Welcome to our research page featuring recent publications in the field of biostatistics and epidemiology! These fields play a crucial role in advancing our understanding of the causes, prevention, and treatment of various health conditions. Our team is dedicated to advancing the field through innovative studies and cutting-edge statistical analyses. On this page, you will find our collection of research publications describing the development of new statistical methods and their application to real-world data. Please feel free to contact us with any questions or comments.
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Objective: To determine whether assessment tools for non-randomised studies (NRS) address critical elements that influence the validity of NRS findings for comparative safety and effectiveness of medications.
Design: Systematic review and Delphi survey.
Data sources: We searched PubMed, Embase, Google, bibliographies of reviews and websites of influential organisations from inception to November 2019. In parallel, we conducted a Delphi survey among the International Society for Pharmacoepidemiology Comparative Effectiveness Research Special Interest Group to identify key methodological challenges for NRS of medications. We created a framework consisting of the reported methodological challenges to evaluate the selected NRS tools.
Study selection Checklists or scales assessing NRS.
Data extraction: Two reviewers extracted general information and content data related to the prespecified framework.
Results: Of 44 tools reviewed, 48% (n=21) assess multiple NRS designs, while other tools specifically addressed case-control (n=12, 27%) or cohort studies (n=11, 25%) only. Response rate to the Delphi survey was 73% (35 out of 48 content experts), and a consensus was reached in only two rounds. Most tools evaluated methods for selecting study participants (n=43, 98%), although only one addressed selection bias due to depletion of susceptibles (2%). Many tools addressed the measurement of exposure and outcome (n=40, 91%), and measurement and control for confounders (n=40, 91%). Most tools have at least one item/question on design-specific sources of bias (n=40, 91%), but only a few investigate reverse causation (n=8, 18%), detection bias (n=4, 9%), time-related bias (n=3, 7%), lack of new-user design (n=2, 5%) or active comparator design (n=0). Few tools address the appropriateness of statistical analyses (n=15, 34%), methods for assessing internal (n=15, 34%) or external validity (n=11, 25%) and statistical uncertainty in the findings (n=21, 48%). None of the reviewed tools investigated all the methodological domains and subdomains.
Conclusions: The acknowledgement of major design-specific sources of bias (eg, lack of new-user design, lack of active comparator design, time-related bias, depletion of susceptibles, reverse causation) and statistical assessment of internal and external validity is currently not sufficiently addressed in most of the existing tools. These critical elements should be integrated to systematically investigate the validity of NRS on comparative safety and effectiveness of medications.
Systematic review protocol and registration: https://osf.io/es65q.
Background: Individual participant data meta-analysis (IPD-MA) is considered the gold standard for investigating subgroup effects. Frequently used regression-based approaches to detect subgroups in IPD-MA are: meta-regression, per-subgroup meta-analysis (PS-MA), meta-analysis of interaction terms (MA-IT), naive one-stage IPD-MA (ignoring potential study-level confounding), and centred one-stage IPD-MA (accounting for potential study-level confounding). Clear guidance on the analyses is lacking and clinical researchers may use approaches with suboptimal efficiency to investigate subgroup effects in an IPD setting. Therefore, our aim is to overview and compare the aforementioned methods, and provide recommendations over which should be preferred.
Methods: We conducted a simulation study where we generated IPD of randomised trials and varied the magnitude of subgroup effect (0, 25, 50%; relative reduction), between-study treatment effect heterogeneity (none, medium, large), ecological bias (none, quantitative, qualitative), sample size (50,100,200), and number of trials (5,10) for binary, continuous and time-to-event outcomes. For each scenario, we assessed the power, false positive rate (FPR) and bias of aforementioned five approaches.
Results: Naive and centred IPD-MA yielded the highest power, whilst preserving acceptable FPR around the nominal 5% in all scenarios. Centred IPD-MA showed slightly less biased estimates than naïve IPD-MA. Similar results were obtained for MA-IT, except when analysing binary outcomes (where it yielded less power and FPR <5%). PS-MA showed similar power as MA-IT in non-heterogeneous scenarios, but power collapsed as heterogeneity increased, and decreased even more in the presence of ecological bias. PS-MA suffered from too high FPRs in non-heterogeneous settings and showed biased estimates in all scenarios. Meta-regression showed poor power (<20%) in all scenarios and completely biased results in settings with qualitative ecological bias.
Conclusions: Our results indicate that subgroup detection in IPD-MA requires careful modelling. Naive and centred IPD-MA performed equally well, but due to less bias of the estimates in the presence of ecological bias, we recommend the latter.
In light of increasing attention towards the use of Real-World Evidence (RWE) in decision making in recent years, this commentary aims to reflect on the experiences gained in accessing and using RWE for Comparative Effectiveness Research (CER) as part of the Innovative Medicines Initiative GetReal Consortium (IMI-GetReal) and discuss their implications for RWE use in decision-making. For the purposes of this commentary, we define RWE as evidence generated based on health data collected outside the context of RCTs. Meanwhile, we define Comparative Effectiveness Research (CER) as the conduct and/or synthesis of research comparing different benefits and harms of alternative interventions and strategies to prevent, diagnose, treat, and monitor health conditions in routine clinical practice (i.e. the real-world setting). The equivalent term for CER as used in the European context of Health Technology Assessment (HTA) and decision making is Relative Effectiveness Assessment (REA).
