Saint S, Veenstra D L, Sullivan S D
Department of Medicine, University of Washington, Seattle, USA.
Pharmacoeconomics. 1999 Jan;15(1):1-8. doi: 10.2165/00019053-199915010-00001.
Meta-analysis is used to statistically pool the results from individual studies, usually randomised trials, to obtain an estimate of the summary effect size across studies. The summary measure from a meta-analysis is often used to derive the probability of treatment success in a cost-effectiveness analysis. Recently, LeLorier and colleagues questioned the ability of meta-analysis to accurately predict the results of a subsequent large-scale trial, implying that the use of a summary measure from a meta-analysis may be inappropriate in an economic evaluation. We comment on this potential shortcoming by first providing an outline of the use of meta-analysis results in a cost-effectiveness analysis. Then, using examples of discrepancies between meta-analyses and subsequent large trials noted by LeLorier and colleagues, we examine the potential impact of using the results from a small trial versus a meta-analysis. We found that the meta-analyses were comparable to or better than small trials at predicting the results of subsequent large trials. We, therefore, argue that a meta-analysis of homogeneous studies can provide a reasonable estimate of the treatment effect for use in a cost-effectiveness analysis when no large, definitive clinical trial has been performed. However, care must be taken not to over-interpret the precision of the estimate, since both the homogeneity and quality of the primary studies need to be considered. We conclude by providing guidance on the appropriate use of summary measures derived from meta-analyses for cost-effectiveness studies.
Meta分析用于对各个研究（通常是随机试验）的结果进行统计学汇总，以获得各项研究汇总效应量的估计值。Meta分析得出的汇总指标常被用于推导成本效益分析中治疗成功的概率。最近，勒洛里埃及其同事对Meta分析准确预测后续大规模试验结果的能力提出质疑，这意味着在经济评估中使用Meta分析得出的汇总指标可能并不恰当。我们通过首先概述Meta分析结果在成本效益分析中的应用，来对这一潜在缺陷进行评论。然后，利用勒洛里埃及其同事指出的Meta分析与后续大型试验之间差异的实例，我们考察了使用小型试验结果与Meta分析结果的潜在影响。我们发现，在预测后续大型试验结果方面，Meta分析与小型试验相当或优于小型试验。因此，我们认为，在尚未开展大型确定性临床试验时，对同类研究进行Meta分析能够为成本效益分析提供合理的治疗效果估计值。然而，必须注意不要过度解读估计值的精确性，因为需要考虑原始研究的同质性和质量。我们通过为成本效益研究合理使用Meta分析得出的汇总指标提供指导来结束本文。
