Synthesis of evidence on heterogeneous interventions with multiple outcomes recorded over multiple follow‐up times reported inconsistently: a smoking cessation case‐study

type="main" xml:id="rssa12018-abs-0001"> Health technology assessment requires the synthesis of evidence from multiple sources to assess the cost-effectiveness of competing interventions. However, the format of the available reported evidence is often complex. We present a case-study of electronic aids to smoking cessation, which raises various methodological challenges. The evidence base evaluated highly complex and diverse interventions, reporting one or both of two different, but related, outcome measures. Furthermore, there were differences between studies in the number and timing of follow-up times reported, whereas 12-month continuous abstinence is required in the cost-effectiveness analysis. We develop a categorization system to evaluate the interventions, and we use network meta-analysis of time-to-relapse model parameters to estimate coherent intervention effects for any pair of categories. We compare the fit of alternative time-to-relapse models and explore the effect of joint models for both outcome measures, which can be used to estimate treatment effects when a given outcome is not reported, so that all the available evidence can be combined.

[1]  M J Daniels,et al.  Meta-analysis for the evaluation of potential surrogate markers. , 1997, Statistics in medicine.

[2]  A E Ades,et al.  Meta‐analysis of mixed treatment comparisons at multiple follow‐up times , 2007, Statistics in medicine.

[3]  E. Balas,et al.  Healthcare via cell phones: a systematic review. , 2009, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[4]  B. O'brien,et al.  Economic evaluation of pharmaceuticals. Frankenstein's monster or vampire of trials? , 1996, Medical care.

[5]  Andrew Gelman,et al.  General methods for monitoring convergence of iterative simulations , 1998 .

[6]  Seung-Kwon Myung,et al.  Effects of Web- and computer-based smoking cessation programs: meta-analysis of randomized controlled trials. , 2009, Archives of internal medicine.

[7]  David R. Jones,et al.  How vague is vague? A simulation study of the impact of the use of vague prior distributions in MCMC using WinBUGS , 2005, Statistics in medicine.

[8]  Nicky J Welton,et al.  A Generalised Linear Modelling Framework for Pairwise and Network Meta-Analysis of Randomised Controlled Trials , 2014 .

[9]  Deborah M Caldwell,et al.  Simultaneous comparison of multiple treatments: combining direct and indirect evidence , 2005, BMJ : British Medical Journal.

[10]  David Collett Modelling Survival Data in Medical Research , 1994 .

[11]  Mark C Simmonds,et al.  Meta-analysis of individual patient data from randomized trials: a review of methods used in practice , 2005, Clinical trials.

[12]  Bradley P. Carlin,et al.  Bayesian measures of model complexity and fit , 2002 .

[13]  Nicky J Welton,et al.  Mixed treatment comparison of repeated measurements of a continuous endpoint: an example using topical treatments for primary open‐angle glaucoma and ocular hypertension , 2011, Statistics in medicine.

[14]  G. Lu,et al.  Combination of direct and indirect evidence in mixed treatment comparisons , 2004, Statistics in medicine.

[15]  M. Pfisterer,et al.  Drug eluting and bare metal stents in people with and without diabetes: collaborative network meta-analysis , 2008, BMJ : British Medical Journal.

[16]  V. Strecher Computer-tailored smoking cessation materials: a review and discussion. , 1999, Patient education and counseling.

[17]  M. Drummond,et al.  The Iterative Use of Economic Evaluation as Part of the Process of Health Technology Assessment , 1997, Journal of health services research & policy.

[18]  Nicky J Welton,et al.  Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis , 2010, BMJ : British Medical Journal.

[19]  R. Whittaker,et al.  Mobile phone-based interventions for smoking cessation. , 2016, The Cochrane database of systematic reviews.

[20]  Andy McEwen,et al.  Online support for smoking cessation: a systematic review of the literature. , 2009, Addiction.

[21]  Andrew Thomas,et al.  WinBUGS - A Bayesian modelling framework: Concepts, structure, and extensibility , 2000, Stat. Comput..

[22]  Arthur P. Dempster,et al.  The direct use of likelihood for significance testing , 1997, Stat. Comput..

[23]  M. Munafo,et al.  Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: a systematic review and network meta-analysis. , 2012, Health technology assessment.

[24]  Nicky J Welton,et al.  Evidence Synthesis for Decision Making in Healthcare: Welton/Evidence Synthesis for Decision Making in Healthcare , 2012 .

[25]  A E Ades,et al.  Mixed treatment comparison with multiple outcomes reported inconsistently across trials: Evaluation of antivirals for treatment of influenza A and B , 2008, Statistics in medicine.

[26]  Robert West,et al.  Development of a taxonomy of behaviour change techniques used in individual behavioural support for smoking cessation. , 2011, Addictive behaviors.

[27]  Nicky J Welton,et al.  How valuable are multiple treatment comparison methods in evidence-based health-care evaluation? , 2011, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[28]  Nicky J Welton,et al.  Mixed treatment comparison meta-analysis of complex interventions: psychological interventions in coronary heart disease. , 2009, American journal of epidemiology.

[29]  Pål Kraft,et al.  A Digital Smoking Cessation Program Delivered Through Internet and Cell Phone Without Nicotine Replacement (Happy Ending): Randomized Controlled Trial , 2008, Journal of medical Internet research.

[30]  R. Shegog,et al.  A review of computer and Internet-based interventions for smoking behavior. , 2006, Addictive behaviors.

[31]  P Aveyard,et al.  'Cut down to quit' with nicotine replacement therapies in smoking cessation: a systematic review of effectiveness and economic analysis. , 2008, Health technology assessment.

[32]  Guobing Lu,et al.  Modeling between-trial variance structure in mixed treatment comparisons. , 2009, Biostatistics.

[33]  P. McCullagh,et al.  Generalized Linear Models, 2nd Edn. , 1990 .

[34]  Simon Wandel,et al.  Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis , 2007, The Lancet.