Interpreting discordant indirect and multiple treatment comparison meta-analyses: an evaluation of direct acting antivirals for chronic hepatitis C infection

Abstract

Indirect treatment comparison (ITC) and multiple treatment comparison (MTC) meta-analyses are increasingly being used to estimate the comparative effectiveness of interventions when head-to-head data do not exist. ITC meta-analyses can be conducted using simple methodology to compare two interventions. MTC meta-analyses can be conducted using more complex methodology, often employing Bayesian approaches, to compare multiple interventions. As the number of ITC and MTC meta-analyses increase, it is common to find multiple analyses evaluating the same interventions in similar therapeutic areas. Depending on the choice of the methodological approach, the conclusions about relative treatment efficacy may differ. Such situations create uncertainty for decision makers. An illustration of this is provided by four ITC and MTC meta-analyses assessing the efficacy of boceprevir and telaprevir for chronic hepatitis C virus infection. This paper examines why these evaluations provide discordant results by examining specific methodological issues that can strengthen or weaken inferences.

Causes and Risk Factors of Breast Cancer, What Do We Know for Sure? An Evidence Synthesis of Systematic Reviews and Meta-Analyses

“…Out of these six analyses, three were from only one of the 122 systematic reviews. Some researchers explain the challenges related to confusing results and interpretations with the lack of guidelines and recommend checking if the included studies used the same questions, if they had the same quality and selection criteria, etc., or if their interpretations of similar results were weak [151]. Our findings from the studies on red and processed meat confirm some of these challenges.…”

Cost-effectiveness of Telaprevir Combination Therapy for Chronic Hepatitis C

“…No head-to-head data are currently available for any of these comparisons. Meta-analysis results are available only for comparison with boceprevir; however, several available meta-analyses have shown highly discrepant results [58] . Future work is needed to help decision makers understand the comparative efficacy, safety, and cost-effectiveness of TVR+PR compared with all existing options for HCV treatment.…”