directory This article reviews pair-wise meta-analysis and indirect and MTC approaches to synthesis, clearly outlining the assumptions involved in each approach. We focus here on presenting means of checking the robustness of results for subsequent analysis, instead of discussing the impact on cost-effectiveness conclusions, as this was not the aim of the present work. g. To further judge clinical similarity between studies, we assessed known effect modifiers so that study results could be meaningfully combined in meta-analysis. A. Example 2: Adjusted indirect comparison where drug A and drug B have not been evaluated directly.
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29As with standard pair-wise meta-analysis, the assumption that trials include similar populations, methodological approaches, and interventions should be assessed using both visual assessment and, where possible, an assessment of statistical homogeneity. The search strategy included searching Medline 1966–2006 using the Cochrane Epilepsy Groups comprehensive search strategy, the Cochrane Controlled Trials Register and the Cochrane Epilepsy Group’s register of randomised controlled trials. the subgroup included in studies of elderly patients only), we only considered studies in the MTC that represented the broader clinical question of the health economic evaluation. If you would like to get in touch and see how we can help, email, or call us today at: contact@remapconsulting.
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g. For the sertraline-placebo contrast, the direct estimate was based on a single trial, which was excluded due to inconsistency in the MTC. The impact of this uncertainty must be considered when making treatment decisions based on the results of an ITC. Using data from clinical studies of antidepressants included in a health technology assessment their explanation we present a stepwise approach to dealing with challenges related to checking the above assumptions and to judging the robustness of the results of an MTC. This is achieved in the analysis by including terms to represent the main effects of treatment and epilepsy type and their interaction in the Cox model. springer.
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SANAD (A RCT Of Longer-Term Clinical Outcomes And Cost Effectiveness Of S tandard A nd N ew A Read Full Report D rugs) was an unblinded randomized controlled trial recruiting patients between January 1999 and August 2004. There is increasing recognition of a need to use multiple treatment comparisons with direct and indirect evidence to find out here healthcare decisions [18] and it appears the logical next step following individual pair-wise meta-analyses. Heterogeneity was analysed using I2 and was classified to be substantial if I2 50% [17]. Paula Williamson, proposed a multiple treatment comparisons analysis, participated in developing ideas and methods, provided statistical support and advice for analyses, presentation and interpretation of results, and participated in writing the manuscript. The effect estimate of the main analysis showed a wide credible interval (CrI) containing the null effect (OR 0. J.
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If substantial heterogeneity was identified, the studies with potential contributing factors such as predefined effect modifiers (e. We had to deal with issues arising in this specific HTA context and, to the best of our knowledge, our approach has not been applied before. Epilepsy is a common neurological condition with a prevalence of around 0. However, the exclusion of studies has its disadvantages (e.
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1 = Meets objective 2 = Partially meets objective 3 = Rarely or seldom meets objectiveNo ranking indicates objective is not applicable to treatment. Comparing multiple treatments should be considered as the bedrock for decisions when several treatments are available [18]. The full set of estimates for all 78 contrasts in the network is provided in S3 Appendix. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwideSign In or Create an AccountThis PDF is available to Subscribers OnlyFor full access to this pdf, sign in to an existing account, or purchase an annual subscription.
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Systematic reviews and meta-analysis of randomised controlled trials should be a major source of evidence supporting this decision making process. Permission can also be obtained via Rightslink. After finishing her work on these projects and leaving IQWiG, she received personal fees from Astellas Pharma Europe B. Comparing effects of study pool 2 (similar studies and outcomes) with study pool 3 (homogeneous network including inconsistencies) allows us to explore the degree of change resulting from our method of dealing with heterogeneity.
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