Transporting subgroup analyses of randomized trials for planning implementation of new interventions

Am J Epidemiol. 2021 Feb 22:kwab045. doi: 10.1093/aje/kwab045. Online ahead of print.ABSTRACTSubgroup analyses of randomized controlled trials guide resource allocation and implementation of new interventions by identifying groups of individuals who are likely to benefit most from the intervention. Unfortunately, trial populations are rarely representative of the target populations of public health or clinical interest; unless the relevant differences between trial and target populations are accounted for, subgroup results from trials might not reflect which groups in the target population will benefit most from the intervention. Transportability provides a rigorous framework for applying results derived in potentially highly selected study populations to external target populations. The method requires that researchers measure and adjust for all variables that (1) modify the effect of interest and (2) differ between the target and trial populations. To date, applications of transportability have focused on the external validity of overall study results and understanding within-trial heterogeneity; but this approach has not yet been used for subgroup analyses of trials. Through an example from the iPrEx study of HIV pre-exposure prophylaxis, we illustrate how transporting subgroup analyses can produce target-specific subgroup effect estimates and numbers needed to treat. This approach may lead to more tailored and accurate guidance for resource allocation and cost-effectivene...
Source: Am J Epidemiol - Category: Epidemiology Authors: Source Type: research