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Ren S, Ren S, Welton NJ, Strong M. Advancing unanchored simulated treatment comparisons: A novel implementation and simulation study. Res Synth Methods 2024; 15:657-670. [PMID: 38590103 DOI: 10.1002/jrsm.1718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
Population-adjusted indirect comparisons, developed in the 2010s, enable comparisons between two treatments in different studies by balancing patient characteristics in the case where individual patient-level data (IPD) are available for only one study. Health technology assessment (HTA) bodies increasingly rely on these methods to inform funding decisions, typically using unanchored indirect comparisons (i.e., without a common comparator), due to the need to evaluate comparative efficacy and safety for single-arm trials. Unanchored matching-adjusted indirect comparison (MAIC) and unanchored simulated treatment comparison (STC) are currently the only two approaches available for population-adjusted indirect comparisons based on single-arm trials. However, there is a notable underutilisation of unanchored STC in HTA, largely due to a lack of understanding of its implementation. We therefore develop a novel way to implement unanchored STC by incorporating standardisation/marginalisation and the NORmal To Anything (NORTA) algorithm for sampling covariates. This methodology aims to derive a suitable marginal treatment effect without aggregation bias for HTA evaluations. We use a non-parametric bootstrap and propose separately calculating the standard error for the IPD study and the comparator study to ensure the appropriate quantification of the uncertainty associated with the estimated treatment effect. The performance of our proposed unanchored STC approach is evaluated through a comprehensive simulation study focused on binary outcomes. Our findings demonstrate that the proposed approach is asymptotically unbiased. We argue that unanchored STC should be considered when conducting unanchored indirect comparisons with single-arm studies, presenting a robust approach for HTA decision-making.
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Affiliation(s)
- Shijie Ren
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Sa Ren
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mark Strong
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
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2
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Tanaka S, Igarashi A, De Moor R, Li N, Hirozane M, Hong LW, Wu DBC, Yu DY, Hashim M, Hutton B, Tantakoun K, Olsen C, Mirzayeh Fashami F, Samjoo IA, Cameron C. A Targeted Review of Worldwide Indirect Treatment Comparison Guidelines and Best Practices. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02402-1. [PMID: 38843980 DOI: 10.1016/j.jval.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/10/2024] [Accepted: 05/21/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVES Controls and governance over the methodology and reporting of indirect treatment comparisons (ITCs) have been introduced to minimize bias and ensure scientific credibility and transparency in healthcare decision making. The objective of this study was to highlight ITC techniques that are key to conducting objective and analytically sound analyses and to ascertain circumstantial suitability of ITCs as a source of comparative evidence for healthcare interventions. METHODS Ovid MEDLINE was searched from January 2010 through August 2023 to identify publicly available ITC-related documents (ie, guidelines and best practices) in the English language. This was supplemented with hand searches of websites of various international organizations, regulatory agencies, and reimbursement agencies of Europe, North America, and Asia-Pacific. The jurisdiction-specific ITC methodology and reporting recommendations were reviewed. RESULTS Sixty-eight guidelines from 10 authorities worldwide were included for synthesis. Many of the included guidelines were updated within the last 5 years and commonly cited the absence of direct comparative studies as primary justification for using ITCs. Most jurisdictions favored population-adjusted or anchored ITC techniques opposed to naive comparisons. Recommendations on the reporting and presentation of these ITCs varied across authorities; however, there was some overlap among the key elements. CONCLUSIONS Given the challenges of conducting head-to-head randomized controlled trials, comparative data from ITCs offer valuable insights into clinical-effectiveness. As such, multiple ITC guidelines have emerged worldwide. According to the most recent versions of the guidelines, the suitability and subsequent acceptability of the ITC technique used depends on the data sources, available evidence, and magnitude of benefit/uncertainty.
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Affiliation(s)
- Shiro Tanaka
- Faculty of medicine, Kyoto University, Kyoto, Japan
| | - Ataru Igarashi
- Unit of Public Health and Preventive Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Raf De Moor
- Value, Evidence and Access Department, IMAT, Janssen Pharmaceutical K.K., Tokyo, Japan
| | - Nan Li
- Value, Evidence and Access Department, IMAT, Janssen Pharmaceutical K.K., Tokyo, Japan
| | - Mariko Hirozane
- Policy Department, IMAT, Janssen Pharmaceutical K.K., Tokyo, Japan
| | - Li Wen Hong
- Asia Pacific Regional Market Access, Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore
| | - David Bin-Chia Wu
- Asia Pacific Regional Market Access, Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Dae Young Yu
- Asia Pacific Regional Market Access, Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore
| | - Mahmoud Hashim
- Janssen Vaccines and Prevention B.V., Leiden, The Netherlands
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | | | | | - Chris Cameron
- Value and Evidence, EVERSANA, Burlington, ON, Canada.
