Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
PLoS One. 2011 Jan 21;6(1):e16237. doi: 10.1371/journal.pone.0016237.
Indirect comparisons are becoming increasingly popular for evaluating medical treatments that have not been compared head-to-head in randomized clinical trials (RCTs). While indirect methods have grown in popularity and acceptance, little is known about the fragility of confidence interval estimations and hypothesis testing relying on this method.
We present the findings of a simulation study that examined the fragility of indirect confidence interval estimation and hypothesis testing relying on the adjusted indirect method.
Our results suggest that, for the settings considered in this study, indirect confidence interval estimation suffers from under-coverage while indirect hypothesis testing suffers from low power in the presence of moderate to large between-study heterogeneity. In addition, the risk of overestimation is large when the indirect comparison of interest relies on just one trial for one of the two direct comparisons.
Indirect comparisons typically suffer from low power. The risk of imprecision is increased when comparisons are unbalanced.
间接比较在评估未在随机临床试验 (RCT) 中进行头对头比较的医疗治疗方法方面变得越来越流行。虽然间接方法越来越受欢迎并被接受，但对于依赖这种方法的置信区间估计和假设检验的脆弱性知之甚少。
我们介绍了一项模拟研究的结果，该研究检查了依赖调整间接法的间接置信区间估计和假设检验的脆弱性。
我们的研究结果表明，对于本研究考虑的情况，在存在中等至大的研究间异质性的情况下，间接置信区间估计存在覆盖不足的问题，而间接假设检验则存在低功效的问题。此外，当感兴趣的间接比较仅依赖于两个直接比较之一的一个试验时，高估的风险很大。
间接比较通常功效较低。当比较不平衡时，精度风险会增加。
