Use of Bayesian Multivariate Meta-Analysis to Estimate the HAQ for Mapping Onto the EQ-5D Questionnaire in Rheumatoid Arthritis
Use of Bayesian Multivariate Meta-Analysis to Estimate the HAQ for Mapping Onto the EQ-5D Questionnaire in Rheumatoid Arthritis
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DOI：
10.1016/j.jval.2013.11.005
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发表时间：
2014-01-01
期刊：
影响因子：
4.5
通讯作者：
Abrams, Keith R.
中科院分区：
文献类型：
--
作者：
Bujkiewicz, Sylwia;Thompson, John R.;Abrams, Keith R.
背景：在卫生技术评估中，关于新卫生技术补偿的决定主要基于有效性估计。然而，有时候目标成效估计数并不容易获得。这可能是因为正在使用许多测量这些结局的替代工具（并非所有都报告），或者需要延长临床试验的随访时间来评估长期终点，导致目标临床结局的数据有限。在卫生保健的最高优先领域，需要在短时间内作出决定。因此，替代临床结局，包括替代终点，越来越多地被考虑用于证据合成，作为经济评价的一部分。目的：为了说明当从多变量荟萃分析中估计临床结局时，降低临床结局不确定性对效用的潜在影响。研究方法：贝叶斯多变量荟萃分析已被用于合成类风湿性关节炎相关结果的数据，并将外部数据以信息先验分布的形式纳入模型。然后将健康评估问卷的估计值映射到健康相关的生活质量测量EuroQol五维问卷上，并将其效果与从单变量方法获得的健康评估问卷进行比较。结果如下：使用多元荟萃分析可以减少有效性参数的不确定性，最终减少效用的不确定性。结论：通过允许将所有相关数据纳入估计临床有效性结局，多变量荟萃分析可以改善通过映射方法估计的健康效用的估计。虽然减少不确定性可能会对基于新保健技术的经济评价的决定产生影响，但使用短期替代终点可以提前作出决定。需要进行更多的研究，以确定在何种情况下减少不确定性。
Background: In health technology assessment, decisions about reimbursement for new health technologies are largely based on effectiveness estimates. Sometimes, however, the target effectiveness estimates are not readily available. This may be because many alternative instruments measuring these outcomes are being used (and not all always reported) or an extended follow-up time of clinical trials is needed to evaluate long-term end points, leading to the limited data on the target clinical outcome. In the areas of highest priority in health care, decisions are required to be made on a short time scale. Therefore, alternative clinical outcomes, including surrogate end points, are increasingly being considered for use in evidence synthesis as part of economic evaluation. Objective: To illustrate the potential effect of reduced uncertainty around the clinical outcome on the utility when estimating it from a multivariate meta-analysis. Methods: Bayesian multivariate meta-analysis has been used to synthesize data on correlated outcomes in rheumatoid arthritis and to incorporate external data in the model in the form of informative prior distributions. Estimates of Health Assessment Questionnaire were then mapped onto the health-related quality-of-life measure EuroQol five dimensional questionnaire, and the effect was compared with mapping the Health Assessment Questionnaire obtained from the univariate approach. Results: The use of multivariate meta-analysis can lead to reduced uncertainty around the effectiveness parameter and ultimately uncertainty around the utility. Conclusions: By allowing all the relevant data to be incorporated in estimating clinical effectiveness outcomes, multivariate meta-analysis can improve the estimation of health utilities estimated through mapping methods. While reduced uncertainty may have an effect on decisions based on economic evaluation of new health technologies, the use of short-term surrogate end points can allow for early decisions. More research is needed to determine the circumstances under which uncertainty is reduced.