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3
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Baio G. Discussion on "Bayesian meta-analysis of penetrance for cancer risk" by Thanthirige Lakshika M. Ruberu, Danielle Braun, Giovanni Parmigiani, and Swati Biswas. Biometrics 2024; 80:ujae041. [PMID: 38819312 DOI: 10.1093/biomtc/ujae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/19/2023] [Accepted: 05/01/2024] [Indexed: 06/01/2024]
Affiliation(s)
- Gianluca Baio
- Department of Statistical Science, University College London, WC1E 6BT London, United Kingdom
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4
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Park JE, Campbell H, Towle K, Yuan Y, Jansen JP, Phillippo D, Cope S. Unanchored Population-Adjusted Indirect Comparison Methods for Time-to-Event Outcomes Using Inverse Odds Weighting, Regression Adjustment, and Doubly Robust Methods With Either Individual Patient or Aggregate Data. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:278-286. [PMID: 38135212 DOI: 10.1016/j.jval.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 10/18/2023] [Accepted: 11/15/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Several methods for unanchored population-adjusted indirect comparisons (PAICs) are available. Exploring alternative adjustment methods, depending on the available individual patient data (IPD) and the aggregate data (AD) in the external study, may help minimize bias in unanchored indirect comparisons. However, methods for time-to-event outcomes are not well understood. This study provides an overview and comparison of methods using a case study to increase familiarity. A recent method is applied to marginalize conditional hazard ratios, which allows for the comparisons of methods, and a doubly robust method is proposed. METHODS The following PAIC methods were compared through a case study in third-line small cell lung cancer, comparing nivolumab with standard of care based on a single-arm phase II trial (CheckMate 032) and real-world study (Flatiron) in terms of overall survival: IPD-IPD analyses using inverse odds weighting, regression adjustment, and a doubly robust method; IPD-AD analyses using matching-adjusted indirect comparison, simulated treatment comparison, and a doubly robust method. RESULTS Nivolumab extended survival versus standard of care with hazard ratios ranging from 0.63 (95% CI 0.44-0.90) in naive comparisons (identical estimates for IPD-IPD and IPD-AD analyses) to 0.69 (95% CI 0.44-0.98) in the IPD-IPD analyses using regression adjustment. Regression-based and doubly robust estimates yielded slightly wider confidence intervals versus the propensity score-based analyses. CONCLUSIONS The proposed doubly robust approach for time-to-event outcomes may help to minimize bias due to model misspecification. However, all methods for unanchored PAIC rely on the strong assumption that all prognostic covariates have been included.
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Affiliation(s)
- Julie E Park
- PRECISIONheor, Evidence Synthesis and Decision Modeling, Vancouver, BC, Canada
| | - Harlan Campbell
- PRECISIONheor, Evidence Synthesis and Decision Modeling, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - Kevin Towle
- PRECISIONheor, Evidence Synthesis and Decision Modeling, Vancouver, BC, Canada
| | - Yong Yuan
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
| | - Jeroen P Jansen
- PRECISIONheor, Evidence Synthesis and Decision Modeling, Vancouver, BC, Canada
| | - David Phillippo
- University of Bristol, Bristol Medical School, Bristol, England, UK
| | - Shannon Cope
- PRECISIONheor, Evidence Synthesis and Decision Modeling, Vancouver, BC, Canada.
