  The regression discontinuity (RD) design is a quasi-experimental design that
estimates the causal effects of a treatment by exploiting naturally occurring
treatment rules. It can be applied in any context where a particular treatment
or intervention is administered according to a pre-specified rule linked to a
continuous variable. Such thresholds are common in primary care drug
prescription where the RD design can be used to estimate the causal effect of
medication in the general population. Such results can then be contrasted to
those obtained from randomised controlled trials (RCTs) and inform prescription
policy and guidelines based on a more realistic and less expensive context. In
this paper we focus on statins, a class of cholesterol-lowering drugs, however,
the methodology can be applied to many other drugs provided these are
prescribed in accordance to pre-determined guidelines. NHS guidelines state
that statins should be prescribed to patients with 10 year cardiovascular
disease risk scores in excess of 20%. If we consider patients whose scores are
close to this threshold we find that there is an element of random variation in
both the risk score itself and its measurement. We can thus consider the
threshold a randomising device assigning the prescription to units just above
the threshold and withholds it from those just below. Thus we are effectively
replicating the conditions of an RCT in the area around the threshold, removing
or at least mitigating confounding. We frame the RD design in the language of
conditional independence which clarifies the assumptions necessary to apply it
to data, and which makes the links with instrumental variables clear. We also
have context specific knowledge about the expected sizes of the effects of
statin prescription and are thus able to incorporate this into Bayesian models
by formulating informative priors on our causal parameters.
