarios. Simulation studies show that the KMC algorithm has overall better performance compared with the other three clustering algorithms. Therefore, we recommend using the KMC algorithm to group similar subjects based on the transformed GPS. [ABSTRACT FROM PUBLISHER]

The generalized doubly robust estimator is proposed for estimating the average treatment effect (ATE) of multiple treatments based on the generalized propensity score (GPS). In medical researches where observational studies are conducted, estimations of ATEs are usually biased since the covariate distributions could be unbalanced among treatments. To overcome this problem, Imbens [The role of the propensity score in estimating dose-response functions, Biometrika 87 (2000), pp. 706–710] and Fenget al.[Generalized propensity score for estimating the average treatment effect of multiple treatments,Stat. Med. (2011), in press. Available at:http://onlinelibrary.wiley.com/doi/10.1002/sim.4168/abstract] proposed weighted estimators that are extensions of a ratio estimator based on GPS to estimate ATEs with multiple treatments. However, the ratio estimator always produces a larger empirical sample variance than the doubly robust estimator, which estimates an ATE between two treatments based on the estimated propensity score (PS). We conduct a simulation study to compare the performance of our proposed estimator with Imbens’ and Fenget al.’s estimators, and simulation results show that our proposed estimator outperforms their estimators in terms of bias, empirical sample variance and mean-squared error of the estimated ATEs. [ABSTRACT FROM PUBLISHER]