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5
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Remiro-Azócar A, Heath A, Baio G. Model-based standardization using multiple imputation. BMC Med Res Methodol 2024; 24:32. [PMID: 38341552 PMCID: PMC10858574 DOI: 10.1186/s12874-024-02157-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND When studying the association between treatment and a clinical outcome, a parametric multivariable model of the conditional outcome expectation is often used to adjust for covariates. The treatment coefficient of the outcome model targets a conditional treatment effect. Model-based standardization is typically applied to average the model predictions over the target covariate distribution, and generate a covariate-adjusted estimate of the marginal treatment effect. METHODS The standard approach to model-based standardization involves maximum-likelihood estimation and use of the non-parametric bootstrap. We introduce a novel, general-purpose, model-based standardization method based on multiple imputation that is easily applicable when the outcome model is a generalized linear model. We term our proposed approach multiple imputation marginalization (MIM). MIM consists of two main stages: the generation of synthetic datasets and their analysis. MIM accommodates a Bayesian statistical framework, which naturally allows for the principled propagation of uncertainty, integrates the analysis into a probabilistic framework, and allows for the incorporation of prior evidence. RESULTS We conduct a simulation study to benchmark the finite-sample performance of MIM in conjunction with a parametric outcome model. The simulations provide proof-of-principle in scenarios with binary outcomes, continuous-valued covariates, a logistic outcome model and the marginal log odds ratio as the target effect measure. When parametric modeling assumptions hold, MIM yields unbiased estimation in the target covariate distribution, valid coverage rates, and similar precision and efficiency than the standard approach to model-based standardization. CONCLUSION We demonstrate that multiple imputation can be used to marginalize over a target covariate distribution, providing appropriate inference with a correctly specified parametric outcome model and offering statistical performance comparable to that of the standard approach to model-based standardization.
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Affiliation(s)
| | - Anna Heath
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, 115 College Street, Toronto, Canada
- Department of Statistical Science, University College London, 1-19 Torrington Place, London, UK
| | - Gianluca Baio
- Department of Statistical Science, University College London, 1-19 Torrington Place, London, UK
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Ades AE, Welton NJ, Dias S, Phillippo DM, Caldwell DM. Twenty years of network meta-analysis: Continuing controversies and recent developments. Res Synth Methods 2024. [PMID: 38234221 DOI: 10.1002/jrsm.1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/19/2024]
Abstract
Network meta-analysis (NMA) is an extension of pairwise meta-analysis (PMA) which combines evidence from trials on multiple treatments in connected networks. NMA delivers internally consistent estimates of relative treatment efficacy, needed for rational decision making. Over its first 20 years NMA's use has grown exponentially, with applications in both health technology assessment (HTA), primarily re-imbursement decisions and clinical guideline development, and clinical research publications. This has been a period of transition in meta-analysis, first from its roots in educational and social psychology, where large heterogeneous datasets could be explored to find effect modifiers, to smaller pairwise meta-analyses in clinical medicine on average with less than six studies. This has been followed by narrowly-focused estimation of the effects of specific treatments at specific doses in specific populations in sparse networks, where direct comparisons are unavailable or informed by only one or two studies. NMA is a powerful and well-established technique but, in spite of the exponential increase in applications, doubts about the reliability and validity of NMA persist. Here we outline the continuing controversies, and review some recent developments. We suggest that heterogeneity should be minimized, as it poses a threat to the reliability of NMA which has not been fully appreciated, perhaps because it has not been seen as a problem in PMA. More research is needed on the extent of heterogeneity and inconsistency in datasets used for decision making, on formal methods for making recommendations based on NMA, and on the further development of multi-level network meta-regression.
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Affiliation(s)
- A E Ades
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, UK
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Hess G, Dreyling M, Oberic L, Gine E, Zinzani PL, Linton K, Vilmar A, Jerkeman M, Chen JMH, Ohler A, Stilgenbauer S, Thieblemont C, Lambert J, Zilioli VR, Sancho JM, Jimenez-Ubieto A, Fischer L, Eyre TA, Keeping S, Park JE, Wu JJ, Nunes A, Reitan J, Wade SW, Salles G. Indirect treatment comparison of brexucabtagene autoleucel (ZUMA-2) versus standard of care (SCHOLAR-2) in relapsed/refractory mantle cell lymphoma. Leuk Lymphoma 2024; 65:14-25. [PMID: 37840282 DOI: 10.1080/10428194.2023.2268228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
The SCHOLAR-2 retrospective study highlighted poor overall survival (OS) with standard of care (SOC) regimens among patients with relapsed/refractory (R/R) mantle cell lymphoma (MCL) who failed a covalent Bruton tyrosine kinase inhibitor (BTKi). In the ZUMA-2 single-arm trial, brexucabtagene autoleucel (brexu-cel; autologous anti-CD19 CAR T-cell therapy) demonstrated high rates of durable responses in patients with R/R MCL who had previous BTKi exposure. Here, we compared OS in ZUMA-2 and SCHOLAR-2 using three different methods which adjusted for imbalances in prognostic factors between populations: inverse probability weighting (IPW), regression adjustment (RA), and doubly robust (DR). Brexu-cel was associated with improved OS compared to SOC across all unadjusted and adjusted comparisons. Hazard ratios (95% confidence intervals) were 0.38 (0.23, 0.61) for IPW, 0.45 (0.28, 0.74) for RA, and 0.37 (0.23, 0.59) for DR. These results suggest a substantial survival benefit with brexu-cel versus SOC in patients with R/R MCL after BTKi exposure.
