Controlling for Drug Dose in Systematic Review and Meta-Analysis: A Case Study of the Effect of Antidepressant Dose

Richard A. Hansen, Charity G. Moore, Stacie B. Dusetzina, Brian I. Leinwand, Gerald Gartlehner and Bradley N. Gaynes
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Richard A. Hansen: University of North Carolina-School of Pharmacy, Chapel Hill, rahansen@unc.edu
Charity G. Moore: University of Pittsburgh-School of Medicine
Stacie B. Dusetzina: University of North Carolina-School of Pharmacy, Chapel Hill
Brian I. Leinwand: University of North Carolina-School of Pharmacy, Chapel Hill
Gerald Gartlehner: Department for Clinical Epidemiology and Evidence-based Medicine, Danube University, Krems, Austria
Bradley N. Gaynes: University of North Carolina-School of Medicine, Chapel Hill

Medical Decision Making, 2009, vol. 29, issue 1, 91-103

Abstract: Purpose . To describe a method for quantitatively dealing with drug dose in comparative effectiveness reviews. Second-generation antidepressants are used as an example to illustrate this method and to determine whether dose influences conclusions on comparative effectiveness. Methods . Studies previously identified in a systematic review of second-generation antidepressants were included if data on drug dose were available. The usual dosing range for each drug was defined and then used to create 2- and 3-level dose categories. Placebo-controlled data were used to calculate overall effect sizes for the drug class and effect sizes stratified by drug dose. Meta-regression tested the impact of dose on effect size. Weighted mean differences and risk ratios were calculated for comparative studies, stratifying by whether compared doses were equivalent. Results . The dose classification method was able to identify dose-response trends in the context of meta-analysis. Compared to low-dose studies, medium- and high-dose studies had a 1- to 2-point greater differential in mean Hamilton Depression Rating Scale (HAM-D) change ( P

Keywords: meta-analysis; meta-regression; dose; dose-response; comparative effectiveness. (Med Decis Making 2009; 29:91—103) (search for similar items in EconPapers)
Date: 2009
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:29:y:2009:i:1:p:91-103

DOI: 10.1177/0272989X08323298

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