Meta-Analysis, Decision Analysis, and Cost-Effectiveness Analysis Methods for Quantitative Synthesis in Medicine

by Petitti, Diana B.

• ISBN13: 9780195133646
• ISBN10: 0195133641
• Edition: 2nd
• Format: Hardcover
• Copyright: 1999-10-14
• Publisher: Oxford University Press

Summary

Meta-analysis, decision analysis, and cost-effectiveness analysis are the cornerstones of evidence-based medicine. These related quantitative methods have become essential tools in the formulation of clinical and public policy based on the synthesis of evidence. All three methods are taughtwith increasing frequency in medical schools and schools of public health and in health policy courses at the undergraduate and graduate level. This book is a lucid introduction, and will serve the needs of students taking introductory courses that cover these topics. It will also be useful toclinicians and policymakers who need to understand the quantitative underpinnings of the methods in order to best apply the information that derives from them. The second edition of this popular book adds new material on cumulative meta-analysis as a method to explore heterogeneity. The coverage ofcost-effectiveness analysis has been brought into close alignment with recommendations of the U.S. Public Health Panel on Cost-Effectiveness Analysis in Health and Medicine. Many of the examples have been replaced with more current examples, and all of the material has been updated to reflect recentadvances in the methods and the emergence of consensus about some previously controversial issues. analysis. These three closely related methods have become even more important for synthesizing research since the first edition was published in 1994. And they have gained legitimacy as tools forguiding health policy.

Table of Contents

Introduction	1	(12)
Three Illustrative Problems	2	(1)
Definitions	2	(2)
Historical Perspective	4	(4)
Linkages of the Three Methods	8	(4)
Organization of the Book	12	(1)
Overview of the Methods	13	(20)
Meta-Analysis	13	(4)
Decision Analysis	17	(12)
Cost-Effectiveness Analysis	29	(4)
Planning the Study	33	(10)
Defining the Problem	33	(1)
Developing a Study Protocol	34	(6)
Acquiring Resources	40	(1)
Procuring Administrative Approvals	40	(3)
Information Retrieval	43	(25)
Overall Strategy for Retrieving Information from Published Studies	43	(2)
Computerized Searches of Medline	45	(5)
Other Computer-Stored Databases	50	(1)
Limitations of Computerized Searches of Computer-Stored Databases	51	(7)
Publication Bias	58	(10)
Data Collection	68	(7)
Overall Goals	68	(1)
Reliability	69	(3)
Validity	72	(1)
Bias	73	(2)
Advanced Issues in Meta-Analysis	75	(19)
Defining Eligibility Criteria and Determining Eligibility of Individual Studies	76	(3)
Study Design	79	(1)
Inclusive Dates of Publication	80	(1)
English-Language Publications	81	(1)
Multiple Publications from the Same Study Population	81	(2)
Restrictions on Sample Size or Length of Follow-Up	83	(1)
Eligibility Based on Similarity of Treatments (or Exposures) or Outcomes	83	(2)
Completeness of Information	85	(2)
Choosing Estimates of Effect Within Eligible Studies	87	(2)
Study Quality	89	(5)
Statistical Methods in Meta-Analysis	94	(25)
Goals of Meta-Analysis and the Problem of Heterogeneity	95	(5)
Choice of Effect Measure	100	(1)
Mantel-Haenszel Method	101	(3)
Peto Method	104	(3)
General Variance-Based Methods	107	(4)
General Variance-Based Methods That Use Confidence Intervals	111	(4)
Statistical Tests of Homogeneity	115	(1)
DerSimonian and Laird Method	116	(3)
Appendix	118	(1)
Other Statistical and Methodologic Issues in Meta-Analysis	119	(21)
Measures on a Continuous Scale	119	(8)
Trend or ``Dose Response'' Analysis	127	(5)
Vote Counting and Related Methods	132	(1)
Statistical Approaches to Publication Bias	133	(2)
Cumulative Meta-Analysis	135	(1)
Meta-Analysis of Individual Level Data	136	(4)
Complex Decision Problems	140	(19)
More Than Two Alternative Treatments or Interventions	141	(1)
More Than One Outcome	142	(5)
Many Intervening Events	147	(2)
Estimating Life Expectancy	149	(3)
Markov Models	152	(7)
Estimating Probabilities	159	(10)
Overall Goals	159	(2)
Relying on Selected Published Sources of Information on Probabilities	161	(3)
Aggregating Information from Multiple Published Sources	164	(1)
Experts as Sources of Probability Estimates	165	(1)
Personal Experience and ``Guessing'' to Estimate Probabilities	166	(1)
Accounting for Uncertainty in Probability Estimates	166	(3)
Measuring Preferences for Health States	169	(13)
The Concept of Utility	169	(1)
Conceptual Issues in the Measurement of Preferences for Health States	170	(3)
Developing Measurement Scales in Practice	173	(6)
Use of Generic Measures of Health-Related Quality of Life as Preference Measures	179	(2)
Limitations of Measures of Preferences for Health States	181	(1)
Advanced Cost-Effectiveness Analysis	182	(20)
Types of Economic Evaluation	183	(2)
Key Concepts	185	(4)
Time Horizon	189	(1)
Identifying Contributors to Cost	190	(4)
Valuing Costs	194	(2)
Discounting	196	(3)
Inflation	199	(3)
Utility and Cost-Utility Analysis	202	(11)
Quality-Adjusted Life-Years	203	(3)
Steps in a Utility or Cost-Utility Analysis	206	(1)
Review of Approaches to Measuring Preferences (Utilities)	207	(1)
Incorporating Preference Measures into the Analysis	207	(6)
Exploring Heterogeneity	213	(16)
Overview	214	(1)
Statistical Versus Clinical Heterogeneity	214	(1)
Practices to be Avoided	215	(1)
Limitations of Statistical Tests of Heterogeneity	216	(2)
Framework for Exploration of Clinical Heterogeneity	218	(4)
Stratification as a Method for Exploring Heterogeneity	222	(2)
Meta-Regression	224	(1)
Subgroup Analysis in Decision Analysis and Cost-Effectiveness Analysis	225	(2)
Limitations of Subgroup Analysis	227	(2)
Sensitivity Analysis	229	(15)
Goals of Sensitivity Analysis	229	(1)
One-way Sensitivity Analysis in Decision Analysis and Cost-Effectiveness Analysis	230	(4)
Two-way, Three-way, and n-way Sensitivity Analysis	234	(5)
Application of the Principles of Sensitivity Analysis to Meta-Analysis	239	(5)
Reporting Results	244	(19)
Meta-Analysis	244	(3)
Decision Analysis	247	(1)
Cost-Effectiveness Analysis	248	(2)
Graphical Presentation of the Results of Meta-Analysis	250	(9)
Graphical Presentation of the Results of Decision Analysis and Cost-Effectiveness Analysis	259	(4)
Limitations	263	(20)
Meta-Analysis	264	(7)
Decision Analysis	271	(2)
Cost-Effectiveness Analysis	273	(2)
Life Expectancy	275	(4)
Situations Where the Methods Are Most and Least Useful	279	(1)
Improving the Methods: Recommendations of Experts	279	(4)
References	283	(14)
Subject Index	297	(8)
Index of Examples	305