Evaluating the Quality of Evidence from a Network Meta-Analysis
Publication Date
July 03, 2014
Journal
PLOS ONE
Authors
Georgia Salanti, Cinzia Del Giovane, Anna Chaimani, Deborah M. Caldwell, et al
Volume
9
Issue
7
Pages
e99682
DOI
https://dx.plos.org/10.1371/journal.pone.0099682
Publisher URL
http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0099682
PubMed
http://www.ncbi.nlm.nih.gov/pubmed/24992266
PubMed Central
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4084629
Europe PMC
http://europepmc.org/abstract/MED/24992266
Web of Science
000341253400012
Scopus
84903759043
Mendeley
http://www.mendeley.com/research/evaluating-quality-evidence-network-metaanalysis-7
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Mendeley | Further Information

{"title"=>"Evaluating the quality of evidence from a network meta-analysis", "type"=>"journal", "authors"=>[{"first_name"=>"Georgia", "last_name"=>"Salanti", "scopus_author_id"=>"55927919500"}, {"first_name"=>"Cinzia Del", "last_name"=>"Giovane", "scopus_author_id"=>"39561192800"}, {"first_name"=>"Anna", "last_name"=>"Chaimani", "scopus_author_id"=>"55867072000"}, {"first_name"=>"Deborah M.", "last_name"=>"Caldwell", "scopus_author_id"=>"8961655400"}, {"first_name"=>"Julian P T", "last_name"=>"Higgins", "scopus_author_id"=>"55616553600"}], "year"=>2014, "source"=>"PLoS ONE", "identifiers"=>{"scopus"=>"2-s2.0-84903759043", "sgr"=>"84903759043", "issn"=>"19326203", "doi"=>"10.1371/journal.pone.0099682", "pmid"=>"24992266", "isbn"=>"1932-6203 (Electronic)\\r1932-6203 (Linking)", "pui"=>"373460221"}, "id"=>"c22264a2-9691-3f65-a40e-7b17ce58d4ae", "abstract"=>"Systematic reviews that collate data about the relative effects of multiple interventions via network meta-analysis are highly informative for decision-making purposes. A network meta-analysis provides two types of findings for a specific outcome: the relative treatment effect for all pairwise comparisons, and a ranking of the treatments. It is important to consider the confidence with which these two types of results can enable clinicians, policy makers and patients to make informed decisions. We propose an approach to determining confidence in the output of a network meta-analysis. Our proposed approach is based on methodology developed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group for pairwise meta-analyses. The suggested framework for evaluating a network meta-analysis acknowledges (i) the key role of indirect comparisons (ii) the contributions of each piece of direct evidence to the network meta-analysis estimates of effect size; (iii) the importance of the transitivity assumption to the validity of network meta-analysis; and (iv) the possibility of disagreement between direct evidence and indirect evidence. We apply our proposed strategy to a systematic review comparing topical antibiotics without steroids for chronically discharging ears with underlying eardrum perforations. The proposed framework can be used to determine confidence in the results from a network meta-analysis. Judgements about evidence from a network meta-analysis can be different from those made about evidence from pairwise meta-analyses.", "link"=>"http://www.mendeley.com/research/evaluating-quality-evidence-network-metaanalysis-7", "reader_count"=>112, "reader_count_by_academic_status"=>{"Unspecified"=>5, "Professor > Associate Professor"=>11, "Researcher"=>25, "Student > Doctoral Student"=>4, "Student > Ph. D. Student"=>22, "Student > Postgraduate"=>7, "Other"=>14, "Student > Master"=>9, "Student > Bachelor"=>5, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>2, "Professor"=>6}, "reader_count_by_user_role"=>{"Unspecified"=>5, "Professor > Associate Professor"=>11, "Researcher"=>25, "Student > Doctoral Student"=>4, "Student > Ph. D. Student"=>22, "Student > Postgraduate"=>7, "Other"=>14, "Student > Master"=>9, "Student > Bachelor"=>5, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>2, "Professor"=>6}, "reader_count_by_subject_area"=>{"Unspecified"=>14, "Agricultural and Biological Sciences"=>3, "Business, Management and Accounting"=>1, "Computer Science"=>3, "Economics, Econometrics and Finance"=>2, "Nursing and Health Professions"=>1, "Biochemistry, Genetics and Molecular Biology"=>1, "Mathematics"=>12, "Medicine and Dentistry"=>57, "Neuroscience"=>1, "Pharmacology, Toxicology and Pharmaceutical Science"=>4, "Psychology"=>5, "Social Sciences"=>8}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>57}, "Social Sciences"=>{"Social Sciences"=>8}, "Psychology"=>{"Psychology"=>5}, "Mathematics"=>{"Mathematics"=>12}, "Unspecified"=>{"Unspecified"=>14}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>4}, "Neuroscience"=>{"Neuroscience"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>3}, "Computer Science"=>{"Computer Science"=>3}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>1}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}}, "reader_count_by_country"=>{"Saudi Arabia"=>1, "Greece"=>1, "Netherlands"=>1, "Japan"=>2, "United Kingdom"=>3, "France"=>1, "Germany"=>1, "Spain"=>2}, "group_count"=>6}

