Journal
INTERNATIONAL JOURNAL OF TECHNOLOGY ASSESSMENT IN HEALTH CARE
Volume 35, Issue 3, Pages 221-228Publisher
CAMBRIDGE UNIV PRESS
DOI: 10.1017/S0266462319000333
Keywords
Network meta-analysis; Technology assessment; Effect modifier; Bias; Comparative effectiveness research
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Funding
- MRC [MC_U145079307, MR/M005232/1, MR/P015298/1, MR/K025643/1] Funding Source: UKRI
- Medical Research Council [MR/P015298/1, MR/K025643/1, MR/M005232/1, MC_U145079307] Funding Source: Medline
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Objectives Indirect comparisons via a common comparator (anchored comparisons) are commonly used in health technology assessment. However, common comparators may not be available, or the comparison may be biased due to differences in effect modifiers between the included studies. Recently proposed population adjustment methods aim to adjust for differences between study populations in the situation where individual patient data are available from at least one study, but not all studies. They can also be used when there is no common comparator or for single-arm studies (unanchored comparisons). We aim to characterise the use of population adjustment methods in technology appraisals (TAs) submitted to the United Kingdom National Institute for Health and Care Excellence (NICE). Methods We reviewed NICE TAs published between 01/01/2010 and 20/04/2018. Results Population adjustment methods were used in 7 percent (18/268) of TAs. Most applications used unanchored comparisons (89 percent, 16/18), and were in oncology (83 percent, 15/18). Methods used included matching-adjusted indirect comparisons (89 percent, 16/18) and simulated treatment comparisons (17 percent, 3/18). Covariates were included based on: availability, expert opinion, effective sample size, statistical significance, or cross-validation. Larger treatment networks were commonplace (56 percent, 10/18), but current methods cannot account for this. Appraisal committees received results of population-adjusted analyses with caution and typically looked for greater cost effectiveness to minimise decision risk. Conclusions Population adjustment methods are becoming increasingly common in NICE TAs, although their impact on decisions has been limited to date. Further research is needed to improve upon current methods, and to investigate their properties in simulation studies.
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