Please use this identifier to cite or link to this item: http://buratest.brunel.ac.uk/handle/2438/10487
Title: Comparing multiple competing interventions in the absence of randomized trials using clinical risk-benefit analysis
Authors: Lazo-Langner, A
Rodger, MA
Barrowman, NJ
Ramsay, T
Wells, PS
Coyle, DA
Keywords: Decision Making;Indirect comparison;Meta-Analysis;Methods;Monte Carlo Method;Risk;Risk-Benefit Analysis
Issue Date: 2012
Publisher: BioMed Central
Citation: BMC Medical Research Methodology, 12:3, (2012)
Abstract: Background: To demonstrate the use of risk-benefit analysis for comparing multiple competing interventions in the absence of randomized trials, we applied this approach to the evaluation of five anticoagulants to prevent thrombosis in patients undergoing orthopedic surgery. Methods. Using a cost-effectiveness approach from a clinical perspective (i.e. risk benefit analysis) we compared thromboprophylaxis with warfarin, low molecular weight heparin, unfractionated heparin, fondaparinux or ximelagatran in patients undergoing major orthopedic surgery, with sub-analyses according to surgery type. Proportions and variances of events defining risk (major bleeding) and benefit (thrombosis averted) were obtained through a meta-analysis and used to define beta distributions. Monte Carlo simulations were conducted and used to calculate incremental risks, benefits, and risk-benefit ratios. Finally, net clinical benefit was calculated for all replications across a range of risk-benefit acceptability thresholds, with a reference range obtained by estimating the case fatality rate - ratio of thrombosis to bleeding. Results: The analysis showed that compared to placebo ximelagatran was superior to other options but final results were influenced by type of surgery, since ximelagatran was superior in total knee replacement but not in total hip replacement. Conclusions: Using simulation and economic techniques we demonstrate a method that allows comparing multiple competing interventions in the absence of randomized trials with multiple arms by determining the option with the best risk-benefit profile. It can be helpful in clinical decision making since it incorporates risk, benefit, and personal risk acceptance.
Description: © 2012 Lazo-Langner et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
URI: http://www.biomedcentral.com/1471-2288/12/3
http://bura.brunel.ac.uk/handle/2438/10487
DOI: http://dx.doi.org/10.1186/1471-2288-12-3
ISSN: 1471-2288
Appears in Collections:Publications
Health Economics Research Group (HERG)

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