Heeg Bart, Garcia Andrea, Beekhuizen Sophie van, Verhoek Andre, Oostrum Ilse van, Roychoudhury Satrajit, Cappelleri Joseph Christopher, Postma Maarten Jacobus, Nicolaas Martinus Ouwens Mario Johannes
Cytel, 3012 NJ, Rotterdam, The Netherlands.
Pfizer, Inc., 235 E 42nd St, New York, NY 10017, USA.
J Comp Eff Res. 2022 Sep 12. doi: 10.2217/cer-2022-0044.
Technical Support Document 21 discusses trial-based, flexible relative survival models. The authors generalized flexible relative survival models to the network meta-analysis (NMA) setting while accounting for different treatment-effect specifications. The authors compared the standard parametric model with mixture, mixture cure and nonmixture cure, piecewise, splines and fractional polynomial models. The optimal treatment-effect parametrization was defined in two steps. First, all models were run with treatment effects on all parameters and subsequently the optimal model was defined by removing uncertain treatment effects, for which the parameter was smaller than its standard deviation. The authors used a network in previously treated advanced non-small-cell lung cancer. Flexible model-based NMAs impact fit and incremental mean survival and they increase corresponding uncertainty. Treatment-effect specification impacts incremental survival, reduces uncertainty and improves the fit statistic. Extrapolation techniques already available for individual trials can now be used for NMAs to ensure that the most plausible extrapolations are being used for health technology assessment submissions.
技术支持文件21讨论了基于试验的灵活相对生存模型。作者将灵活相对生存模型推广到网络荟萃分析（NMA）环境中，同时考虑了不同的治疗效果规范。作者将标准参数模型与混合模型、混合治愈和非混合治愈模型、分段模型、样条模型和分数多项式模型进行了比较。最佳治疗效果参数化分两步定义。首先，所有模型都在所有参数上运行治疗效果，随后通过去除不确定的治疗效果来定义最佳模型，即参数小于其标准差的情况。作者在先前接受治疗的晚期非小细胞肺癌中使用了一个网络。基于灵活模型的NMA会影响拟合度和增量平均生存期，并且会增加相应的不确定性。治疗效果规范会影响增量生存期，降低不确定性并改善拟合统计量。现在，个体试验中已经可用的外推技术可用于NMA，以确保在卫生技术评估提交中使用最合理的外推方法。
