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Related Experiment Video

Updated: Jun 26, 2026

An R-Based Landscape Validation of a Competing Risk Model

An R-Based Landscape Validation of a Competing Risk Model

Published on: September 16, 2022

Indirect comparison: relative risk fallacies and odds solution.

Simon Eckermann¹, Michael Coory, Andrew R Willan

¹Flinders University, Flinders Centre for Clinical Change & Health Care Research, Adelaide, South Australia, Australia. simon.eckermann@flinders.edu.au

Journal of Clinical Epidemiology

|January 31, 2009

Summary

Relative risk (RR) in indirect comparisons can be misleading due to outcome framing. Odds ratios (ORs) provide a stable alternative, avoiding inferential fallacies in treatment effect analysis.

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Last Updated: Jun 26, 2026

An R-Based Landscape Validation of a Competing Risk Model

An R-Based Landscape Validation of a Competing Risk Model

Published on: September 16, 2022

Area of Science:

Biostatistics
Clinical Epidemiology
Health Economics

Background:

Indirect treatment comparisons are crucial for evaluating therapies when head-to-head trials are absent.
Relative risk (RR) is frequently used to express treatment effects, especially when baseline risks vary.
However, the choice of outcome framing can impact the interpretation of RR.

Purpose of the Study:

To demonstrate the instability of relative risk (RR) in indirect comparisons when outcome framing is altered.
To highlight the potential for inferential fallacies arising from the use of RR.
To propose odds ratios (ORs) as a more stable and reliable measure for indirect comparisons.

Main Methods:

The study analyzes the use of RR in indirect comparisons, focusing on how framing (e.g., progression vs. no progression) affects results.
It illustrates inferential fallacies using a case study comparing natalizumab and interferon beta-1b for multiple sclerosis.
The application of odds ratios (ORs) is presented as a solution to these framing-dependent issues.

Main Results:

Using RR, natalizumab showed a 30% greater effect than interferon for disease progression (RR=0.70).
Conversely, RR suggested natalizumab was 16% less effective for no progression (RR=0.84), an anomaly.
Odds ratios (ORs) resolved this discrepancy, showing consistent results for progression (OR=0.83) and no progression (OR=1.21).

Conclusions:

The use of relative risk (RR) in indirect comparisons can lead to contradictory conclusions based on outcome framing.
This instability can be exploited or lead to confounded decision-making in treatment evaluation.
Odds ratios (ORs) provide a robust solution, ensuring consistent and reliable inference of treatment effects regardless of outcome framing.