Please use this identifier to cite or link to this item: http://buratest.brunel.ac.uk/handle/2438/10487
Full metadata record
DC FieldValueLanguage
dc.contributor.authorLazo-Langner, A-
dc.contributor.authorRodger, MA-
dc.contributor.authorBarrowman, NJ-
dc.contributor.authorRamsay, T-
dc.contributor.authorWells, PS-
dc.contributor.authorCoyle, DA-
dc.date.accessioned2015-03-24T10:24:15Z-
dc.date.available2012-
dc.date.available2015-03-24T10:24:15Z-
dc.date.issued2012-
dc.identifier.citationBMC Medical Research Methodology, 12:3, (2012)en_US
dc.identifier.issn1471-2288-
dc.identifier.urihttp://www.biomedcentral.com/1471-2288/12/3-
dc.identifier.urihttp://bura.brunel.ac.uk/handle/2438/10487-
dc.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.en_US
dc.description.abstractBackground: 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.en_US
dc.description.sponsorshipDuring the conduction of this work Dr. Alejandro Lazo-Langner was supported by a Graduate Scholarship from Consejo Nacional de Ciencia y Tecnología (CONACyT), México, an International Fellowship awarded by the University of Ottawa and by Program Grant PRG 5513 of the Heart and Stroke Foundation of Ontario. Dr. Marc A. Rodger is supported by a Career Scientist Research award from the Heart and Stroke Foundation of Ontario. Dr. Philip S. Wells is supported by the Canada Research Chairs Program.en_US
dc.languageeng-
dc.language.isoenen_US
dc.publisherBioMed Centralen_US
dc.subjectDecision Makingen_US
dc.subjectIndirect comparisonen_US
dc.subjectMeta-Analysisen_US
dc.subjectMethodsen_US
dc.subjectMonte Carlo Methoden_US
dc.subjectRisken_US
dc.subjectRisk-Benefit Analysisen_US
dc.titleComparing multiple competing interventions in the absence of randomized trials using clinical risk-benefit analysisen_US
dc.typeArticleen_US
dc.identifier.doihttp://dx.doi.org/10.1186/1471-2288-12-3-
dc.relation.isPartOfBMC Medical Research Methodology-
dc.relation.isPartOfBMC Medical Research Methodology-
pubs.volume12-
pubs.volume12-
pubs.organisational-data/Brunel-
pubs.organisational-data/Brunel/Brunel Staff by College/Department/Division-
pubs.organisational-data/Brunel/Brunel Staff by College/Department/Division/College of Health and Life Sciences-
pubs.organisational-data/Brunel/Brunel Staff by College/Department/Division/College of Health and Life Sciences/Dept of Life Sciences-
pubs.organisational-data/Brunel/Brunel Staff by College/Department/Division/College of Health and Life Sciences/Dept of Life Sciences/Biological Sciences-
pubs.organisational-data/Brunel/Brunel Staff by Institute/Theme-
pubs.organisational-data/Brunel/Brunel Staff by Institute/Theme/Institute of Environmental, Health and Societies-
pubs.organisational-data/Brunel/Brunel Staff by Institute/Theme/Institute of Environmental, Health and Societies/Health Economics-
pubs.organisational-data/Brunel/Specialist Centres-
pubs.organisational-data/Brunel/Specialist Centres/HERG-
Appears in Collections:Publications
Health Economics Research Group (HERG)

Files in This Item:
File Description SizeFormat 
Fulltext.pdf1.28 MBAdobe PDFView/Open


Items in BURA are protected by copyright, with all rights reserved, unless otherwise indicated.