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Watt, Jennifer; Del Giovane, Cinzia
Methods in molecular biology (Clifton, N.J.), 2022, Volume: 2345Journal Article
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.
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