CrossRef

Scopus | Further Information

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Figshare

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  • {"files"=>["https://ndownloader.figshare.com/files/1579702"], "description"=>"<p>Rows correspond to network meta-analysis ORs (separated for mixed and indirect evidence) and columns correspond to direct meta-analysis ORs. The contribution of each direct comparison to the total network evidence that provides the ranking of the treatments is presented separately (row named Entire network). The sizes of the boxes are proportional to the percentage contribution of each direct estimate to the network meta-analysis estimates (rows 1–6) and to the entire network (row 7). The last row shows the number of included direct comparisons. The names of the treatments are given in <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0099682#pone-0099682-g001\" target=\"_blank\">Figure 1</a>.</p>", "links"=>[], "tags"=>["epidemiology", "Epidemiological methods and statistics", "Research assessment", "Research validity", "meta-analysis"], "article_id"=>1093019, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Georgia Salanti", "Cinzia Del Giovane", "Anna Chaimani", "Deborah M. Caldwell", "Julian P. T. Higgins"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0099682.g002"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Contributions_matrix_percentage_contribution_of_each_direct_estimate_to_the_network_meta_analysis_estimates_/1093019", "title"=>"Contributions matrix: percentage contribution of each direct estimate to the network meta-analysis estimates.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-07-03 02:59:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1579704"], "description"=>"<p>Calculations are based on the contributions of direct evidence. The colours represent the risk of bias (green: low, yellow: moderate, red: high). The initial judgements about the risk of bias in the direct estimates are shown on the right side of the figure (there is no direct evidence for AC). The names of the treatments are given in <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0099682#pone-0099682-g001\" target=\"_blank\">Figure 1</a>.</p>", "links"=>[], "tags"=>["epidemiology", "Epidemiological methods and statistics", "Research assessment", "Research validity", "limitations", "pairwise", "comparisons", "topical"], "article_id"=>1093021, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Georgia Salanti", "Cinzia Del Giovane", "Anna Chaimani", "Deborah M. Caldwell", "Julian P. T. Higgins"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0099682.g003"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Study_limitations_for_each_network_estimate_for_pairwise_comparisons_of_topical_antibiotics_/1093021", "title"=>"Study limitations for each network estimate for pairwise comparisons of topical antibiotics.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-07-03 02:59:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1579706"], "description"=>"<p>The names of the treatments are given in <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0099682#pone-0099682-g001\" target=\"_blank\">Figure 1</a>.</p>", "links"=>[], "tags"=>["epidemiology", "Epidemiological methods and statistics", "Research assessment", "Research validity", "estimates", "intervals", "predictive"], "article_id"=>1093023, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Georgia Salanti", "Cinzia Del Giovane", "Anna Chaimani", "Deborah M. Caldwell", "Julian P. T. Higgins"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0099682.g004"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Network_estimates_of_mean_ORs_their_95_confidence_intervals_and_95_predictive_intervals_red_extensions_/1093023", "title"=>"Network estimates of mean ORs, their 95% confidence intervals and 95% predictive intervals (red extensions).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-07-03 02:59:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1579707"], "description"=>"<p>The colours represent the risk of bias (green: low, yellow: moderate, red: high). The names of the treatments are given in <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0099682#pone-0099682-g001\" target=\"_blank\">Figure 1</a>.</p>", "links"=>[], "tags"=>["epidemiology", "Epidemiological methods and statistics", "Research assessment", "Research validity", "limitations", "weighted", "estimates", "topical"], "article_id"=>1093025, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Georgia Salanti", "Cinzia Del Giovane", "Anna Chaimani", "Deborah M. Caldwell", "Julian P. T. Higgins"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0099682.g005"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Study_limitations_weighted_by_contribution_of_direct_estimates_to_the_network_of_topical_antibiotics_/1093025", "title"=>"Study limitations weighted by contribution of direct estimates to the network of topical antibiotics.