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Cope S, Chan K, Campbell H, Chen J, Borrill J, May JR, Malcolm W, Branchoux S, Kupas K, Jansen JP. A Comparison of Alternative Network Meta-Analysis Methods in the Presence of Nonproportional Hazards: A Case Study in First-Line Advanced or Metastatic Renal Cell Carcinoma. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:465-476. [PMID: 36503035 DOI: 10.1016/j.jval.2022.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Network meta-analysis (NMA) of time-to-event outcomes based on constant hazard ratios can result in biased findings when the proportional hazards (PHs) assumption does not hold in a subset of trials. We aimed to summarize the published non-PH NMA methods for time-to-event outcomes, demonstrate their application, and compare their results. METHODS The following non-PH NMA methods were compared through an illustrative case study in oncology of 4 randomized controlled trials in terms of progression-free survival and overall survival: (1) 1-step or (2) 2-step multivariate NMAs based on traditional survival distributions or fractional polynomials, (3) NMAs with restricted cubic splines for baseline hazard, and (4) restricted mean survival NMA. RESULTS For progression-free survival, the PH assumption did not hold across trials and non-PH NMA methods better reflected the relative treatment effects over time. The most flexible models (fractional polynomials and restricted cubic splines) fit better to the data than the other approaches. Estimated hazard ratios obtained with different non-PH NMA methods were similar at 5 years of follow-up but differed thereafter in the extrapolations. Although there was no strong evidence of PH violation for overall survival, non-PH NMA methods captured this uncertainty in the relative treatment effects over time. CONCLUSIONS When the PH assumption is questionable in a subset of the randomized controlled trials, we recommend assessing alternative non-PH NMA methods to estimate relative treatment effects for time-to-event outcomes. We propose a transparent and explicit stepwise model selection process considering model fit, external constraints, and clinical validity. Given inherent uncertainty, sensitivity analyses are suggested.
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Affiliation(s)
- Shannon Cope
- Evidence Synthesis and Decision Modeling, PRECISIONheor, Vancouver, BC, Canada.
| | - Keith Chan
- Evidence Synthesis and Decision Modeling, PRECISIONheor, Vancouver, BC, Canada
| | - Harlan Campbell
- Evidence Synthesis and Decision Modeling, PRECISIONheor, Vancouver, BC, Canada
| | - Jenny Chen
- Evidence Synthesis and Decision Modeling, PRECISIONheor, Vancouver, BC, Canada
| | - John Borrill
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Uxbridge, England, UK
| | - Jessica R May
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Uxbridge, England, UK
| | - William Malcolm
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Uxbridge, England, UK
| | - Sebastien Branchoux
- Health Economics and Outcomes Research, Bristol Myers Squibb, Rueil-Malmaison, France
| | - Katrin Kupas
- Global Biometric Sciences, Bristol Myers Squibb, Boudry, Switzerland
| | - Jeroen P Jansen
- Evidence Synthesis and Decision Modeling, PRECISIONheor, Vancouver, BC, Canada
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Petit C, Blanchard P, Pignon JP, Lueza B. Individual patient data network meta-analysis using either restricted mean survival time difference or hazard ratios: is there a difference? A case study on locoregionally advanced nasopharyngeal carcinomas. Syst Rev 2019; 8:96. [PMID: 30987679 PMCID: PMC6463649 DOI: 10.1186/s13643-019-0984-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/11/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study aimed at applying the restricted mean survival time difference (rmstD) as an absolute outcome measure in a network meta-analysis and comparing the results with those obtained using hazard ratios (HR) from the individual patient data (IPD) network meta-analysis (NMA) on the role of chemotherapy for nasopharyngeal carcinoma (NPC) recently published by the MAC-NPC collaborative group (Meta-Analysis of Chemotherapy [CT] in NPC). PATIENTS AND METHODS Twenty trials (5144 patients) comparing radiotherapy (RT) with or without CT in non-metastatic NPC were included. Treatments were grouped in seven categories: RT alone (RT), induction CT followed by RT (IC-RT), RT followed by adjuvant CT (RT-AC), IC followed by RT followed by AC (IC-RT-AC), concomitant chemoradiotherapy (CRT), IC followed by CRT (IC-CRT), and CRT followed by AC (CRT-AC). The primary endpoint was overall survival (OS); secondary endpoints were progression-free survival and locoregional control. The rmstD was estimated at t* = 10 years in each trial. Random-effect frequentist NMA models were applied. P score was used to rank treatments. Heterogeneity and inconsistency were evaluated. RESULTS The three treatments that had the highest effect on OS with rmstD were CRT-AC, IC-CRT, and CRT (respective P scores of 92%, 72%, and 64%) compared to CRT-AC, CRT, and IC-CRT when using HR (respective P scores of 96%, 71%, and 63%). Of the 32 HR and rmstD analyzed, 5 had a different interpretation, 3 with a direction change (different direction of treatment effect) and 2 with a change in significance (same direction but a change in statistical significance). Results for secondary endpoints were overall in agreement. CONCLUSION The use of either HR or rmstD impacts the results of NMA. Given the sensitivity of HR to non-proportional hazards, this finding could have implications in terms of meta-analysis methodology.