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Affiliation(s)
- Georg Hess
- Department of Hematology, Oncology and Pneumology, Comprehensive Cancer Center, University Medical School of the Johannes Gutenberg-University, Mainz, Germany
| | | | - Lucie Oberic
- Department of Hematology, University Hospital Centre Toulouse, Service d'Hématologie, Toulouse, France
| | - Eva Gine
- GELTAMO, Hematology Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Kim Linton
- The Manchester Cancer Research Center, Manchester, UK
| | | | - Mats Jerkeman
- Department of Oncology, Skane University Hospital and Lund University, Lund, Sweden
| | | | - Anke Ohler
- Department of Hematology, Oncology and Pneumology, Comprehensive Cancer Center, University Medical School of the Johannes Gutenberg-University, Mainz, Germany
| | | | | | - Jonathan Lambert
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Juan-Manuel Sancho
- GELTAMO, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Luca Fischer
- Medizinische Klinik III, LMU Klinikum, Munich, Germany
| | | | | | | | - James J Wu
- Kite, a Gilead Company, Santa Monica, CA, USA
| | - Ana Nunes
- Kite, a Gilead Company, Santa Monica, CA, USA
| | | | - Sally W Wade
- Wade Outcomes Research & Consulting, Salt Lake City, UT, USA
| | - Gilles Salles
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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8
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Cassidy O, Harte M, Trela-Larsen L, Walsh C, White A, McCullagh L, Leahy J. A Comparison of Relative-Efficacy Estimate(S) Derived From Both Matching-Adjusted Indirect Comparisons and Standard Anchored Indirect Treatment Comparisons: A Review of Matching-Adjusted Indirect Comparisons. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1665-1674. [PMID: 37460009 DOI: 10.1016/j.jval.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 06/06/2023] [Accepted: 07/07/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES We present an empirical comparison of relative-efficacy estimate(s) from matching-adjusted indirect comparisons (MAICs) with estimates from corresponding standard anchored indirect treatment comparisons. METHODS A total of 80 comparisons were identified from 17 publications through a systematic rapid review. A standardized metric that used reported relative treatment efficacy estimates and their associated uncertainty was used to compare the methods across different treatment indications and outcome measures. RESULTS On aggregate, MAICs presented for connected networks tended to report a more favorable relative-efficacy estimate for the treatment for which individual-level patient data were available relative to the reported indirect treatment comparison estimate. CONCLUSIONS Although we recognize the importance of MAIC and other population adjustment methods in certain situations, we recommend that results from these analyses are interpreted with caution. Researchers and analysts should carefully consider if MAICs are appropriate where presented and whether MAICs would have added value where omitted.
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Affiliation(s)
- Owen Cassidy
- National Centre for Pharmacoeconomics Ireland, St. James's Hospital, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - Marie Harte
- National Centre for Pharmacoeconomics Ireland, St. James's Hospital, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - Lea Trela-Larsen
- National Centre for Pharmacoeconomics Ireland, St. James's Hospital, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - Cathal Walsh
- Health Research Institute and MACSI, Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Arthur White
- Department of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Laura McCullagh
- National Centre for Pharmacoeconomics Ireland, St. James's Hospital, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - Joy Leahy
- National Centre for Pharmacoeconomics Ireland, St. James's Hospital, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland.
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Truong B, Tran LAT, Le TA, Pham TT, Vo TT. Population adjusted-indirect comparisons in health technology assessment: A methodological systematic review. Res Synth Methods 2023; 14:660-670. [PMID: 37400080 DOI: 10.1002/jrsm.1653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
In health technology assessment (HTA), population-adjusted indirect comparisons (PAICs) are increasingly considered to adjust for the difference in the target population between studies. We aim to assess the conduct and reporting of PAICs in recent HTA practice, by performing, a methodological systematic review of studies implementing PAICs from PubMed, EMBASE Classic, Embase/Ovid Medline All, and Cochrane databases from January 1, 2010 to Feb 13, 2023. Four independent researchers screened the titles, abstracts, and full-texts of the identified records, then extracted data on methodological and reporting characteristics of 106 eligible articles. Most PAIC analyses (96.9%, n = 157) were conducted by (or received funding from) pharmaceutical companies. Prior to adjustment, 44.5% of analyses (n = 72) (partially) aligned the eligibility criteria of different studies to enhance the similarity of their target populations. In 37.0% of analyses (n = 60), the clinical and methodological heterogeneity across studies were extensively assessed. In 9.3% of analyses (n = 15), the quality (or bias) of individual studies was evaluated. Among 18 analyses using methods that required an outcome model specification, results of the model fitting procedure were adequately reported in three analyses (16.7%). These findings suggest that the conduct and reporting of PAICs are remarkably heterogeneous and suboptimal in current practice. More recommendations and guidelines on PAICs are thus warranted to enhance the quality of these analyses in the future.
