Multiparameter evidence synthesis in epidemiology and medical decision-making

Meta-analysis has been well-established for many years, but has been largely confined to pooling evidence on pair-wise contrasts. Broader forms of synthesis have also been described, apparently re-invented in disparate fields, each time taking different computational approaches. The potential value of Bayesian estimation of a joint posterior parameter distribution and simultaneously sampling from it for decision analysis has also been appreciated. However, applications have been relatively few in number, sometimes stylized, and presented mainly to a statistical methods audience. As a result, the potential for multiparameter evidence synthesis in both epidemiology and health technology assessment has remained largely unrecognized. The advent of flexible software for Bayesian Markov chain Monte Carlo in the shape of WinBUGS has the made these earlier strands of work more widely available. Researchers can now carry out synthesis at a realistic level of complexity. The Bristol programme has not only contributed to a growing body of literature on how to synthesize different evidence structures, but also on how to check the consistency of multiple information sources and how to use the resulting models to prioritize future research.