Article

Interpreting Indirect Treatment Comparisons and Network Meta-Analysis for Health-Care Decision Making: Report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: Part 1

Mapi Values, Boston, MA, USA.
Value in Health (Impact Factor: 3.28). 06/2011; 14(4):417-28. DOI: 10.1016/j.jval.2011.04.002
Source: PubMed

ABSTRACT

Evidence-based health-care decision making requires comparisons of all relevant competing interventions. In the absence of randomized, controlled trials involving a direct comparison of all treatments of interest, indirect treatment comparisons and network meta-analysis provide useful evidence for judiciously selecting the best choice(s) of treatment. Mixed treatment comparisons, a special case of network meta-analysis, combine direct and indirect evidence for particular pairwise comparisons, thereby synthesizing a greater share of the available evidence than a traditional meta-analysis. This report from the ISPOR Indirect Treatment Comparisons Good Research Practices Task Force provides guidance on the interpretation of indirect treatment comparisons and network meta-analysis to assist policymakers and health-care professionals in using its findings for decision making. We start with an overview of how networks of randomized, controlled trials allow multiple treatment comparisons of competing interventions. Next, an introduction to the synthesis of the available evidence with a focus on terminology, assumptions, validity, and statistical methods is provided, followed by advice on critically reviewing and interpreting an indirect treatment comparison or network meta-analysis to inform decision making. We finish with a discussion of what to do if there are no direct or indirect treatment comparisons of randomized, controlled trials possible and a health-care decision still needs to be made.

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    • "Network meta-analysis combines evidence from trials comparing different sets of treatments in a single coherent analysis (Lu and Ades, 2004; Caldwell et al., 2005; Jansen et al., 2011) providing estimates of relative treatment effects that are informed by both direct and indirect evidence. Methods for network meta-analysis have been studied and extended considerably in recent years. "
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    ABSTRACT: We present an alternative to the contrast-based parameterization used in a number of publications for network meta-analysis. This alternative "arm-based" parameterization offers a number of advantages: it allows for a "long" normalized data structure that remains constant regardless of the number of comparators; it can be used to directly incorporate individual patient data into the analysis; the incorporation of multi-arm trials is straightforward and avoids the need to generate a multivariate distribution describing treatment effects; there is a direct mapping between the parameterization and the analysis script in languages such as WinBUGS and finally, the arm-based parameterization allows simple extension to treatment-specific random treatment effect variances. We validated the parameterization using a published smoking cessation dataset. Network meta-analysis using arm- and contrast-based parameterizations produced comparable results (with means and standard deviations being within +/- 0.01) for both fixed and random effects models. We recommend that analysts consider using arm-based parameterization when carrying out network meta-analyses. © 2015 The Authors Research Synthesis Methods Published by John Wiley & Sons Ltd.
    No preview · Article · Nov 2015 · Research Synthesis Methods
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    • "Interpretation guidelines are available for the readers of both traditional meta-analyses (Greenhalgh, 1997; Leucht, Kissling, & Davis, 2009; Oxman, Cook, & Guyatt, 1994) and network meta-analyses (Jansen et al., 2011; Mills et al., 2012). A structured approach to the appraisal of empirical evidence from meta-analyses (and from other studies) is oered by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system (GRADE Working Group, 2004; Guyatt et al., 2008), which has also been adapted to evidence from network-meta-analyses (Puhan et al., 2014; Salanti et al., 2014). "
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    ABSTRACT: In this chapter, an introductory overview on various evidence synthesis methods is given. A particular focus is set on the systematic reviews and meta-analyses of randomized controlled trials. Preparation, reporting, and interpretation of meta-analyses are addressed with a non-technical guidance to the most widespread statistical procedures and the underlying assumptions behind them. In addition to describing traditional evidence synthesis approaches contrasting two treatment options, the tools, challenges, and pitfalls of indirect and multiple treatment comparison (network) meta-analyses are discussed. A case study on antimanic drug treatments for acute mania in bipolar disorder is used throughout the chapter for illustration. Above the role of meta-analysis as a scientific method, its relevance and applicability in real-life treatment decision making is outlined. At last, current developments in the methodology of evidence synthesis methods in general are highlighted.
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    • "This review followed international guidelines for performing and reporting systematic reviews and pairwise or network metaanalysis [28] [29] [30], and assessed if, in human patients with cavities resulting from caries removal, cavity lining compared with another cavity liner or no liner has different effects on the remaining number of bacteria (sterility of the cavity, reduction of bacterial numbers within the dentin). Assessing how antibacterial effects translate into clinical outcomes (pain, clinical success) was beyond the scope of this review. "
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    ABSTRACT: Cavity liners are frequently used prior placing a restoration, with one main aim being to reduce the number of remaining bacteria. We systematically appraised studies comparing antibacterial effects of different liners against each other or no liner. DATA STUDIES: reporting the number of sterile cavities before/after lining or sealing, or the reduction in bacterial numbers (colony-forming-units) in two or more treatment groups were included. Treatments were categorized as: no/placebo liner, calcium hydroxide, mineral trioxide aggregate, antibiotic/disinfectant, calcium phosphates, zinc oxide eugenol, black copper cement, and glass ionomer cement liners. Pairwise and network meta-analyses were performed. From 113 identified studies, 14 (500 treated lesions) were included. Risk of bias was high or unclear. Based on 11 studies, network meta-analysis found mineral trioxide lining to yield the greatest probability of achieving sterile cavities after a lining/sealing period (73%), followed by antibiotic/disinfectant (8%) and zinc oxide eugenol (7%). Only six studies assessed bacterial reduction after lining/sealing, and calcium hydroxide was found to have the highest probability of achieving a bacterial reduction. In both analyses, not providing any lining was found to have low antibacterial effects. Within the limitations of this review and the included studies, certain liners seem more suitable to achieve sterile cavities or reduce bacterial numbers than others. Given the paucity of data and the unclear impact of remaining bacteria on clinical outcomes, further recommendations for specific cavity treatments prior a restoration are not possible. There is insufficient evidence to generally recommend cavity lining or the use of any specific liner based on their antibacterial effects. Dentists might continue to use liners, but should be aware that such use is not strongly supported by clinical studies. Copyright © 2015. Published by Elsevier Ltd.
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