Using prediction intervals from random-effects meta-analyses in an economic model.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Health Information and Quality Authority.
Conor
C
Teljeur
Health Information and Quality Authority.
Michelle
M
O'Neill
Health Information and Quality Authority.
Patrick
P
Moran
Health Information and Quality Authority.
Linda
L
Murphy
Health Information and Quality Authority.
Patricia
P
Harrington
Health Information and Quality Authority.
Máirín
M
Ryan
Baxter Healthcare Corporation.
Martin
M
Flattery
D003362:Cost-Benefit Analysis; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D008297:Male; D015201:Meta-Analysis as Topic; D018803:Models, Economic; D010043:Outcome and Process Assessment, Health Care; D011468:Prostatectomy / Q000191:economics* / Q000295:instrumentation*; D019057:Quality-Adjusted Life Years; D012371:Robotics / Q000191:economics*; D013673:Technology Assessment, Biomedical