USING PREDICTION INTERVALS FROM RANDOM-EFFECTS META-ANALYSES IN AN ECONOMIC MODEL. (29th January 2014)

• Record Type: Journal Article
• Authors: Teljeur, Conor; O'Neill, Michelle; Moran, Patrick; Murphy, Linda; Harrington, Patricia; Ryan, Máirín; Flattery, Martin
• Is Part Of: International journal of technology assessment in health care. Volume 30:Number 1(2014:Jan.)
• Page Start: 44
• Page End: 49
• Publication Date: 2014-01-29
• Subjects: Medical technology -- Periodicals; Technology assessment -- Periodicals; 610.28
• DOI: 10.1017/S0266462313000676
• Languages: English
• ISSNs: 0266-4623

Abstract

<abstract abstract-type="normal"> <title> <x content-type="archive" xml:space="preserve">Abstract</x> </title> <p> <bold>Objectives:</bold> When incorporating treatment effect estimates derived from a random-effect meta-analysis it is tempting to use the confidence bounds to determine the potential range of treatment effect. However, prediction intervals reflect the potential effect of a technology rather than the more narrowly defined average treatment effect. Using a case study of robot-assisted radical prostatectomy, this study investigates the impact on a cost-utility analysis of using clinical effectiveness derived from random-effects meta-analyses presented as confidence bounds and prediction intervals, respectively.</p> <p> <bold>Methods:</bold> To determine the cost-utility of robot-assisted prostatectomy, an economic model was developed. The clinical effectiveness of robot-assisted surgery compared with open and conventional laparoscopic surgery was estimated using meta-analysis of peer-reviewed publications. Assuming treatment effect would vary across studies due to both sampling variability and differences between surgical teams, random-effects meta-analysis was used to pool effect estimates.</p> <p> <bold>Results:</bold> Using the confidence bounds approach the mean and median ICER was €24, 193 and €26, 731/QALY (95%CI: €13, 752 to €68, 861/QALY), respectively. The prediction interval approach produced an equivalent mean and median ICER of €26, 920 and €26, 643/QALY (95%CI: -€135, 244 to €239, 166/QALY), respectively. Using prediction intervals, there is a probability of 0.042 that robot-assisted surgery will result in a net reduction in QALYs.</p> <p> <bold>Conclusions:</bold> Using prediction intervals rather than confidence bounds does not affect the point estimate of the treatment effect. In meta-analyses with significant heterogeneity, the use of prediction intervals will produce wider ranges of treatment effect, and hence result in greater uncertainty, but a better reflection of the effect of the technology.</p> </abstract>