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Estimating pooled survival benefit using individual patient level data meta analyses

The aim of a meta-analysis is to estimate a pooled treatment effect from data of all randomised controlled trials that investigated the same clinical question. Individual patient data (IPD) meta-analysis (MA) has become the gold standard for obtaining the best evidence to inform treatment effects. In economic evaluation, a commonly used outcome measure for the treatment effect is survival benefit (SB). A challenge when using IPD from a MA is taking into account the hierarchical structure of the data (data clustering with patients within trials) to estimate the pooled SB. The impact of using different methods to estimate treatment effect using IPD-MA has not been extensively explored in the literature. In order to contribute to fill this gap, our objective was to compare survival analysis methods (both parametric and non-parametric) to estimate the pooled SB from IPD-MA. First, we show a case study in lung cancer that suggests that the method chosen to estimate the pooled SB is likely to impact cost-effectiveness results. Then, we present results from a simulation study in which we introduced between-trial heterogeneity (treatment effect and baseline hazard) through discrete random effects. It allowed us to analytically derive the “true” pooled SB. We considered scenarios varying key parameters such as treatment effect size, between-trial heterogeneity, the number of trials, and the number of patients. Over 1,000 replicates per scenario, we compared the survival analysis methods in terms of bias, empirical standard error, and average standard error. Preliminary results suggest that all methods perform well even for high treatment effect and high heterogeneity. However, with high treatment effect heterogeneity, the variance of pooled SB is under-estimated.

Forthcoming Talks

Avoiding harm from over prescribing conference

Strategies to reduce inappropriate antibiotic use

Monday, 11 November 2019 @ Royal College of Physicians, London

Koen Pouwels, HERC Senior Researcher, will be presenting on 11 November 2019 on this topical subject

Pharmaceutical policies in the long run: Reflections on 60th anniversary of the Hinchliffe Report

Monday, 11 November 2019, 9.15am to 5pm @ Merton College, Merton Street Oxford, OX1 4JD

Organised by the Nuffield Department of Population Health, University of Oxford 11th November 2019 at Merton College, Merton Street Oxford, 9:30 am to 5:00 pm

Sex, risk, and preferences: Using stated preference data to model behaviour in HIV prevention.

Wednesday, 13 November 2019, 12pm to 1pm @ Richard Doll Building, Oxford, OX3 7LF

Antimicrobial resistance summit 2020 london

Rotating interview: crunching the numbers – engaging big business and the public sector

Thursday, 19 March 2020 @ BMA House Conference & Events Venue Tavistock Square, Bloomsbury, London WC1H 9JP, UK - London

Koen Pouwels, HERC Senior Researcher, will be presenting at this conference, organised by The Economist, on 19 March 2020