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-07-03 02:59:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1579710"], "description"=>"<p>On the horizontal axes are the possible ranks and on the vertical axis the probability that each treatment achieves each rank.</p>", "links"=>[], "tags"=>["epidemiology", "Epidemiological methods and statistics", "Research assessment", "Research validity", "topical", "antibiotics", "steroids", "chronically", "discharging"], "article_id"=>1093028, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Georgia Salanti", "Cinzia Del Giovane", "Anna Chaimani", "Deborah M. Caldwell", "Julian P. T. Higgins"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0099682.g006"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Rankograms_for_topical_antibiotics_without_steroids_for_chronically_discharging_ears_/1093028", "title"=>"Rankograms for topical antibiotics without steroids for chronically discharging ears.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-07-03 02:59:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1579713"], "description"=>"<p>Each observation is the difference between a study estimate and its direct meta-analysis mean effect. Studies on the right hand side ‘overestimate’ the effect of newer treatments.</p>", "links"=>[], "tags"=>["epidemiology", "Epidemiological methods and statistics", "Research assessment", "Research validity", "funnel", "topical", "antibiotics", "steroids", "chronically", "discharging"], "article_id"=>1093030, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Georgia Salanti", "Cinzia Del Giovane", "Anna Chaimani", "Deborah M. Caldwell", "Julian P. T. Higgins"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0099682.g007"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Comparison_adjusted_funnel_plot_for_the_network_of_topical_antibiotics_without_steroids_for_chronically_discharging_ears_/1093030", "title"=>"Comparison-adjusted funnel plot for the network of topical antibiotics without steroids for chronically discharging ears.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-07-03 02:59:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1579714"], "description"=>"1<p>Dominated by evidence at high or moderate risk of bias.</p>2<p>No convincing evidence for the plausibility of the transitivity assumption.</p>3<p>Predictive intervals for treatment effect include effects that would have different interpretations (there is additionally no convincing evidence for the plausibility of the transitivity assumption).</p>4<p>Confidence intervals include values favouring either treatment.</p>5<p>60% of the information is from studies at moderate risk of bias.</p>6<p>Moderate level of heterogeneity, and some evidence of inconsistency in the network.</p>", "links"=>[], "tags"=>["epidemiology", "Epidemiological methods and statistics", "Research assessment", "Research validity", "estimates", "ranking"], "article_id"=>1093031, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Georgia Salanti", "Cinzia Del Giovane", "Anna Chaimani", "Deborah M. Caldwell", "Julian P. T. Higgins"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0099682.t004"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_of_our_confidence_in_effect_estimates_and_ranking_of_treatments_/1093031", "title"=>"Summary of our confidence in effect estimates and ranking of treatments.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-07-03 02:59:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1579716"], "description"=>"<p>The entries in the table are the probabilities (as a percentage) of each treatment achieving each possible rank.</p>", "links"=>[], "tags"=>["epidemiology", "Epidemiological methods and statistics", "Research assessment", "Research validity", "examples", "ranking", "treatments"], "article_id"=>1093033, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Georgia Salanti", "Cinzia Del Giovane", "Anna Chaimani", "Deborah M. Caldwell", "Julian P. T. Higgins"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0099682.t002"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Hypothetical_extreme_examples_for_ranking_treatments_with_maximum_left_and_minimal_right_imprecision_/1093033", "title"=>"Hypothetical (extreme) examples for ranking treatments with maximum (left) and minimal (right) imprecision.