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Answering Complex Hierarchy Questions in Network Meta-analysis
Answering Complex Hierarchy Questions in Network Meta-analysis
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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.
Het COMPAR-EU project heeft financiering ontvangen van het Horizon 2020 onderzoeks- en innovatieprogramma van de Europese Unie in het kader van subsidie overeenkomst nummer 754936.
Houd er rekening mee dat dit de bètaversie van het COMPAR-EU-platform is. Het bevat nu de voltooide resultaten voor Diabetes Type 2 en gedurende de zomer van 2022 zullen de resultaten voor obesitas, COPD en hartfalen worden voltooid. Ook wordt het platform de komende maanden uitgebreid en verbeterd.