The DOI matches its Crossref record; 60 of the 60 references it cites were found in a registry or an index.
Evidence Synthesis for Decision Making 3: Heterogeneity—Subgroups, Meta-Regression, Bias, and Bias-Adjustment
Open accessAbstract
In meta-analysis, between-study heterogeneity indicates the presence of effect-modifiers and has implications for the interpretation of results in cost-effectiveness analysis and decision making. A distinction is usually made between true variability in treatment effects due to variation in patient populations or settings and biases related to the way in which trials were conducted. Variability in relative treatment effects threatens the external validity of trial evidence and limits the ability to generalize from the results; imperfections in trial conduct represent threats to internal validity. We provide guidance on methods for meta-regression and bias-adjustment, in pairwise and network meta-analysis (including indirect comparisons), using illustrative examples. We argue that the predictive distribution of a treatment effect in a “new” trial may, in many cases, be more relevant to decision making than the distribution of the mean effect. Investigators should consider the relative contribution of true variability and random variation due to biases when considering their response to heterogeneity. In network meta-analyses, various types of meta-regression models are possible when trial-level effect-modifying covariates are present or suspected. We argue that a model with a single interaction term is the one most likely to be useful in a decision-making context. Illustrative examples of Bayesian meta-regression against a continuous covariate and meta-regression against “baseline” risk are provided. Annotated WinBUGS code is set out in an appendix.
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Cites
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“It is expected that this bias-adjustment method will be used more when more data are available on how the degree of bias depends on the nature of the outcome measure and the clinical condition.(4) In principle, the same form of bias-adjustment could be extended to other types of bias or to mixtures of RCTs and observa…”
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Cited by
Hutton, B., Salanti, G., Caldwell, D. M., Chaimani, A., Schmid, C. H., Cameron, C., Ioannidis, J. P. A., Straus, S., Thorlund, K., Jansen, J. P., et al. (2015) · Annals of Internal Medicine · doi:10.7326/m14-2385 · Cited by 8,269
Dias, S., Sutton, A. J., Ades, A. E., & Welton, N. J. (2013) · Medical Decision Making · doi:10.1177/0272989x12458724 · Cited by 1,207
Self-citationBannuru, R. R., Schmid, C. H., Kent, D. M., Vaysbrot, E. E., Wong, J. B., & McAlindon, T. E. (2015) · Annals of Internal Medicine · doi:10.7326/m14-1231 · Cited by 623
Ge, L., Sadeghirad, B., Ball, G. D. C., da Costa, B. R., Hitchcock, C. L., Svendrovski, A., Kiflen, R., Quadri, K., Kwon, H. Y., Karamouzian, M., et al. (2020) · BMJ · doi:10.1136/bmj.m696 · Cited by 426
Catalá-López, F., Hutton, B., Núñez-Beltrán, A., Page, M. J., Ridao, M., Macías Saint-Gerons, D., Catalá, M. A., Tabarés-Seisdedos, R., & Moher, D. (2017) · PLOS ONE · doi:10.1371/journal.pone.0180355 · Cited by 396
Metadata
- Authors
- Dias, S., Sutton, A. J., Welton, N. J., & Ades, A. E.
- Venue
- Medical Decision Making
- Publisher
- SAGE Publications
- Published
- 2013-06-26
- Volume
- 33
- Issue
- 5
- Pages
- 618-640
- ISSN
- 0272-989X (ISSN-L)
- 1552-681X
- OpenAlex
- W2616379431
- Cited by
- 466
- References
- 60
- FWCI
- 38.00
- Type
- journal article
- Language
- en
- Open access
- hybrid
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