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-07-03 02:59:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1579717"], "description"=>"1<p>When integrating assessments about direct comparisons into a judgement about an NMA treatment effect or the ranking, more weight should be given to assessments from direct comparisons that contribute more information. We recommend use of the contributions matrix to quantify how much information each direct comparison contributes to the estimation of the NMA treatment effect under evaluation or the ranking.</p>", "links"=>[], "tags"=>["epidemiology", "Epidemiological methods and statistics", "Research assessment", "Research validity", "evaluating", "procedures", "pairwise"], "article_id"=>1093034, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Georgia Salanti", "Cinzia Del Giovane", "Anna Chaimani", "Deborah M. Caldwell", "Julian P. T. Higgins"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0099682.t003"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_of_domain_assessment_for_evaluating_the_quality_of_evidence_from_a_network_meta_analysis_Procedures_for_a_pairwise_effect_estimate_and_overall_ranking_/1093034", "title"=>"Summary of domain assessment for evaluating the quality of evidence from a network meta-analysis: Procedures for a pairwise effect estimate and overall ranking.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-07-03 02:59:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1579720"], "description"=>"<p>Number of studies, the direct evidence from pairwise meta-analysis (OR, 95% confidence interval and variance) and information about heterogeneity (I<sup>2</sup> and heterogeneity variance τ<sup>2</sup>).</p><p>NE: Not estimable.</p>", "links"=>[], "tags"=>["epidemiology", "Epidemiological methods and statistics", "Research assessment", "Research validity", "comparisons", "topical", "antibiotics", "steroids", "chronically", "discharging"], "article_id"=>1093037, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Georgia Salanti", "Cinzia Del Giovane", "Anna Chaimani", "Deborah M. Caldwell", "Julian P. T. Higgins"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0099682.t001"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_information_from_direct_comparisons_of_topical_antibiotics_without_steroids_for_chronically_discharging_ears_/1093037", "title"=>"Summary information from direct comparisons of topical antibiotics without steroids for chronically discharging ears.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-07-03 02:59:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1579722", "https://ndownloader.figshare.com/files/1579723", "https://ndownloader.figshare.com/files/1579724"], "description"=>"<div><p>Systematic reviews that collate data about the relative effects of multiple interventions via network meta-analysis are highly informative for decision-making purposes. A network meta-analysis provides two types of findings for a specific outcome: the relative treatment effect for all pairwise comparisons, and a ranking of the treatments. It is important to consider the confidence with which these two types of results can enable clinicians, policy makers and patients to make informed decisions. We propose an approach to determining confidence in the output of a network meta-analysis. Our proposed approach is based on methodology developed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group for pairwise meta-analyses. The suggested framework for evaluating a network meta-analysis acknowledges (i) the key role of indirect comparisons (ii) the contributions of each piece of direct evidence to the network meta-analysis estimates of effect size; (iii) the importance of the transitivity assumption to the validity of network meta-analysis; and (iv) the possibility of disagreement between direct evidence and indirect evidence. We apply our proposed strategy to a systematic review comparing topical antibiotics without steroids for chronically discharging ears with underlying eardrum perforations. The proposed framework can be used to determine confidence in the results from a network meta-analysis. Judgements about evidence from a network meta-analysis can be different from those made about evidence from pairwise meta-analyses.</p></div>", "links"=>[], "tags"=>["epidemiology", "Epidemiological methods and statistics", "Research assessment", "Research validity"], "article_id"=>1093039, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Georgia Salanti", "Cinzia Del Giovane", "Anna Chaimani", "Deborah M. Caldwell", "Julian P. T. Higgins"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0099682.s001", "https://dx.doi.org/10.1371/journal.pone.0099682.s002", "https://dx.doi.org/10.1371/journal.pone.0099682.s003"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Evaluating_the_Quality_of_Evidence_from_a_Network_Meta_Analysis_/1093039", "title"=>"Evaluating the Quality of Evidence from a Network Meta-Analysis", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2014-07-03 02:59:06"}

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