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Area of Science:

  • Health Technology Assessment (HTA)
  • Evidence Synthesis
  • Biostatistics

Background:

  • Limited direct evidence is a common challenge in HTA, particularly for specific populations or due to study design limitations.
  • Existing HTA methods for handling indirect evidence include disregarding it ('splitting') or fully incorporating it ('lumping'), with limited options for moderate information-sharing.

Purpose of the Study:

  • To describe and implement various information-sharing methods for incorporating indirect evidence in HTA.
  • To evaluate the impact of different information-sharing methods on the assessment of effectiveness, cost-effectiveness, and value of research.
  • To provide metrics for quantifying the degree of information-sharing.

Main Methods:

  • A case study was conducted to evaluate intravenous immunoglobulin for severe sepsis and septic shock.
  • Multiple information-sharing methods were implemented, ranging from no sharing to full sharing.
  • Metrics were developed to assess the degree of information-sharing and its impact on study outcomes.

Main Results:

  • The choice of information-sharing method significantly impacted the results, with odds ratio estimates ranging from 0.55 to 0.90.
  • Incremental cost-effectiveness ratios varied widely (£16,000-£52,000 per quality-adjusted life year gained) depending on the method used.
  • The necessity for future research also differed across the information-sharing models.

Conclusions:

  • When indirect evidence is relevant, a comprehensive range of information-sharing methods should be considered in HTA.
  • Method selection requires a deliberative process, weighing the plausibility of assumptions against the degree of information-sharing.
  • Careful consideration of heterogeneity in indirect evidence is crucial as it can substantially influence estimates.