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 language | English |
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Pages (from-to) | 371-380 |
Number of pages | 10 |
Journal | Value in Health |
Volume | 14 |
Issue number | 2 |
DOIs | |
Publication status | Published - 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