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

Cooper, Nicola J; Peters, Jaime; Lai, Monica C W; Juni, Peter; Wandel, Simon; Palmer, Steve; Paulden, Mike; Conti, Stefano; Welton, Nicky J; Abrams, Keith R; Bujkiewicz, Sylwia; Spiegelhalter, David; Sutton, Alex J (2011). How valuable are multiple treatment comparison methods in evidence-based health-care evaluation? Value in health, 14(2), pp. 371-380. New York, N.Y.: Elsevier 10.1016/j.jval.2010.09.001

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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 randomized controlled 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Jüni, Peter and Wandel, Simon

ISSN:

1098-3015

Publisher:

Elsevier

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:22

Last Modified:

11 Sep 2017 14:36

Publisher DOI:

10.1016/j.jval.2010.09.001

PubMed ID:

21296599

Web of Science ID:

000299040300019

BORIS DOI:

10.7892/boris.7362

URI:

https://boris.unibe.ch/id/eprint/7362 (FactScience: 212571)

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