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Answering Complex Hierarchy Questions in Network Meta-analysis
Answering Complex Hierarchy Questions in Network Meta-analysis
Version 1.0 Approuvé- Type de document
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- 21/10/22 13:31 par mir mir
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- 21/10/22 13:31 par mir mir
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Version 1.0Par mir mir, sur 21/10/22 13:31Log Pas de changement
Résumé
Background: Network meta-analysis estimates all relative effects between competing treatments and can produce a treatment hierarchy from the most to the least desirable option according to a health outcome. While about half of the published network meta-analyses present such a hierarchy, it is rarely the case that it is related to a clinically relevant decision question.
Methods: We first define treatment hierarchy and treatment ranking in a network meta-analysis and suggest a simulation method to estimate the probability of each possible hierarchy to occur. We then propose a stepwise approach to express clinically relevant decision questions as hierarchy questions and quantify the uncertainty of the criteria that constitute them. The steps of the approach are summarized as follows: a) a question of clinical relevance is defined, b) the hierarchies that satisfy the defined question are collected and c) the frequencies of the respective hierarchies are added; the resulted sum expresses the certainty of the defined set of criteria to hold. We then show how the frequencies of all possible hierarchies relate to common ranking metrics.
Results: We exemplify the method and its implementation using two networks. The first is a network of four treatments for chronic obstructive pulmonary disease where the most probable hierarchy has a frequency of 28%. The second is a network of 18 antidepressants, among which Vortioxetine, Bupropion and Escitalopram occupy the first three ranks with frequency 19%.
Conclusions: The developed method offers a generalised approach of producing treatment hierarchies in NMA, which moves towards attaching treatment ranking to a clear decision question, relevant to all or a subset of competing treatments.
Le projet COMPAR-EU a été financé par le programme de recherche et d'innovation Horizon 2020 de l'Union européenne dans le cadre de la convention de subvention n° 754936.
Veuillez noter qu'il s'agit de la version bêta de la plateforme COMPAR-EU. Il comprend désormais les résultats complets concernant le diabète et, au cours de l'été 2022, les résultats concernant l'obésité, la BPCO ainsi que l'insuffisance cardiaque seront complétés. La plateforme sera également étendue et améliorée pendant les mois à venir.