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Is network meta-analysis as valid as standard pairwise meta-analysis? It all depends on the distribution of effect modifiers

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  • Jansen, Jeroen P.
  • Naci, Huseyin

Abstract

Background In the last decade, network meta-analysis of randomized controlled trials has been introduced as an extension of pairwise meta-analysis. The advantage of network meta-analysis over standard pairwise meta-analysis is that it facilitates indirect comparisons of multiple interventions that have not been studied in a head-to-head fashion. Although assumptions underlying pairwise meta-analyses are well understood, those concerning network meta-analyses are perceived to be more complex and prone to misinterpretation. Discussion In this paper, we aim to provide a basic explanation when network meta-analysis is as valid as pairwise meta-analysis. We focus on the primary role of effect modifiers, which are study and patient characteristics associated with treatment effects. Because network meta-analysis includes different trials comparing different interventions, the distribution of effect modifiers cannot only vary across studies for a particular comparison (as with standard pairwise meta-analysis, causing heterogeneity), but also between comparisons (causing inconsistency). If there is an imbalance in the distribution of effect modifiers between different types of direct comparisons, the related indirect comparisons will be biased. If it can be assumed that this is not the case, network meta-analysis is as valid as pairwise meta-analysis. Summary The validity of network meta-analysis is based on the underlying assumption that there is no imbalance in the distribution of effect modifiers across the different types of direct treatment comparisons, regardless of the structure of the evidence network.

Suggested Citation

  • Jansen, Jeroen P. & Naci, Huseyin, 2013. "Is network meta-analysis as valid as standard pairwise meta-analysis? It all depends on the distribution of effect modifiers," LSE Research Online Documents on Economics 55472, London School of Economics and Political Science, LSE Library.
  • Handle: RePEc:ehl:lserod:55472
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    File URL: http://eprints.lse.ac.uk/55472/
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    Cited by:

    1. Fernanda S Tonin & Helena H Borba & Antonio M Mendes & Astrid Wiens & Fernando Fernandez-Llimos & Roberto Pontarolo, 2019. "Description of network meta-analysis geometry: A metrics design study," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-14, February.
    2. Konstantinos Katsanos & Panagiotis Kitrou & Stavros Spiliopoulos & Ioannis Maroulis & Theodore Petsas & Dimitris Karnabatidis, 2017. "Comparative effectiveness of different transarterial embolization therapies alone or in combination with local ablative or adjuvant systemic treatments for unresectable hepatocellular carcinoma: A net," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-31, September.
    3. Areti Angeliki Veroniki & Jesmin Antony & Sharon E Straus & Huda M Ashoor & Yaron Finkelstein & Paul A Khan & Marco Ghassemi & Erik Blondal & John D Ivory & Brian Hutton & Kevin Gough & Brenda R Hemme, 2018. "Comparative safety and effectiveness of perinatal antiretroviral therapies for HIV-infected women and their children: Systematic review and network meta-analysis including different study designs," PLOS ONE, Public Library of Science, vol. 13(6), pages 1-23, June.
    4. Mubarak Ahmed Mashrah & Taghrid Aldhohrah & Ahmed Abdelrehem & Karim Ahmed Sakran & Hyat Ahmad & Hamada Mahran & Faisal Abu-lohom & Hanfu Su & Ying Fang & Liping Wang, 2021. "Survival of vascularized osseous flaps in mandibular reconstruction: A network meta-analysis," PLOS ONE, Public Library of Science, vol. 16(10), pages 1-19, October.
    5. Gabriel Tremblay & Heather J McElroy & Tracy Westley & Genevieve Meier & Derek Misurski & Matthew Guo, 2019. "Indirect treatment comparisons including network meta-analysis: Lenvatinib plus everolimus for the second-line treatment of advanced/metastatic renal cell carcinoma," PLOS ONE, Public Library of Science, vol. 14(3), pages 1-13, March.
    6. Stephane Régnier & William Malcolm & Felicity Allen & Jonathan Wright & Vladimir Bezlyak, 2014. "Efficacy of Anti-VEGF and Laser Photocoagulation in the Treatment of Visual Impairment due to Diabetic Macular Edema: A Systematic Review and Network Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(7), pages 1-10, July.

    More about this item

    Keywords

    bias; comparative effectiveness; confounding; effect modification; indirect comparison; meta-analysis; mixed treatment comparison; network meta-analysis; randomized controlled trial; systematic review;
    All these keywords.

    JEL classification:

    • J50 - Labor and Demographic Economics - - Labor-Management Relations, Trade Unions, and Collective Bargaining - - - General

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