Accessibility statement

Evidence Synthesis


Contacts: Beth Woods, Pedro Saramago Goncalves

A key principle when developing models for economic evaluation is that they should reflect all relevant evidence. For some model parameters, multiple estimates will be available, and in such situations there is often a need to combine or synthesise these sources of evidence. Most commonly this involves synthesizing information on the effects of treatment from multiple randomized controlled trials. This requires a set of methods called meta-analysis when only two treatments are considered, and a set of methods called network meta-analysis or mixed treatment comparisons when more than two treatments are being compared. However, there is also a need to synthesise other types of data to inform decision models for economic evaluation. For example, multiple studies might be available relating to the long-term consequences of a health event and these can also be synthesised.

The Centre for Health Economics has developed a broad range of expertise in synthesising evidence to populate cost-effectiveness models, including the development and application of methods for:

  • Combining evidence from different study designs, including combining evidence from randomized-controlled trials with evidence from observational studies and elicited expert opinion;
  • Synthesising individual patient data, and combining this with data available only in summary form from the published literature;
  • Synthesising data relating to a single clinical outcome, but reported in different formats across different studies; and
  • Reflecting the uncertainty around parameters estimated via synthesis within decision models.



Saramago Goncalves P, Espinoza MA, Sutton AJ, Manca A, Claxton K. The value of further research: The added value of individual-participant level data. Applied Health Economics and Health Policy 2019;17(3):273-284. 

Yang H, Llewellyn A, Walker R, Harden M, Saramago Goncalves P, Griffin S et al. High-throughput, non-invasive prenatal testing for fetal rhesus D status in RhD- negative women: a systematic review and meta-analysis. BMC Medicine 2019;17:37. 


Bee P, Pedley R, Rithalia A, Richardson G, Pryjmachuk S, Kirk S, Bower P. Self-care support for children and adolescents with long-term conditions:the REfOCUS evidence synthesis. NIHR HS&DR Journal 2018;6(3).

Norman G, Westby M, Rithalia A, Stubbs N, Soares M, Dumville JC. Dressings and topical agents for treating venous leg ulcers. Cochrane Database of Systematic Reviews 2018;15(6):CD012583.

Peron M, Llewellyn A, Moe-Byrne T, Walker S, Walton M, Harden M, Palmer S, Simmonds M. Adjunctive colposcopy technologies for assessing suspected cervical abnormalities: Systematic reviews and economic evaluation. Health Technology Assessment 2018;22(54).

Saramago Goncalves P, Yang H, Llewellyn A, Walker R, Harden M, Palmer S, Griffin S, Simmonds M.High-throughput non-invasive prenatal testing for fetal rhesus D status in RhD-negative women not known to be sensitised to the RhD antigen: a systematic review and economic evaluation. Health Technology Assessment 2018;22(13):1-172.

Wade R, Grosso A, South E, Rothery C, Saramago Goncalves P, Schmitt L, Wright K, Palmer S. Brodalumab for the treatment of moderate to severe plaque psoriasis: an Evidence Review Group evaluation of a NICE Single Technology Appraisal. Pharmacoeconomics 2018;doi:10.1007/s40273-018-0698-2.


Corbett M, Chehadah F, Biswas M, Moe-Byrne T, Palmer S, Soares M, Walton M, Harden M, Ho P, Woolacott N, Bojke L. Certolizumab pegol and secukinumab for treating active psoriatic arthritis following inadequate response to disease-modifying antirheumatic drugs: a systematic review and economic evaluation. Health Technology Assessment 2017;21(56):1-326.

Dhami S, Nurmatov U, Arasi S, Khan T, Asaria M, et al. Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic review and meta-analysis. Allergy 2017;72(11):1597-1631.

Dhami S, Kakourou A, Asamoah F, et al. Asaria M, Netuveli G, Zaman H, Akhlaq A, Sheikh A. Allergen immunotherapy for allergic asthma: a systematic review and meta-analysis. Allergy 2017;72(12):1825-1848.

Dhami S, Zaman H, Varga E-M, Sturm GJ, Muraro A, Akdis CA, Antolin-Amerigo D, Bilo MB, Bokanovic D, Calderon MA, Cichocka-Jarosz E, Oude Elberink JNG, Gawlik R, Jakob T, Kosnik M, Lange J, Mingomataj E, Mitsias DI, Mosbech H, Ollert M, Pfaar O, Pitsios C, Pravettoni V, Roberts G, Rueff F, Sin BA, Asaria M, Netuveli G, Sheikh A. Allergen immunotherapy for insect venom allergy: a systematic review and meta-analysis. Allergy 2017;72(3):342-365.

Duarte A, Mebrahtu T, Goncalves PS, Harden M, Murphy R, Palmer S, Woolacott N, Rodgers M, Rothery C. Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation. Health Technology Assessment 2017;21(64):1-244. 

MacPherson H, Vickers A, Bland M, Torgerson D, Corbett M, Spackman E, Saramago P, Woods B, Weatherly H, Sculpher M, Manca A, Richmond S, Hopton A, Eldred J, Watt I. Acupuncture for chronic pain and depression in primary care: a programme of research. Programme Grants for Applied Research 2017;5(3). 

Saramago Goncalves P, Duarte A, Rothery C, Palmer S. Tackling network meta-analysis methodological challenges: a case study on biologic treatments for moderate to severe plaque psoriasis in children and young people. Value in Health 2017;20(9):A756.

Westby M, Dumville JC, Soares M, Stubbs N, Norman G. Dressings and topical agents for treating pressure ulcers. Cochrane Database of Systematic Reviews 2017; Issue 6:CD011947.


