How valuable are multiple treatment comparison methods in evidence-based health-care evaluation

Nicola J. Cooper, Jaime Peters, Monica C.W. Lai, Peter Juni, Simon Wandel, Steve Palmer, Mike Paulden, Stefano Conti, Nicky J. Welton, Keith R. Abrams, Sylwia Bujkiewicz, David Spiegelhalter, Alex J. Sutton

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    60 Citations (Scopus)

    Abstract

    Objectives: To compare the use of pair-wise meta-analysis methods to multiple treatment comparison (MTC) methods for evidence-based health-care evaluation to estimate the effectiveness and cost-effectiveness of alternative health-care interventions based on the available evidence. Methods: Pair-wise meta-analysis and more complex evidence syntheses, incorporating an MTC component, are applied to three examples: 1) clinical effectiveness of interventions for preventing strokes in people with atrial fibrillation; 2) clinical and cost-effectiveness of using drug-eluting stents in percutaneous coronary intervention in patients with coronary artery disease; and 3) clinical and cost-effectiveness of using neuraminidase inhibitors in the treatment of influenza. We compare the two synthesis approaches with respect to the assumptions made, empirical estimates produced, and conclusions drawn. Results: The difference between point estimates of effectiveness produced by the pair-wise and MTC approaches was generally unpredictable-sometimes agreeing closely whereas in other instances differing considerably. In all three examples, the MTC approach allowed the inclusion of randomizedcontrolled trial evidence ignored in the pair-wise meta-analysis approach. This generally increased the precision of the effectiveness estimates from the MTC model. Conclusions: The MTC approach to synthesis allows the evidence base on clinical effectiveness to be treated as a coherent whole, include more data, and sometimes relax the assumptions made in the pair-wise approaches. However, MTC models are necessarily more complex than those developed for pair-wise meta-analysis and thus could be seen as less transparent. Therefore, it is important that model details and the assumptions made are carefully reported alongside the results.

    Original languageEnglish
    Pages (from-to)371-380
    Number of pages10
    JournalValue in Health
    Volume14
    Issue number2
    DOIs
    Publication statusPublished - 2011

    Bibliographical note

    Funding Information:
    Source of financial support: This work was funded by a Medical Research Council (MRC) (MRC reference: G0800770). KRA is partly supported by the UK National Institute for Health Research (NIHR) as a Senior Investigator (NF-SI-0508-10061). NC, AS, KA, SB, and NW have run courses on MTC methodology commercially. NC, AS, KA, and NW have all done consultancy work on MTC methods.

    Keywords

    • Decision models
    • Evidence synthesis
    • Meta-analysis
    • Mixed treatment comparisons
    • Network meta-analysis

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