Purpose: In the absence of head-to-head trials, indirect comparisons (IDCs) or network meta-analysis (NMA) can be used to inform the comparative clinical effectiveness of health interventions, which can further be used to determine comparative cost effectiveness. The purpose of this review was to assess the use of IDCs and NMAs in pharmacoeconomic (PE) submissions to the Common Drug Review at the Canadian Agency for Drugs and Technologies in Health (CADTH) between 2007 and 2010.
Method: All PE submissions to CADTH between 2007 and 2010 were reviewed; submissions relying on IDCs and NMAs were identified; and, details on the methodology were collected and assessed.
Result: In 2007, six of 28 (21%) PE submissions included an IDC – none were based on an NMA. In 2010, eleven of 21 (52%) PE submissions included either an IDC or NMA – four (36%) used an NMA. There was also a trend towards increased use of Bayesian methods and a greater number of treatments and studies included in evidence networks. Given the increased complexity of evidence networks, assessment of heterogeneity/inconsistency, model fit, and convergence is required; however, information on these parameters was not typically reported.
Conclusion: The use of IDC and NMA in PE evaluations submitted to CADTH increased sharply between 2007 and 2010. To allow for critical assessment of PE submissions, which employ IDC or NMA, clear and transparent methods need to be provided for the purpose of reimbursement recommendations based on comparative clinical effectiveness and cost effectiveness.
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