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Affiliation(s)
- Bang Truong
- Faculty of Pharmacy, HUTECH University, Ho Chi Minh City, Vietnam
- Department of Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, Auburn, Alabama, USA
| | - Lan-Anh T Tran
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Tuan Anh Le
- Department of Biology, KU Leuven, Leuven, Belgium
| | - Thi Thu Pham
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tat-Thang Vo
- Department of Statistics and Data Science, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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10
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Neupane B, Shukla P, Slim M, Martin A, Petri M, Bertsias GK, Kim AHJ, Fanouriakis A, Levy RA, Chauhan D, Ballew N. Belimumab versus anifrolumab in adults with systemic lupus erythematosus: an indirect comparison of clinical response at 52 weeks. Lupus Sci Med 2023; 10:10/1/e000907. [PMID: 37147022 DOI: 10.1136/lupus-2023-000907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/06/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To generate comparative efficacy evidence of belimumab versus anifrolumab in SLE that can inform treatment practices. METHODS The SLE Responder Index (SRI)-4 response at 52 weeks of belimumab versus anifrolumab was evaluated with an indirect treatment comparison. The evidence base consisted of randomised trials that were compiled through a systemic literature review.A feasibility assessment was performed to comprehensively compare the eligible trials and to determine the most appropriate indirect treatment comparison analysis method. A multilevel network meta-regression (ML-NMR) was implemented that adjusted for differences across trials in four baseline characteristics: SLE Disease Activity Index-2K, anti-double-stranded DNA antibody positive, low complement (C)3 and low C4. Additional analyses were conducted to explore if the results were robust to different sets of baseline characteristics included for adjustment, alternative adjustment methods and changes to the trials included in the evidence base. RESULTS The ML-NMR included eight trials: five belimumab trials (BLISS-52, BLISS-76, NEA, BLISS-SC, EMBRACE) and three anifrolumab trials (MUSE, TULIP-1, TULIP-2). Belimumab and anifrolumab were comparable in terms of SRI-4 response (OR (95% credible interval), 1.04 (0.74-1.45)), with the direction of the point estimate slightly favouring belimumab. Belimumab had a 0.58 probability of being the more effective treatment. The results were highly consistent across all analysis scenarios. CONCLUSIONS Our results suggest that the SRI-4 response of belimumab and anifrolumab are similar at 52 weeks in the general SLE population, but the level of uncertainty around the point estimate means we cannot rule out the possibility of a clinically meaningful benefit for either treatment. It remains to be seen if specific groups of patients could derive a greater benefit from anifrolumab or from belimumab, and there is certainly an unmet need to identify robust predictors towards more personalised selection of available biological agents in SLE.
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Affiliation(s)
- Binod Neupane
- Evidence Synthesis, Modeling & Simulation, Evidera, St-Laurent, Quebec, Canada
| | - Pragya Shukla
- Evidence Synthesis, Modeling & Simulation, Evidera, St-Laurent, Quebec, Canada
| | - Mahmoud Slim
- Evidence Synthesis, Modeling & Simulation, Evidera, St-Laurent, Quebec, Canada
- Institute of Neurosciences "Federico Olóriz", University of Granada, Granada, Spain
| | - Amber Martin
- Evidence Synthesis, Modeling & Communication, Evidera, Waltham, Massachusetts, USA
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - George K Bertsias
- Department of Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Crete, Greece
| | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Antonis Fanouriakis
- First Department of Propaedeutic Internal Medicine, "Laikon" General Hospital, National Kapodistrian University of Athens Medical School, Athens, Greece
| | - Roger A Levy
- Specialty Care, Global Medical Affairs, GSK, Collegeville, Pennsylvania, USA
| | | | - Nick Ballew
- Value Evidence and Outcomes, GSK, Collegeville, Pennsylvania, USA
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11
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Vo TT. A cautionary note on the use of G-computation in population adjustment. Res Synth Methods 2023; 14:338-341. [PMID: 36633531 DOI: 10.1002/jrsm.1621] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 12/26/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023]
Abstract
In a recent issue of the Journal; Remiro-Azócar et al. introduce a new method to adjust for population difference between two trials; when the individual patient data (IPD) are only accessible for one study. The proposed method generates the covariate data for the trial without IPD; then using a G-computation approach to transport information about the treatment effect from the other study with IPD to this trial. The authors advocate the use of G-computation over matching-adjusted indirect comparison because (i) the former allows for "useful extrapolation" when there is poor case-mix overlap between populations; and (ii) nonparametric; data-adaptive methods can be used to reduce the risk of (outcome) model misspecification. In this commentary; we provide a different perspective from these arguments. Despite certain disagreements; we believe that the proposed data generation approaches can open new and interesting research directions for population adjustment methodology in the future.
