Abstract
Many observational studies estimate causal effects using methods based on matching on the propensity score. Full matching on the propensity score is an effective and flexible method for utilizing all available data and for creating well-balanced treatment and control groups. An important component of the full matching algorithm is the decision about whether to impose a restriction on the maximum ratio of controls matched to each treated subject. Despite the possible effect of this restriction on subsequent inferences, this issue has not been examined. We used a series of Monte Carlo simulations to evaluate the effect of imposing a restriction on the maximum ratio of controls matched to each treated subject when estimating risk differences. We considered full matching both with and without a caliper restriction. When using full matching with a caliper restriction, the imposition of a subsequent constraint on the maximum ratio of the number of controls matched to each treated subject had no effect on the quality of inferences. However, when using full matching without a caliper restriction, the imposition of a constraint on the maximum ratio of the number of controls matched to each treated subject tended to result in an increase in bias in the estimated risk difference. However, this increase in bias tended to be accompanied by a corresponding decrease in the sampling variability of the estimated risk difference. We illustrate the consequences of these restrictions using observational data to estimate the effect of medication prescribing on survival following hospitalization for a heart attack.