Bayesian Hierarchical Models for Meta-Analysis of Quality-of-Life Outcomes: An Application in Multimorbidity.

Abstract:

BACKGROUND:Health-related quality of life (HRQoL) is a key outcome in cost-utility analyses, which are commonly used to inform healthcare decisions. Different instruments exist to evaluate HRQoL, however while some jurisdictions have a preferred system, no gold standard exists. Standard meta-analysis struggles with the variety of outcome measures, which may result in the exclusion of potentially relevant evidence. OBJECTIVE:Using a case study in multimorbidity, the objective of this analysis is to illustrate how a Bayesian hierarchical model can be used to combine data across different instruments. The outcome of interest is the slope relating HRQoL to the number of coexisting conditions. METHODS:We propose a three-level Bayesian hierarchical model to systematically include a large number of studies evaluating HRQoL using multiple instruments. Random effects assumptions yield instrument-level estimates benefitting from borrowing strength across the evidence base. This is particularly useful where little evidence is available for the outcome of choice for further evaluation. RESULTS:Our analysis estimated a reduction in quality of life of 3.8-4.1% per additional condition depending on HRQoL instrument. Uncertainty was reduced by approximately 80% for the instrument with the least evidence. CONCLUSION:Bayesian hierarchical models may provide a useful modelling approach to systematically synthesize data from HRQoL studies.

journal_name

Pharmacoeconomics

journal_title

PharmacoEconomics

authors

Schmitz S,Makovski TT,Adams R,van den Akker M,Stranges S,Zeegers MP

doi

10.1007/s40273-019-00843-z

subject

Has Abstract

pub_date

2020-01-01 00:00:00

pages

85-95

issue

1

eissn

1170-7690

issn

1179-2027

pii

10.1007/s40273-019-00843-z

journal_volume

38

pub_type

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