Uptake of Methodological Advances for Synthesis of Continuous and Time-to-event Outcomes Would Maximize Use of the Evidence Base

Objective: The objective of the study is to establish how often continuous and time-to-event outcomes are synthesized in health technology assessment (HTA), the statistical methods and software used in their analysis and how often evidence synthesis informs decision models.

Study Design And Setting: This is a review of National Institute of Health Research HTA reports, National Institute for Health and Care Excellence (NICE) technology appraisals, and NICE guidelines reporting quantitative meta-analysis or network meta-analysis of at least one continuous or time-to-event outcome published from April 01, 2018 to March 31, 2019.

Results: We identified 47 eligible articles. At least one continuous or time-to-event outcome was synthesized in 51% and 55% of articles, respectively. Evidence synthesis results informed decision models in two-thirds of articles. The review and expert knowledge identified five areas where methodology is available for improving the synthesis of continuous and time-to-event outcomes: i) outcomes reported on multiple scales, ii) reporting of multiple related outcomes, iii) appropriateness of the additive scale, iv) reporting of multiple time points, and v) nonproportional hazards. We identified three anticipated barriers to the uptake and implementation of these methods: i) statistical expertise, ii) software, and iii) reporting of trials.

Conclusion: Continuous and time-to-event outcomes are routinely reported in HTA. However, increased uptake of methodological advances could maximize the evidence base used to inform the decision making process.