Validating the Assumptions of Population Adjustment: Application of Multilevel Network Meta-regression to a Network of Treatments for Plaque Psoriasis

Phillippo, DM (通讯作者),Univ Bristol, Canynge Hall,39 Whatley Rd, Bristol BS8 2PS, Avon, England.
2023-1
Background Network meta-analysis (NMA) and indirect comparisons combine aggregate data (AgD) from multiple studies on treatments of interest but may give biased estimates if study populations differ. Population adjustment methods such as multilevel network meta-regression (ML-NMR) aim to reduce bias by adjusting for differences in study populations using individual patient data (IPD) from 1 or more studies under the conditional constancy assumption. A shared effect modifier assumption may also be necessary for identifiability. This article aims to demonstrate how the assumptions made by ML-NMR can be assessed in practice to obtain reliable treatment effect estimates in a target population. Methods We apply ML-NMR to a network of evidence on treatments for plaque psoriasis with a mix of IPD and AgD trials reporting ordered categorical outcomes. Relative treatment effects are estimated for each trial population and for 3 external target populations represented by a registry and 2 cohort studies. We examine residual heterogeneity and inconsistency and relax the shared effect modifier assumption for each covariate in turn. Results Estimated population-average treatment effects were similar across study populations, as differences in the distributions of effect modifiers were small. Better fit was achieved with ML-NMR than with NMA, and uncertainty was reduced by explaining within- and between-study variation. We found little evidence that the conditional constancy or shared effect modifier assumptions were invalid. Conclusions ML-NMR extends the NMA framework and addresses issues with previous population adjustment approaches. It coherently synthesizes evidence from IPD and AgD studies in networks of any size while avoiding aggregation bias and noncollapsibility bias, allows for key assumptions to be assessed or relaxed, and can produce estimates relevant to a target population for decision-making.
MEDICAL DECISION MAKING
卷号:43|期号:1|页码:53-67
ISSN:0272-989X|收录类别:SCIE
语种
英语
来源机构
University of Bristol; University of York - UK; Eli Lilly; Eli Lilly; Lilly Deutschland GmbH
资助机构
UK Medical Research Council(UK Research & Innovation (UKRI)Medical Research Council UK (MRC))
资助信息
This work was supported by the UK Medical Research Council, grant Nos. MR/P015298/1, MR/R025223/1, and MR/W016648/1
被引频次(WOS)
0
被引频次(其他)
0
180天使用计数
1
2013以来使用计数
2
EISSN
1552-681X
出版年
2023-1
DOI
10.1177/0272989X221117162
学科领域
循证公共卫生
关键词
effect modification indirect comparison individual patient data network meta-analysis population adjustment
WOS学科分类
Health Care Sciences & Services Health Policy & Services Medical Informatics