Urgency as the cardinal symptom of overactive bladder: a critical analysis

Cardozo, Linda; Chapple, Christopher R.; Wein, Alan J.

doi:10.1007/s00345-009-0445-6

Cited by 5 publications

(3 citation statements)

References 15 publications

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“…In the OAB example, the datasets used in univariate analyses for each outcome independently, included 115, 119 and 60 studies evaluating 97, 100, and 54 interventions for incontinence, voiding, and urgency episodes, respectively. Despite urgency being documented as “the cardinal symptom" of OAB [ 25 ], it was sufficiently under-reported in the original trials, and consequently fewer interventions were able to be evaluated in univariate analyses. Adopting a multivariate approach, we were able to borrow information across outcomes and consequently included 143 studies evaluating all 115 interventions for the management of incontinence, voiding and urgency.…”

Section: Discussionmentioning

confidence: 99%

“…However, many of the key symptoms are often under-reported. For example, in the current literature urgency is defined as “the cardinal symptom" of OAB [ 25 ], but there are far fewer studies evaluating interventions for urgency (n=62) compared to incontinence (n=117) and voiding episodes (n=124). This poses several limitations for decision makers; most notably, it is difficult to estimate both clinical and cost-effectiveness of interventions across the entire symptom syndrome.…”

Section: Introductionmentioning

confidence: 99%

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Multivariate network meta-analysis incorporating class effects

Owen

Bujkiewicz

Tincello

et al. 2020

BMC Med Res Methodol

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Background: Network meta-analysis synthesises data from a number of clinical trials in order to assess the comparative efficacy of multiple healthcare interventions in similar patient populations. In situations where clinical trial data are heterogeneously reported i.e. data are missing for one or more outcomes of interest, synthesising such data can lead to disconnected networks of evidence, increased uncertainty, and potentially biased estimates which can have severe implications for decision-making. To overcome this issue, strength can be borrowed between outcomes of interest in multivariate network meta-analyses. Furthermore, in situations where there are relatively few trials informing each treatment comparison, there is a potential issue with the sparsity of data in the treatment networks, which can lead to substantial parameter uncertainty. A multivariate network meta-analysis approach can be further extended to borrow strength between interventions of the same class using hierarchical models. Methods: We extend the trivariate network meta-analysis model to incorporate the exchangeability between treatment effects belonging to the same class of intervention to increase precision in treatment effect estimates. We further incorporate a missing data framework to estimate uncertainty in trials that did not report measures of variability in order to maximise the use of all available information for healthcare decision-making. The methods are applied to a motivating dataset in overactive bladder syndrome. The outcomes of interest were mean change from baseline in incontinence, voiding and urgency episodes. All models were fitted using Bayesian Markov Chain Monte Carlo (MCMC) methods in WinBUGS. Results: All models (univariate, multivariate, and multivariate models incorporating class effects) produced similar point estimates for all treatment effects. Incorporating class effects in multivariate models often increased precision in treatment effect estimates. Conclusions: Multivariate network meta-analysis incorporating class effects allowed for the comparison of all interventions across all outcome measures to ameliorate the potential impact of outcome reporting bias, and further borrowed strength between interventions belonging to the same class of treatment to increase the precision in treatment effect estimates for healthcare policy and decision-making.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multivariate network meta-analysis incorporating class effects

Owen

Bujkiewicz

Tincello

et al. 2020

BMC Med Res Methodol

View full text Add to dashboard Cite

show abstract

“…In recent literature, urgency has been described as the cardinal symptom of OAB and it is the only essential symptom when making the diagnosis . In a study by Coyne et al, the experience of urinary urgency had a significant negative effect on HRQL and increased symptom bother more than incontinence, frequency or nocturia.…”

Section: Discussionmentioning

confidence: 99%