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KMID : 1146320130010010069
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Journal of Health Technology Assessment
2013 Volume.1 No. 1 p.69 ~ p.74
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Use of Indirect Comparisons for Evaluation of Health Care Technologies
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Han Seo-Kyung
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Abstract
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We firstly reviewed the theoretical and practical background of the indirect comparisons that are considered for evaluation of health care technologies. We then discussed the fundamental assumptions behind the methods of synthesis of comparative effects using indirect comparisons; that is basically the combinability at different levels in the trials that constitute the indirect comparison. When competing interventions have not been evaluated in head-to-head randomized controlled trials or there is little available source by those trials, indirect comparisons may be utilized to provide an estimate of the comparative effect. However, the limitations also need to be highlighted, since the indirect comparison methodology relies upon certain important but conceptual and essentially unverifiable key assumption. There have been useful approaches suggested in the methodological literature to dealing with validity of the assumptions statistically. We suggest that the currently available guideline by Korean Health Insurance Review and Assessment Agency would also better consider these options. However, a caution should also always be required in application of the methods. Every methodological approach has not only certain limitations but we also only could expect gains from the applications when there are enough data. In practical circumstances where use of the indirect comparison methods is mostly an issue in Korea, especially in the process for the new drug listing, there is little head-to-head existing trial rather than the method is considered to strengthen the evidence when there are enough data for methodological exploration of the assumptions. Conducting indirect comparisons without an adequate assessment for those assumptions could mislead the conclusion on the comparative effectiveness.
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KEYWORD
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Indirect comparison, Health technology assessment, Clinical evaluation
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