Corbett M, Soares M, Jhuti G, Rice S, Spackman E, Sideris E, Moe-Byrne T, Fox D, Marzo-Ortega H, Kay L, Woolacott N, Palmer S. Tumour necrosis factor-α inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review and economic evaluation. Health Technology Assessment 2016;20(9):doi.10.3310/hta20090.

Farrar D, Simmonds M, Griffin S, Duarte A, Lawlor DA, Sculpher M et al. The identification and treatment of women with hyperglycaemia in pregnancy: an analysis of individual participant data, systematic reviews, meta-analyses and an economic evaluation. Health Technology Assessment 2016;20(86):1-382.

Hawkins N, Scott DA, Woods B. ‘Arm-based’ parameterization for network meta-analysis. Research Synthesis Methods 2016;7(3):306-313.
Mealing S, Woods BS, Hawkins N, Cowie MR, Plummer C, Abraham W et al. Cost-effectiveness of implantable cardiac devices in patients with systolic heart failure. Heart 2016;Jul 13.

Saramago P, Woods B, Weatherly H, Manca A, Sculpher M, Khan K, Vickers AJ, MacPherson H. Methods for network meta-analysis of continuous outcomes using individual patient data: a case study in acupuncture for chronic pain. BMC Medical Research Methodology 2016;16(1):131.


Cullum N, Buckley HL, Dumville J, Hall J, Lamb K, Madden MT, Morley R, O'Meara SM, Saramago Goncalves PR, Soares MO, Stubbs, N. Wounds research for patient benefit: a 5 year programme of research. Health Technology Assessment 2015.

Hawkins N, Scott DA, Woods B. 'Arm-based' parameterization for network meta-analysis. Research Synthesis Methods 2015;doi:10.1002/jrsm.1187.

Scott DA, Woods B, Thompson JC, Clark JF, Hawkins N, Chambers M et al. Mortality and drug therapy in patients with chronic obstructive pulmonary disease: a network meta-analysis. BMC Pulmonary Medicine 2015;15:145. Available from: 10.1186/s12890-015-0138-4.

Welton NJ, Soares MO, Palmer S, Ades AE, Harrison D, Shankar-Hari M, Rowan KM. Accounting for heterogeneity in relative treatment effects for use in cost-effectiveness models and value-of-information analyses. Medical Decision Making 2015;doi:10.1177/0272989X15570113.

Woods B, Hawkins N, Mealing S, Sutton A, Abraham WT, Beshai JF et al. Individual patient data network meta-analysis of mortality effects of implantable cardiac devices. Heart 2015;101(22):1800-1806. Available from: 10.1136/heartjnl-2015-307634.


Ashby RL, Gabe R, Ali S, Saramago P, Chuang L-H, Adderley U, Bland JM, Cullum NA, Dumville JC, Iglesias Urrutia CP, Kang'ombe AR, Soares MO, Stubbs NC, Torgerson DJ. VenUS IV (Venous leg Ulcer Study IV) - compression hosiery compared with compression bandaging in the treatment of venous leg ulcers: a randomised controlled trial, mixed-treatment comparison and decision-analytic model. Health Technology Assessment 2014;18:57:doi:10.3310/hta18570.

Soares MO, Dumville JC, Ades AE, Welton NJ. Treatment comparisons for decision making: facing the problems of sparse and few data. Journal of the Royal Statistical Society: Series A (Statistics in Society) 2014;177(1):259-279:doi:10.1111/rssa.12010.

Saramago P, Chuang L-H, Soares MO. Network meta-analysis of (individual patient) time to event data alongside (aggregate) count data. BMC Medical Research Methodology 2014;14:105:doi:10.1186/1471-2288-14-105.


Epstein D, Mochón LG, Espín J, Soares MO. Use of multiparameter evidence synthesis to assess the appropriateness of data and structure in decision models. Medical Decision Making 2013;33(5):715-730:doi:10.1177/0272989X13480130.

Soares MO, Dumville J, Ashby RL, Iglesias Urrutia CP, Bojke L, Adderley UJ, McGinnis E, Stubbs N, Torgerson DJ, Claxton KP, Cullum N. Methods to assess cost effectiveness and value of further research when data are sparse: negative-pressure wound therapy for severe pressure ulcers. Medical Decision Making 2013;33(3):415-436:doi:10.1177/0272989X12451058.


Cooper NJ, Kendrick D, Achana F, Dhiman P, He Z, Wynn P, Le Cozannet E, Saramago P, Sutton AJ. Network meta-analysis to evaluate the effectiveness of interventions to increase the uptake of smoke alarms. Epidemiologic Reviews 2012;34(1):32-45doi:10.1093/epirev/mxr015.

Dumville JC, Soares MO, O'Meara S, Cullum N. Systematic review and mixed treatment comparison: dressings to heal diabetic foot ulcers. Diabetologia 2012;55(7):1902-1910:doi:10.1007/s00125-012-2558-5.

Saramago Goncalves PR, Sutton A, Cooper N, Manca A. Mixed treatment comparisons using aggregate- and individual-participant level data. Statistics in Medicine 2012;31(28):3516-3536:doi:10.1002/sim.5442.

Soares MO, Welton NJ, Harrison DA, Peura P, Shankar- Hari M, Harvey SE, Madan JJ, Ades AE, Palmer SJ, Rowan KM. An evaluation of the feasibility, cost and value of information of a multicentre randomised controlled trial of intravenous immunoglobulin for sepsis (severe sepsis and septic shock): incorporating a systematic review, meta-analysis and value of information analysis. Health Technology Assessment 2012;16(7):1-186:doi:10.3310/hta16070.