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Affiliation(s)
- C Petit
- Gustave Roussy, Service de Biostatistiques et d'Épidémiologie and Ligue Nationale Contre le Cancer Meta-Analysis Platform, Université Paris-Saclay, F-94805, Villejuif, France. .,Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Saclay University, Villejuif, France. .,Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France.
| | - P Blanchard
- Gustave Roussy, Service de Biostatistiques et d'Épidémiologie and Ligue Nationale Contre le Cancer Meta-Analysis Platform, Université Paris-Saclay, F-94805, Villejuif, France.,Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Saclay University, Villejuif, France.,Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - J P Pignon
- Gustave Roussy, Service de Biostatistiques et d'Épidémiologie and Ligue Nationale Contre le Cancer Meta-Analysis Platform, Université Paris-Saclay, F-94805, Villejuif, France.,Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Saclay University, Villejuif, France
| | - B Lueza
- Gustave Roussy, Service de Biostatistiques et d'Épidémiologie and Ligue Nationale Contre le Cancer Meta-Analysis Platform, Université Paris-Saclay, F-94805, Villejuif, France.,Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Saclay University, Villejuif, France
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Lueza B, Rotolo F, Bonastre J, Pignon JP, Michiels S. Bias and precision of methods for estimating the difference in restricted mean survival time from an individual patient data meta-analysis. BMC Med Res Methodol 2016; 16:37. [PMID: 27025706 PMCID: PMC4812643 DOI: 10.1186/s12874-016-0137-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/15/2016] [Indexed: 11/13/2022] Open
Abstract
Background The difference in restricted mean survival time (\documentclass[12pt]{minimal}
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\begin{document}$$ rmstD\left({t}^{\ast}\right) $$\end{document}rmstDt∗), the area between two survival curves up to time horizon \documentclass[12pt]{minimal}
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\begin{document}$$ {t}^{\ast } $$\end{document}t∗, is often used in cost-effectiveness analyses to estimate the treatment effect in randomized controlled trials. A challenge in individual patient data (IPD) meta-analyses is to account for the trial effect. We aimed at comparing different methods to estimate the \documentclass[12pt]{minimal}
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\begin{document}$$ rmstD\left({t}^{\ast}\right) $$\end{document}rmstDt∗ from an IPD meta-analysis. Methods We compared four methods: the area between Kaplan-Meier curves (experimental vs. control arm) ignoring the trial effect (Naïve Kaplan-Meier); the area between Peto curves computed at quintiles of event times (Peto-quintile); the weighted average of the areas between either trial-specific Kaplan-Meier curves (Pooled Kaplan-Meier) or trial-specific exponential curves (Pooled Exponential). In a simulation study, we varied the between-trial heterogeneity for the baseline hazard and for the treatment effect (possibly correlated), the overall treatment effect, the time horizon \documentclass[12pt]{minimal}
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\begin{document}$$ {t}^{\ast } $$\end{document}t∗, the number of trials and of patients, the use of fixed or DerSimonian-Laird random effects model, and the proportionality of hazards. We compared the methods in terms of bias, empirical and average standard errors. We used IPD from the Meta-Analysis of Chemotherapy in Nasopharynx Carcinoma (MAC-NPC) and its updated version MAC-NPC2 for illustration that included respectively 1,975 and 5,028 patients in 11 and 23 comparisons. Results The Naïve Kaplan-Meier method was unbiased, whereas the Pooled Exponential and, to a much lesser extent, the Pooled Kaplan-Meier methods showed a bias with non-proportional hazards. The Peto-quintile method underestimated the \documentclass[12pt]{minimal}
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\begin{document}$$ rmstD\left({t}^{\ast}\right) $$\end{document}rmstDt∗, except with non-proportional hazards at \documentclass[12pt]{minimal}
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\begin{document}$$ {t}^{\ast } $$\end{document}t∗= 5 years. In the presence of treatment effect heterogeneity, all methods except the Pooled Kaplan-Meier and the Pooled Exponential with DerSimonian-Laird random effects underestimated the standard error of the \documentclass[12pt]{minimal}
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\begin{document}$$ rmstD\left({t}^{\ast}\right) $$\end{document}rmstDt∗. Overall, the Pooled Kaplan-Meier method with DerSimonian-Laird random effects formed the best compromise in terms of bias and variance. The \documentclass[12pt]{minimal}
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\begin{document}$$ rmstD\left({t}^{\ast },=,10,\kern0.5em ,\mathrm{years}\right) $$\end{document}rmstDt∗=10years estimated with the Pooled Kaplan-Meier method was 0.49 years (95 % CI: [−0.06;1.03], p = 0.08) when comparing radiotherapy plus chemotherapy vs. radiotherapy alone in the MAC-NPC and 0.59 years (95 % CI: [0.34;0.84], p < 0.0001) in the MAC-NPC2. Conclusions We recommend the Pooled Kaplan-Meier method with DerSimonian-Laird random effects to estimate the difference in restricted mean survival time from an individual-patient data meta-analysis. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0137-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Béranger Lueza
- Gustave Roussy, Université Paris-Saclay, Service de biostatistique et d'épidémiologie, F-94805, Villejuif, France.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, F-94085, Villejuif, France.,Ligue Nationale Contre le Cancer meta-analysis platform, Gustave Roussy, F-94085, Villejuif, France
| | - Federico Rotolo
- Gustave Roussy, Université Paris-Saclay, Service de biostatistique et d'épidémiologie, F-94805, Villejuif, France. .,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, F-94085, Villejuif, France. .,Ligue Nationale Contre le Cancer meta-analysis platform, Gustave Roussy, F-94085, Villejuif, France.
