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Meta-Analysis
. 2022:2345:187-201.
doi: 10.1007/978-1-0716-1566-9_12.

Network Meta-Analysis

Jennifer Watt  1   2   3 , Cinzia Del Giovane  4   5
Affiliations
Meta-Analysis

Network Meta-Analysis

Jennifer Watt et al. Methods Mol Biol. 2022.

Abstract

There are often multiple potential interventions to treat a disease; therefore, we need a method for simultaneously comparing and ranking all of these available interventions. In contrast to pairwise meta-analysis, which allows for the comparison of one intervention to another based on head-to-head data from randomized trials, network meta-analysis (NMA) facilitates simultaneous comparison of the efficacy or safety of multiple interventions that may not have been directly compared in a randomized trial. NMAs help researchers study important and previously unanswerable questions, which have contributed to a rapid rise in the number of NMA publications in the biomedical literature. However, the conduct and interpretation of NMAs are more complex than pairwise meta-analyses: there are additional NMA model assumptions (i.e., network connectivity, homogeneity, transitivity, and consistency) and outputs (e.g., network plots and surface under the cumulative ranking curves [SUCRAs]). In this chapter, we will: (1) explore similarities and differences between pairwise and network meta-analysis; (2) explain the differences between direct, indirect, and mixed treatment comparisons; (3) describe how treatment effects are derived from NMA models; (4) discuss key criteria predicating completion of NMA; (5) interpret NMA outputs; (6) discuss areas of ongoing methodological research in NMA; (7) outline an approach to conducting a systematic review and NMA; (8) describe common problems that researchers encounter when conducting NMAs and potential solutions; and (9) outline an approach to critically appraising a systematic review and NMA.

Keywords: Consistency; Direct treatment comparisons; Homogeneity; Indirect treatment comparisons; Mixed treatment comparisons; Network connectivity; Network meta-analysis; Pairwise meta-analysis; Systematic review; Transitivity.

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References

    1. Dias S, Sutton AJ, Ades AE, Welton NJ (2013) Evidence synthesis for decision making 2: a generalized linear modeling framework for pairwise and network meta-analysis of randomized controlled trials. Med Decis Mak 33:607–617 - DOI
    1. Zarin W, Veroniki AA, Nincic V, Varaei A, Reynen E, Motiwala SS, Antony J, Sullivan SM, Rios P, Daly C, Ewusie J, Petropoulou M, Nikolakopoulou A, Chaimani A, Salanti G, Straus SE, Tricco AC (2017) Characteristics and knowledge synthesis approach for 456 network meta-analyses: a scoping review. BMC Med 15(3)
    1. Jansen JP, Trikalinos T, Cappelleri JC, Daw J, Andes S, Eldessouki R, Salanti G (2014) Indirect treatment comparison/network meta-analysis study questionnaire to assess relevance and credibility to inform health care decision making: an ISPOR-AMCP-NPC good practice task force report. Value Health 17:157–173 - DOI
    1. Veroniki AA, Straus SE, Fyraridis A, Tricco AC (2016) The rank-heat plot is a novel way to present the results from a network meta-analysis including multiple outcomes. J Clin Epidemiol 76:193–199. https://doi.org/10.1016/j.jclinepi.2016.02.016 - DOI - PubMed
    1. Watt JA, Goodarzi Z, Veroniki AA, Nincic V, Khan PA, Ghassemi M, Thompson Y, Tricco AC, Straus SE (2019) Comparative efficacy of interventions for aggressive and agitated behaviors in dementia: a systematic review and network meta-analysis. Ann Intern Med 171(9):633–642. https://doi.org/10.7326/M19-0993 - DOI - PubMed

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