Presentation (CTI)

OBJECTIVES: When head-to-head trials are missing, indirect treatment comparison (ITC) and network meta-analysis (NMA) carry the evidence. This study examined whether the JCA framework's expectations for indirect comparisons align with established international good-research-practice standards, and what the answer means for evidence planning.
METHODS: A methodological review compared HTACG guidance and early operational practice on ITC and NMA against widely used international standards, including the ISPOR Task Force good-research-practice reports on indirect and mixed-treatment comparisons and the NICE Decision Support Unit technical guidance. Particular attention was given to assumptions of homogeneity and transitivity, the handling of anchored and unanchored comparisons, and the treatment of comparisons judged of uncertain methodological suitability.
RESULTS: The review found broad conceptual alignment but important operational divergence. The framework leans toward a strict homogeneity requirement and tends to treat indirect comparisons of contested suitability as non-contributing to the conclusion, rather than weighting them by methodological quality. International good-practice guidance, by contrast, supports the structured, quality-graded use of indirect evidence where direct comparison is infeasible. The practical consequence is that evidence regarded as decision-relevant under recognised standards may be set aside in the JCA, with particular impact in oncology, rare diseases, and advanced therapies, where indirect comparison is often unavoidable. Developers also face uncertainty because the threshold for acceptable indirect evidence is not transparently specified.
CONCLUSIONS: Indirect evidence is not a luxury; in many indications it is the only evidence available. Anchoring JCA ITC and NMA expectations explicitly in international good-research-practice standards, and weighting rather than excluding contested comparisons, would improve both predictability and scientific credibility.