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A threshold analysis assessed the credibility of conclusions from network meta-analysis

Research output: Contribution to journalArticle

Original languageEnglish
Number of pages9
JournalJournal of Clinical Epidemiology
Early online date16 Jul 2016
DOIs
StateE-pub ahead of print - 16 Jul 2016

Abstract

Objective: To assess the reliability of treatment recommendations based on network meta-analysis (NMA)

Study design: We consider evidence in an NMA to be potentially biased. Taking each pair-wise contrast in turn we use a structured series of threshold analyses to ask: (a) “How large would the bias in this evidence-base have to be before it changed our decision?” and (b) “If the decision changed, what is the new recommendation?” We illustrate the method via two NMAs in which a GRADE assessment for NMAs has been implemented: weight-loss and osteoporosis.

Results. Four of the weight-loss NMA estimates were assessed as “low” and 6 as “moderate” quality by GRADE; for osteoporosis 6 were “low”, 9 “moderate” and 1 “high”. The threshold analysis suggests plausible bias in 3 of 10 estimates in the weight-loss network could have changed the treatment recommendation. For osteoporosis plausible bias in 6 of 16 estimates could change the recommendation. There was no relation between plausible bias changing a treatment recommendation and the original GRADE assessments.

Conclusions. Reliability judgements on individual NMA contrasts do not help decision makers understand whether a treatment recommendation is reliable. Threshold analysis reveals whether the final recommendation is robust against plausible degrees of bias in the data.

Research areas

  • mixed treatment comparison, comparative effectiveness, health technology assessment, GRADE, reliability, quality assessment, bias

Documents

Documents

  • Full-text PDF (accepted author manuscript)

    Rights statement: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at http://dx.doi.org/10.1016/j.jclinepi.2016.07.003. Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 505 KB, PDF-document

    Embargo ends: 15/07/17

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    License: CC BY-NC-ND

  • Supplementary information PDF

    Rights statement: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at http://dx.doi.org/10.1016/j.jclinepi.2016.07.003. Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 369 KB, PDF-document

    Embargo ends: 15/07/17

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    License: CC BY-NC-ND

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