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in-depth feasibility assessment for performing an indirect treatment comparison

Asc Academics performed an in-depth feasibility assessment for an indirect treatment comparison (ITC), including network meta-analysis (NMA) and matching-adjusted indirect comparisons (MAIC), to provide the optimal information about performing indirect comparisons.

What we did

Project background

The client was launching a new oncology treatment and needed to know that all relevant treatments were compared against. Asc Academics performed an in-depth feasibility assessment for an indirect treatment comparison (ITC), including network meta-analysis (NMA) and matching-adjusted indirect comparisons (MAIC), to provide the optimal information about performing indirect comparisons.

Challenges faced

The main challenge was that the client’s new treatment was being investigated in a novel indication. This resulted in a discrepancy between comparator clinical trials and the client's trial. Along with additional differences, this made performing an ITC infeasible. However, it was uncertain whether all HTA agencies would agree with this conclusion.

Our solution

The solution was to perform a detailed and clear analysis that outlined why an ITC could not be performed in this indication and that the only relevant comparative information could be retrieved from the clinical trial. The analysis focused on the inherent assumptions of NMAs and MAICs and assessing to which extent these assumptions were violated. NMAs are the preferred methodology; however, they require a network of treatments that are connected by common comparators in respective RCTs and similar patient populations with regard to treatment effect modifiers (TEM). A review of published ITCs and HTA submissions was performed to determine which parameters would need to be similar between populations. Due to differences in indication and recruitment procedures, an NMA could not be performed. Therefore, the potential for performing both anchored and unanchored MAICs was assessed for treatments that could be seen as relevant comparators based on an investigation of the treatment landscape. Several TEMs were not reported in the comparator studies, and the difference in indication could not be adjusted to match the populations. The only MAIC possible would be severely biased and, due to the inherent reduction in precision arising from the matching process, i.e., a large reduction in effective sample size, would not be able to provide useful information on the relative effectiveness between the treatments. These limitations of the data and the available evidence were outlined in a detailed manner and concluded that no ITC would be possible.

Our impact

Our conclusions and evidence were accepted and supported by HTA agencies globally, providing our clients with an improved needed substantiation of the comparative landscape and eventually providing a large group of patients with much-needed access to improved therapeutic options for treating their cancer. The client’s satisfaction and continued collaboration proved the project's success.

Meet the experts

Bert Sloof, MSc

Bert Sloof, MSc

Steef Konings, Ph.D.

Steef Konings, Ph.D.

Timon Louwsma, MSc

Timon Louwsma, MSc

Services used

Evidence synthesis
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