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Modelling time-course relationships with multiple treatments: Model-based network meta-analysis for continuous summary outcomes.

ABSTRACT: BACKGROUND:Model-based meta-analysis (MBMA) is increasingly used to inform drug-development decisions by synthesising results from multiple studies to estimate treatment, dose-response, and time-course characteristics. Network meta-analysis (NMA) is used in Health Technology Appraisals for simultaneously comparing effects of multiple treatments, to inform reimbursement decisions. Recently, a framework for dose-response model-based network meta-analysis (MBNMA) has been proposed that combines, often nonlinear, MBMA modelling with the statistically robust properties of NMA. Here, we aim to extend this framework to time-course models. METHODS:We propose a Bayesian time-course MBNMA modelling framework for continuous summary outcomes that allows for nonlinear modelling of multiparameter time-course functions, accounts for residual correlation between observations, preserves randomisation by modelling relative effects, and allows for testing of inconsistency between direct and indirect evidence on the time-course parameters. We demonstrate our modelling framework using an illustrative dataset of 23 trials investigating treatments for pain in osteoarthritis. RESULTS:Of the time-course functions that we explored, the Emax model gave the best fit to the data and has biological plausibility. Some simplifying assumptions were needed to identify the ET50 , due to few observations at early follow-up times. Treatment estimates were robust to the inclusion of correlations in the likelihood. CONCLUSIONS:Time-course MBNMA provides a statistically robust framework for synthesising evidence on multiple treatments at multiple time points. The use of placebo-controlled studies in drug-development means there is limited potential for inconsistency. The methods can inform drug-development decisions and provide the rigour needed in the reimbursement decision-making process.

SUBMITTER: Pedder H

PROVIDER: S-EPMC6563489 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Modelling time-course relationships with multiple treatments: Model-based network meta-analysis for continuous summary outcomes.

Pedder Hugo H Dias Sofia S Bennetts Margherita M Boucher Martin M Welton Nicky J NJ

Research synthesis methods 20190529 2

<h4>Background</h4>Model-based meta-analysis (MBMA) is increasingly used to inform drug-development decisions by synthesising results from multiple studies to estimate treatment, dose-response, and time-course characteristics. Network meta-analysis (NMA) is used in Health Technology Appraisals for simultaneously comparing effects of multiple treatments, to inform reimbursement decisions. Recently, a framework for dose-response model-based network meta-analysis (MBNMA) has been proposed that comb ...[more]

PMID: 31013000

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Project description:BackgroundCancer atlases often provide estimates of cancer incidence, mortality or survival across small areas of a region or country. A recent example of a cancer atlas is the Australian cancer atlas (ACA), that provides interactive maps to visualise spatially smoothed estimates of cancer incidence and survival for 20 different cancer types over 2148 small areas across Australia.MethodsThe present study proposes a multivariate Bayesian meta-analysis model, which can model multiple cancers jointly using summary measures without requiring access to the unit record data. This new approach is illustrated by modelling the publicly available spatially smoothed standardised incidence ratios for multiple cancers in the ACA divided into three groups: common, rare/less common and smoking-related. The multivariate Bayesian meta-analysis models are fitted to each group in order to explore any possible association between the cancers in three remoteness regions: major cities, regional and remote areas across Australia. The correlation between the pairs of cancers included in each multivariate model for a group was examined by computing the posterior correlation matrix for each cancer group in each region. The posterior correlation matrices in different remoteness regions were compared using Jennrich's test of equality of correlation matrices (Jennrich in J Am Stat Assoc. 1970;65(330):904-12. https://doi.org/10.1080/01621459.1970.10481133 ).ResultsSubstantive correlation was observed among some cancer types. There was evidence that the magnitude of this correlation varied according to remoteness of a region. For example, there has been significant negative correlation between prostate and lung cancer in major cities, but zero correlation found in regional and remote areas for the same pair of cancer types. High risk areas for specific combinations of cancer types were identified and visualised from the proposed model.ConclusionsPublicly available spatially smoothed disease estimates can be used to explore additional research questions by modelling multiple cancer types jointly. These proposed multivariate meta-analysis models could be useful when unit record data are unavailable because of privacy and confidentiality requirements.

Dataset Information

Modelling time-course relationships with multiple treatments: Model-based network meta-analysis for continuous summary outcomes.

Publications

Modelling time-course relationships with multiple treatments: Model-based network meta-analysis for continuous summary outcomes.

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