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Affiliation(s)
- Tat-Thang Vo
- Department of Statistics and Data Science, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Ballew N, Mian A, Levy RA, Bradley M. Letter to the Editor: indirect treatment comparison of anifrolumab efficacy versus belimumab in adults with systemic lupus erythematosus. J Comp Eff Res 2023; 12:e220106. [PMID: 36515082 PMCID: PMC10288950 DOI: 10.2217/cer-2022-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/17/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Nick Ballew
- GSK, Value Evidence & Outcomes, Collegeville, PA 19426, USA
| | - Aneela Mian
- GSK, Global Medical Affairs, Brentford, Middlesex, UK
| | | | - Matt Bradley
- GSK, Value Evidence & Outcomes, Brentford, Middlesex, UK
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Remiro‐Azócar A. Some considerations on target estimands for health technology assessment. Stat Med 2022; 41:5592-5596. [PMID: 36385477 PMCID: PMC9828791 DOI: 10.1002/sim.9566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022]
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Target estimands for population‐adjusted indirect comparisons. Stat Med 2022; 41:5558-5569. [DOI: 10.1002/sim.9413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 11/18/2022]
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Remiro-Azócar A. Two-stage matching-adjusted indirect comparison. BMC Med Res Methodol 2022; 22:217. [PMID: 35941551 PMCID: PMC9358807 DOI: 10.1186/s12874-022-01692-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/19/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Anchored covariate-adjusted indirect comparisons inform reimbursement decisions where there are no head-to-head trials between the treatments of interest, there is a common comparator arm shared by the studies, and there are patient-level data limitations. Matching-adjusted indirect comparison (MAIC), based on propensity score weighting, is the most widely used covariate-adjusted indirect comparison method in health technology assessment. MAIC has poor precision and is inefficient when the effective sample size after weighting is small. METHODS A modular extension to MAIC, termed two-stage matching-adjusted indirect comparison (2SMAIC), is proposed. This uses two parametric models. One estimates the treatment assignment mechanism in the study with individual patient data (IPD), the other estimates the trial assignment mechanism. The first model produces inverse probability weights that are combined with the odds weights produced by the second model. The resulting weights seek to balance covariates between treatment arms and across studies. A simulation study provides proof-of-principle in an indirect comparison performed across two randomized trials. Nevertheless, 2SMAIC can be applied in situations where the IPD trial is observational, by including potential confounders in the treatment assignment model. The simulation study also explores the use of weight truncation in combination with MAIC for the first time. RESULTS Despite enforcing randomization and knowing the true treatment assignment mechanism in the IPD trial, 2SMAIC yields improved precision and efficiency with respect to MAIC in all scenarios, while maintaining similarly low levels of bias. The two-stage approach is effective when sample sizes in the IPD trial are low, as it controls for chance imbalances in prognostic baseline covariates between study arms. It is not as effective when overlap between the trials' target populations is poor and the extremity of the weights is high. In these scenarios, truncation leads to substantial precision and efficiency gains but induces considerable bias. The combination of a two-stage approach with truncation produces the highest precision and efficiency improvements. CONCLUSIONS Two-stage approaches to MAIC can increase precision and efficiency with respect to the standard approach by adjusting for empirical imbalances in prognostic covariates in the IPD trial. Further modules could be incorporated for additional variance reduction or to account for missingness and non-compliance in the IPD trial.
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Affiliation(s)
- Antonio Remiro-Azócar
- Medical Affairs Statistics, Bayer plc, 400 South Oak Way, Reading, UK. .,Department of Statistical Science, University College London, 1-19 Torrington Place, London, UK.
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