title: How valuable are multiple treatment comparison methods in evidence-based health-care evaluation?
abstract: OBJECTIVE
  To compare the use of pair-wise meta-analysis methods to multiple treatment comparison (MTC) methods for evidence-based health-care evaluation to estimate the effectiveness and cost-effectiveness of alternative health-care interventions based on the available evidence.
  
  
  METHODS
  Pair-wise meta-analysis and more complex evidence syntheses, incorporating an MTC component, are applied to three examples: 1) clinical effectiveness of interventions for preventing strokes in people with atrial fibrillation; 2) clinical and cost-effectiveness of using drug-eluting stents in percutaneous coronary intervention in patients with coronary artery disease; and 3) clinical and cost-effectiveness of using neuraminidase inhibitors in the treatment of influenza. We compare the two synthesis approaches with respect to the assumptions made, empirical estimates produced, and conclusions drawn.
  
  
  RESULTS
  The difference between point estimates of effectiveness produced by the pair-wise and MTC approaches was generally unpredictable-sometimes agreeing closely whereas in other instances differing considerably. In all three examples, the MTC approach allowed the inclusion of randomized controlled trial evidence ignored in the pair-wise meta-analysis approach. This generally increased the precision of the effectiveness estimates from the MTC model.
  
  
  CONCLUSIONS
  The MTC approach to synthesis allows the evidence base on clinical effectiveness to be treated as a coherent whole, include more data, and sometimes relax the assumptions made in the pair-wise approaches. However, MTC models are necessarily more complex than those developed for pair-wise meta-analysis and thus could be seen as less transparent. Therefore, it is important that model details and the assumptions made are carefully reported alongside the results.
authors.affiliation: Department of Health Sciences, University of Leicester, University Road, Leicester, UK. njc21@le.ac.uk
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Cooper
authors.forename: Jaime
authors.initials: J
authors.lastname: Peters
authors.forename: Monica C W
authors.initials: MC
authors.lastname: Lai
authors.forename: Peter
authors.initials: P
authors.lastname: Juni
authors.forename: Simon
authors.initials: S
authors.lastname: Wandel
authors.forename: Steve
authors.initials: S
authors.lastname: Palmer
authors.forename: Mike
authors.initials: M
authors.lastname: Paulden
authors.forename: Stefano
authors.initials: S
authors.lastname: Conti
authors.forename: Nicky J
authors.initials: NJ
authors.lastname: Welton
authors.forename: Keith R
authors.initials: KR
authors.lastname: Abrams
authors.forename: Sylwia
authors.initials: S
authors.lastname: Bujkiewicz
authors.forename: David
authors.initials: D
authors.lastname: Spiegelhalter
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Sutton
mesh_terms: D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine / Q000191:economics / Q000379:methods* / Q000592:standards; D006801:Humans; D015201:Meta-Analysis as Topic; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000379:methods* / Q000592:standards; D016032:Randomized Controlled Trials as Topic / Q000191:economics / Q000379:methods* / Q000592:standards