External validity of rct evidence in cost-effectiveness analyses. A review of recent technology appraisals for nice and proposed methods of adjustment
نویسندگان
چکیده
Introduction Randomised Controlled Trials (RCTs) produce relative treatment effects that have high internal validity. However they may suffer from lack of external validity when used as inputs to cost-effectiveness analyses (CEA). If differences in RCT and CEA populations can be described by a set of observed covariates, then it is possible to adjust for these differences. A common approach is to estimate effects at the mean covariate values. For non-linear models this introduces bias, even if the RCT and CEA populations are comparable.
منابع مشابه
Evaluation of Clinical Trials
In a number of important clinical issues such as evaluation of the efficacy or effectiveness of therapeutic or preventive interventions as well as for comparing the harms of interventions, randomized controlled trials (RCTs) provide the highest levels of evidence, either directly or indirectly. It is obvious that critical appraisal of these studies to assess their validity and precision is of p...
متن کاملPomalidomide with Dexamethasone for Treating Relapsed and Refractory Multiple Myeloma Previously Treated with Lenalidomide and Bortezomib: An Evidence Review Group Perspective of an NICE Single Technology Appraisal
The National Institute for Health and Care Excellence (NICE), as part of the institute's single technology appraisal (STA) process, invited the manufacturer of pomalidomide (POM; Imnovid®, Celgene) to submit evidence regarding the clinical and cost effectiveness of the drug in combination with dexamethasone (POM + LoDEX) for the treatment of relapsed and refractory multiple myeloma (RRMM) after...
متن کاملCharacterizing the Validity and Real-World Utility of Health Technology Assessments in Healthcare: Future Directions; Comment on “Problems and Promises of Health Technologies: The Role of Early Health Economic Modelling”
With their article, Grutters et al raise an important question: What do successful health technology assessments (HTAs) look like, and what is their real-world utility in decision-making? While many HTAs are published in peer-reviewed journals, many are considered proprietary and their attributes remain confidential, limiting researchers’ ability to answer these questio...
متن کاملIncorporating external evidence in trial-based cost-effectiveness analyses: the use of resampling methods
BACKGROUND Cost-effectiveness analyses (CEAs) that use patient-specific data from a randomized controlled trial (RCT) are popular, yet such CEAs are criticized because they neglect to incorporate evidence external to the trial. A popular method for quantifying uncertainty in a RCT-based CEA is the bootstrap. The objective of the present study was to further expand the bootstrap method of RCT-ba...
متن کاملEOS imaging versus current radiography: A health technology as-sessment study
Background: EOS is a 2D/3D muscle skeletal diagnostic imaging system. The device has been developed to produce a high quality 2D, full body radiographs in standing, sitting and squatting positions. Three dimensional images can be reconstructed via sterEOS software. This Health Technology Assessment study aimed to investigate efficacy, effectiveness and cost-effectiveness of new emerged EOS imag...
متن کامل