| | - Julia Bonastre
- Gustave Roussy, Université Paris-Saclay, Service de biostatistique et d'épidémiologie, F-94805, Villejuif, France.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, F-94085, Villejuif, France
| | - Jean-Pierre Pignon
- Gustave Roussy, Université Paris-Saclay, Service de biostatistique et d'épidémiologie, F-94805, Villejuif, France.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, F-94085, Villejuif, France.,Ligue Nationale Contre le Cancer meta-analysis platform, Gustave Roussy, F-94085, Villejuif, France
| | - Stefan Michiels
- Gustave Roussy, Université Paris-Saclay, Service de biostatistique et d'épidémiologie, F-94805, Villejuif, France.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, F-94085, Villejuif, France.,Ligue Nationale Contre le Cancer meta-analysis platform, Gustave Roussy, F-94085, Villejuif, France
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Lueza B, Mauguen A, Pignon JP, Rivero-Arias O, Bonastre J. Difference in Restricted Mean Survival Time for Cost-Effectiveness Analysis Using Individual Patient Data Meta-Analysis: Evidence from a Case Study. PLoS One 2016; 11:e0150032. [PMID: 26960150 PMCID: PMC4784740 DOI: 10.1371/journal.pone.0150032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/08/2016] [Indexed: 12/25/2022] Open
Abstract
Objective In economic evaluation, a commonly used outcome measure for the treatment effect is the between-arm difference in restricted mean survival time (rmstD). This study illustrates how different survival analysis methods can be used to estimate the rmstD for economic evaluation using individual patient data (IPD) meta-analysis. Our aim was to study if/how the choice of a method impacts on cost-effectiveness results. Methods We used IPD from the Meta-Analysis of Radiotherapy in Lung Cancer concerning 2,000 patients with locally advanced non-small cell lung cancer, included in ten trials. We considered methods either used in the field of meta-analysis or in economic evaluation but never applied to assess the rmstD for economic evaluation using IPD meta-analysis. Methods were classified into two approaches. With the first approach, the rmstD is estimated directly as the area between the two pooled survival curves. With the second approach, the rmstD is based on the aggregation of the rmstDs estimated in each trial. Results The average incremental cost-effectiveness ratio (ICER) and acceptability curves were sensitive to the method used to estimate the rmstD. The estimated rmstDs ranged from 1.7 month to 2.5 months, and mean ICERs ranged from € 24,299 to € 34,934 per life-year gained depending on the chosen method. At a ceiling ratio of € 25,000 per life year-gained, the probability of the experimental treatment being cost-effective ranged from 31% to 68%. Conclusions This case study suggests that the method chosen to estimate the rmstD from IPD meta-analysis is likely to influence the results of cost-effectiveness analyses.
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Affiliation(s)
- Béranger Lueza
- Gustave Roussy, Service de biostatistique et d’épidémiologie, Villejuif, France
- CESP, INSERM U1018, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Ligue Nationale Contre le Cancer meta-analysis plateform, Villejuif, France
- * E-mail:
| | - Audrey Mauguen
- Gustave Roussy, Service de biostatistique et d’épidémiologie, Villejuif, France
- Gustave Roussy, Ligue Nationale Contre le Cancer meta-analysis plateform, Villejuif, France
| | - Jean-Pierre Pignon
- Gustave Roussy, Service de biostatistique et d’épidémiologie, Villejuif, France
- CESP, INSERM U1018, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Ligue Nationale Contre le Cancer meta-analysis plateform, Villejuif, France
| | - Oliver Rivero-Arias
- University of Oxford, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford, United Kingdom
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Julia Bonastre
- Gustave Roussy, Service de biostatistique et d’épidémiologie, Villejuif, France
- CESP, INSERM U1018, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
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