Indirect comparisons of treatments based on systematic reviews of randomised controlled trials
Indirect comparisons of treatments based on systematic reviews of randomised controlled trials
复制标题
DOI：
10.1111/j.1742-1241.2009.02072.x
复制
发表时间：
2009-06-01
影响因子：
2.6
通讯作者：
Borrill, J.
中科院分区：
文献类型：
--
作者：
Edwards, S. J.;Clarke, M. J.;Borrill, J.
随机对照试验是区分竞争性干预措施效果的最有效方法。然而，不太可能对所有竞争干预措施进行头对头研究。根据随机对照试验的荟萃分析，对用于间接比较干预措施的不同方法进行评估。对 Cochrane 系统评价数据库、Cochrane 方法学注册库、EMBASE 和 MEDLINE 的报告进行系统审查，包括包含间接比较的荟萃分析。检索于 2007 年 7 月完成。对语言或出版年份没有限制。确定的 62 篇论文包含治疗的间接比较。采用了五种不同的方法：比较点估计（1/62）；比较 95% 置信区间 (26/62)；对汇总估计进行统计测试（8/62）；使用单个通用比较器进行间接比较 (20/62)；和混合治疗比较（MTC）（7/62）。提供对所考虑的干预措施之间差异的估计以及对该估计的不确定性测量的唯一方法是使用单个通用比较器和 MTC 进行间接比较。 MTC 可能比其他方法具有优势，因为它不依赖于单个通用比较器，并且可以将直接和间接比较的结果纳入分析中。间接比较需要证据一致性的基本假设。当该假设不成立时，使用任何方法都可能产生误导性结果。使用通用比较器或 MTC 进行间接比较可提供决策中使用的估计值，而首选方法取决于可用数据。
Randomised controlled trials are the most effective way to differentiate between the effects of competing interventions. However, head-to-head studies are unlikely to have been conducted for all competing interventions.Evaluation of different methodologies used to indirectly compare interventions based on meta analyses of randomised controlled trials.Systematic review of Cochrane Database of Systematic Reviews, Cochrane Methodology Register, EMBASE and MEDLINE for reports including meta analyses that contained an indirect comparison. Searching was completed in July 2007. No restriction was placed on language or year of publication.Sixty-two papers identified contained indirect comparisons of treatments. Five different methodologies were employed: comparing point estimates (1/62); comparing 95% confidence intervals (26/62); performing statistical tests on summary estimates (8/62); indirect comparison using a single common comparator (20/62); and mixed treatment comparison (MTC) (7/62). The only methodologies that provide an estimate of the difference between the interventions under consideration and a measure of the uncertainty around that estimate are indirect comparison using a single common comparator and MTC. The MTC might have advantages over other approaches because it is not reliant on a single common comparator and can incorporate the results of direct and indirect comparisons into the analysis. Indirect comparisons require an underlying assumption of consistency of evidence. Utilising any of the methodologies when this assumption is not true can produce misleading results.Use of either indirect comparison using a common comparator or MTC provides estimates for use in decision making, with the preferred methodology being dependent on the available data.