Searching for indirect evidence and extending the network of studies for network meta-analysis: case study in venous thromboembolic events prevention following elective total knee replacement surgery
Searching for indirect evidence and extending the network of studies for network meta-analysis: case study in venous thromboembolic events prevention following elective total knee replacement surgery
OBJECTIVE: To evaluate the effect of study identification methods and network size on the relative effectiveness and cost-effectiveness of recommended pharmacological venous thromboembolic events (VTEs) prophylaxis for adult patients undergoing elective total knee replacement surgery in the United Kingdom.
METHODS: A stepwise literature search specifically designed to identify indirect evidence was conducted to extend the original clinical review from the latest National Institute for Health and Care Excellence (NICE) VTE technology appraisal. Different network sizes or network orders, based on the successive searches, informed three network meta-analyses (NMAs), which were compared with a replicated base case. The resulting comparative estimates were inputted in an economic model to investigate the effect of network size on cost-effectiveness probabilities.
RESULTS: Searches increased the number of indirect comparisons between VTE interventions, progressively widening the relevant network of studies for NMA. Precision around mean relative treatment effects was increased as the network was extended from the base case to first-order NMA, but further extensions had limited effect. Cost-effectiveness analysis results were largely insensitive to variation in clinical inputs from the different NMA orders.
CONCLUSIONS: No standard methodology is currently recommended by NICE to identify the most relevant network of studies for NMA. Our study showed that optimizing the identification of studies for NMA can extend the evidence base for analysis and reduce the uncertainty in relative effectiveness estimates. Although in our example network extensions did not affect the acceptability of available treatments in VTE prevention based on cost-effectiveness results, it may in other applications.
Adult, Arthroplasty, Replacement, Knee, Cost-Benefit Analysis, Evidence-Based Medicine, Humans, Models, Economic, Postoperative Complications/economics, Pyrazoles/economics, Pyridones/economics, United Kingdom, Venous Thromboembolism/economics
416-23
Dequen, Pascale
2da98ce9-c9af-45cc-a8ba-739306fbc9d0
Sutton, Alex J.
ec96e2f2-e23d-4a9c-a858-8f4efad3505b
Scott, David A.
19b5fd34-9974-4ae4-8be0-27a693639e20
Abrams, Keith R.
f721ace8-fd4f-4d29-817b-b75c6f94157c
June 2014
Dequen, Pascale
2da98ce9-c9af-45cc-a8ba-739306fbc9d0
Sutton, Alex J.
ec96e2f2-e23d-4a9c-a858-8f4efad3505b
Scott, David A.
19b5fd34-9974-4ae4-8be0-27a693639e20
Abrams, Keith R.
f721ace8-fd4f-4d29-817b-b75c6f94157c
Dequen, Pascale, Sutton, Alex J., Scott, David A. and Abrams, Keith R.
(2014)
Searching for indirect evidence and extending the network of studies for network meta-analysis: case study in venous thromboembolic events prevention following elective total knee replacement surgery.
Value in Health, 17 (4), .
(doi:10.1016/j.jval.2014.02.013).
Abstract
OBJECTIVE: To evaluate the effect of study identification methods and network size on the relative effectiveness and cost-effectiveness of recommended pharmacological venous thromboembolic events (VTEs) prophylaxis for adult patients undergoing elective total knee replacement surgery in the United Kingdom.
METHODS: A stepwise literature search specifically designed to identify indirect evidence was conducted to extend the original clinical review from the latest National Institute for Health and Care Excellence (NICE) VTE technology appraisal. Different network sizes or network orders, based on the successive searches, informed three network meta-analyses (NMAs), which were compared with a replicated base case. The resulting comparative estimates were inputted in an economic model to investigate the effect of network size on cost-effectiveness probabilities.
RESULTS: Searches increased the number of indirect comparisons between VTE interventions, progressively widening the relevant network of studies for NMA. Precision around mean relative treatment effects was increased as the network was extended from the base case to first-order NMA, but further extensions had limited effect. Cost-effectiveness analysis results were largely insensitive to variation in clinical inputs from the different NMA orders.
CONCLUSIONS: No standard methodology is currently recommended by NICE to identify the most relevant network of studies for NMA. Our study showed that optimizing the identification of studies for NMA can extend the evidence base for analysis and reduce the uncertainty in relative effectiveness estimates. Although in our example network extensions did not affect the acceptability of available treatments in VTE prevention based on cost-effectiveness results, it may in other applications.
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Published date: June 2014
Keywords:
Adult, Arthroplasty, Replacement, Knee, Cost-Benefit Analysis, Evidence-Based Medicine, Humans, Models, Economic, Postoperative Complications/economics, Pyrazoles/economics, Pyridones/economics, United Kingdom, Venous Thromboembolism/economics
Identifiers
Local EPrints ID: 441444
URI: http://eprints.soton.ac.uk/id/eprint/441444
ISSN: 1098-3015
PURE UUID: 40edc482-12a4-4eb9-9f7f-8997e9284bbf
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Date deposited: 12 Jun 2020 16:30
Last modified: 17 Mar 2024 04:02
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Author:
Pascale Dequen
Author:
Alex J. Sutton
Author:
David A. Scott
Author:
Keith R. Abrams
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