Evaluating the Quality of Evidence from a Network Meta-Analysis

By Georgia Salanti, C. Del Giovane, A. Chaimani, D. Caldwell, Julian P. T. Higgins. PLoS ONE, 2014

1,249 citations recorded by the source corpus.

Systematic reviews that collate data about the relative effects of multiple interventions via network meta-analysis are highly informative for decision-making purposes. A network meta-analysis provides two types of findings for a specific outcome: the relative treatment effect for all pairwise comparisons, and a ranking of the treatments. It is important to consider the confidence with which these two types of results can enable clinicians, policy makers and patients to make informed decisions. We propose an approach to determining confidence in the output of a network meta-analysis. Our proposed approach is based on methodology developed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group for pairwise meta-analyses. The suggested framework for evaluating a network meta-analysis acknowledges (i) the key role of indirect comparisons (ii) the contributions of each piece of direct evidence to the network meta-analysis estimates of effect size; (iii) the importance of the transitivity assumption to the validity of network meta-analysis; and (iv) the possibility of disagreement between direct evidence and indirect evidence. We apply our proposed strategy to a systematic review comparing topical antibiotics without steroids for chronically discharging ears with underlying eardrum perforations. The proposed framework can be used to determine confidence in the results from a network meta-analysis. Judgements about evidence from a network meta-analysis can be different from those made about evidence from pairwise meta-analyses.

Subfields: Statistics and Probability

View Paper: https://www.semanticscholar.org/paper/dae9b4d6b08614f3647de36fe49a17d352673fd2

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Citations in the corpus

Visualizing Assumptions and Results in Network Meta-analysis: The Network Graphs Package (2015, methodology): “The bars are colored according to the bias level (see the edgecolor() option of the networkplot command), and their length is proportional to the percentage contribution of each direct comparison to the network estimates (Salanti et al. 2014).”
CINeMA: An approach for assessing confidence in the results of a network meta-analysis (2020, methodology): “In other words, we are not using assessments of confidence to decide whether to present direct or indirect (or combined) evidence, as has been suggested by others [4,5].”
Network Meta-Analysis: An Introduction for Clinicians (2016, methodology): “the indirect or mixed evidence overall [33].”
Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis (2020, neutral): “inconsistency using the ‘netsplit’ function).(17,18)”
CINeMA: Software for semiautomated assessment of the confidence in the results of network meta‐analysis (2020, positive): “While the main guiding principles of the CINeMA framework have been established (Nikolakopoulou et al., 2019; Salanti et al., 2014), specific methods, recommendations, and implementation of automated rules in CINeMA software are evolving.”