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Evidence in practice: Meta-analysis

Each month, hundreds of medical products come to market and many are competing for sales in the same space. Most will come to market with data supporting their use over the current standard of care, but how credible and persuasive is the evidence? This makes the question of: “which products to provide and reimburse?” an extremely complex one for payers. Strengthening the evidence base of your product through meta-analysis could help push it to the front of the queue.

For medical companies, it is impossible to directly assess the clinical and economic effectiveness of their product against all possible competitors. Similarly, where studies do exist they may individually be underpowered to demonstrate the full potential of a product for all outcomes of relevance. Meta-analysis can be a powerful tool to address this issue, as it combines the data of several studies into a single estimate for efficacy, safety, and efficiency. True for all medical products, it is of specific importance to medical devices as traditionally these products have a weaker evidence base on with which to support their clinical effectiveness  (Taylor and Iglesias 2009, Assessing the Clinical and Cost-Effectiveness of Medical Devices and Drugs: Are They That Different?; Iglesias 2015, Does assessing the value for money of therapeutic medical devices require a flexible approach?). Health technology assessment is coming to the consensus that evidence synthesis of clinical and economic data through meta-analysis and network meta-analysis is critical for assessment of the value of medical products relative to one or multiple competitors (Tarricone 2017, Challenges in the Assessment of Medical Devices: The MedtecHTA Project.).

The robust estimates of efficacy and safety, such as those provided by meta-analysis, are of increasing importance to healthcare and market access. Meta-analysis identifies which product or which of a set of products is most efficacious or safe for use in the analysed setting. Synthesizing data from many sources, meta-analysis gives a robust, overall estimate of comparative performance. Results can be important and informative, as multiple studies showing non-significant benefit may result in a significant difference between products; or significant benefit observed in a few trials may be outweighed by multiple trials showing no difference between products. Meta-analyses are viewed as some of the highest levels of clinical evidence available and their outcomes are often published in respected clinical journals.

Last year, meta-analyses from Coreva Scientific were published in BMJ Open and the International Journal of Surgery.