Conceptual and Technical Challenges in Network Meta-analysis
Top Cited Papers
- 16 July 2013
- journal article
- research article
- Published by American College of Physicians in Annals of Internal Medicine
- Vol. 159 (2), 130-137
- https://doi.org/10.7326/0003-4819-159-2-201307160-00008
Abstract
The increase in treatment options creates an urgent need for comparative effectiveness research. Randomized, controlled trials comparing several treatments are usually not feasible, so other methodological approaches are needed. Meta-analyses provide summary estimates of treatment effects by combining data from many studies. However, an important drawback is that standard meta-analyses can compare only 2 interventions at a time. A new meta-analytic technique, called network meta-analysis (or multiple treatments meta-analysis or mixed-treatment comparison), allows assessment of the relative effectiveness of several interventions, synthesizing evidence across a network of randomized trials. Despite the growing prevalence and influence of network meta-analysis in many fields of medicine, several issues need to be addressed when constructing one to avoid conclusions that are inaccurate, invalid, or not clearly justified. This article explores the scope and limitations of network meta-analysis and offers advice on dealing with heterogeneity, inconsistency, and potential sources of bias in the available evidence to increase awareness among physicians about some of the challenges in interpretation.Keywords
This publication has 34 references indexed in Scilit:
- Simulation evaluation of statistical properties of methods for indirect and mixed treatment comparisonsBMC Medical Research Methodology, 2012
- Directed acyclic graphs can help understand bias in indirect and mixed treatment comparisonsJournal of Clinical Epidemiology, 2012
- Prospective systematic review registration: perspective from the Guidelines International Network (G-I-N)Systematic Reviews, 2012
- The nuts and bolts of PROSPERO: an international prospective register of systematic reviewsSystematic Reviews, 2012
- Network meta-analysis-highly attractive but more methodological research is neededBMC Medicine, 2011
- Indirect Comparisons: A Review of Reporting and Methodological QualityPLOS ONE, 2010
- A Re-Evaluation of Random-Effects Meta-AnalysisJournal of the Royal Statistical Society Series A: Statistics in Society, 2008
- Measuring inconsistency in meta-analysesBMJ, 2003
- Issues in the selection of a summary statistic for meta‐analysis of clinical trials with binary outcomesStatistics in Medicine, 2002
- How should meta‐regression analyses be undertaken and interpreted?Statistics in Medicine, 2002