Comparative Effectiveness & Medical Interventions for Primary Open Angle Glaucoma

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DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05) Comparative Effectiveness Research (CER) and specific Challenge Topic, 05-EY-103: Eyes and Vision Systematic Reviews. Comparative effectiveness research is "a rigorous evaluation of the effectiveness and harms of many treatment options available for a given medical condition for a particular set of patients". Mixed treatment comparison (MTC) meta-analysis is a novel technique attracting considerable interest because of its potential for comparative effectiveness research. It expands the scope of a typical systematic review by comparing the relative benefits and harms among a range of available interventions for a given condition, through synthesizing simultaneously evidence not only within the same trials ("direct evidence") but also across trials ("indirect evidence"). In doing so, MTC meta-analysis efficiently utilizes existing information and parallels more closely the decisions facing clinicians, patients and policymakers who must choose among a variety of alternative interventions. Working in collaboration with leaders in the field, we propose to assess the comparative effectiveness of multiple medical interventions available for primary open angle glaucoma (POAG) using the state-of-art Bayesian MTC meta-analysis models. POAG poses substantial burdens on patients and health care resources. Utilizing data from existing high quality randomized controlled trials, we will perform MTC meta-analysis and rank multiple medical treatment options for POAG. We will validate the MTC meta-analysis models and assess the impact of publication bias. We will report and disseminate our findings on the comparative effectiveness of medical interventions for POAG, as well as utility and validity of MTC meta-analysis techniques for comparative effectiveness research. By providing evidence on comparative effectiveness of interventions, the outcome of our work will have substantial impact on clinical practice, and influence on development of methodology for comparative effectiveness research. This study will also demonstrate and validate a meta-analytical model for generating comparative effectiveness evidence in an accelerated and practical format, which can be attractive and applied across all health care fields. This application addresses broad Challenge Area (05) Comparative Effectiveness Research (CER) and specific Challenge Topic, 05-EY-103: Eyes and Vision Systematic Reviews.