American Journal of Epidemiology Advance Access originally published online on March 22, 2006
American Journal of Epidemiology 2006 163(9):811-817; doi:10.1093/aje/kwj122
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Meta-Analysis |
A Bayesian Meta-analysis of Prophylactic Granulocyte Colony-Stimulating Factor and Granulocyte-Macrophage Colony-Stimulating Factor in Children with Cancer
1 Department of Pediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
2 Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
3 Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
4 The Institute for Work and Health, Toronto, Ontario, Canada
5 Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA
Correspondence to Dr. Lillian Sung, Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada (e-mail: Lillian.sung{at}sickkids.ca).
The purpose of this analysis was to examine the efficacy of prophylactic hematopoietic colony-stimulating factors (CSFs) in pediatric cancer and to describe how a Bayesian meta-analysis can be conducted and then modified to incorporate information not readily included in a frequentist meta-analysis. Three Bayesian models were developed. The simplest model used the same data as a published frequentist meta-analysis. The second model included data that could not easily be incorporated into the frequentist meta-analysis, including data from different courses of chemotherapy and continuous outcomes that did not report variance estimates. The third model examined the effect of CSF type (granulocyte CSF vs. granulocyte-macrophage CSF). Compared with the frequentist model, the Bayesian model with the most data suggested a greater benefit of CSFs, with a 3.2-day reduction in duration of parenteral antibiotics (95% credible interval: –7.1, 0.7) in the expanded Bayesian model compared with a 0.8-day (95% confidence interval: –2.3, 0.7) reduction in the frequentist model. Bayesian meta-analysis also suggested that, compared with granulocyte-macrophage CSF, granulocyte CSF was associated with a 4.8-day decrease in the duration of parenteral antibiotics. Bayesian meta-analysis can readily include information not easily incorporated in a frequentist meta-analysis. Some treatment effect estimates were larger by a clinically important amount when additional data contributed to the pooled estimate.
Bayes theorem; granulocyte colony-stimulating factor; granulocyte-macrophage colony-stimulating factor; meta-analysis; neoplasms; pediatrics
Abbreviations: CSF, colony-stimulating factor; G-CSF, granulocyte colony-stimulating factor; GM-CSF, granulocyte-macrophage colony-stimulating factor