How far to go in comparative assessments of health technologies?
Network Meta-Regression Analysis of Stroke Prevention in Atrial Fibrillation
BURLINGTON, Massachusetts, Sept. 14, 2016 /PRNewswire/ -- Recent research conducted by DRG Abacus in collaboration with leading academics at Leicester University highlights the benefit of extending decision problems to allow for the exploration of heterogeneity within network meta-analysis (NMA).
Network meta-analysis is becoming increasingly important for decision makers to assess the comparative efficacy and safety of interventions and is integral to health technology assessment (HTA). The exploration of covariate effects is important in NMA because the presence of unaccounted treatment covariate interactions can invalidate the assumptions which underlie NMA and bias results. In a recently published paper, DRG Abacus present a series of exploratory network-meta-regression analyses for stroke prevention in atrial fibrillation.
Key points from the research include:
- The inclusion of covariates in NMA via meta-regression methods has implications for precision medicine, as it allows estimates of relative treatment effect beyond an overall mean, facilitating more tailor made patient decisions.
- An approach was taken in this research to extend the evidence network to include additional comparators outside of the decision set comparators of the novel oral anticoagulants (NOACs) and adjusted dose warfarin (i.e. to include those which are not eligible to be considered the most efficacious in this indication such as aspirin) to allow the exploration of covariate effects via meta-regression methods.
- The exploration of 'study follow‑up' as a covariate supported the assumption that differences in trial durations is unimportant in this indication despite the variation across trials in the network.
- It is believed that this research is the first to explore the impact of baseline risk on a clinically important efficacy outcome in atrial fibrillation
Comments from Decision Resources Group NMA specialist Sarah Batson:
- "This study could be considered a 'case study' as the approach taken can be applied within any indication as to highlight the potential benefit of extending decision problems for the purpose of exploration of heterogeneity."
- "Baseline risk can be used as a proxy or surrogate for multiple (and potentially unmeasured) treatment confounding effects when exploring heterogeneity but in our experience it is uncommon to see the exploration of baseline risk in NMA publications."
- "There remains an unmet practical need to know how far to extend an evidence network in the search for indirect evidence particularly for the purpose of HTA."
Comments from Decision Resources Group SR consultant Stephen Mitchell:
- "Advances in NMA such as those reported by Sarah and her colleagues at Leicester University are essential to ensure that findings from any analysis reflect the heterogeneous patient populations that would be routinely seen in clinical practice."
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About Decision Resources Group
DRG, a subsidiary of Piramal Enterprises Ltd., offers best-in-class, high-value data, analytics and insights products and services to the healthcare industry, delivered by more than 1000 employees across 17 offices in North America, Europe and Asia. DRG provides the Life Sciences, Provider, Payer and Financial Services industries the data, tools, insights and advice they need to compete and thrive in an increasingly complex and value-based marketplace. decisionresourcesgroup.com.
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