Network Meta-analysis: A technique to synthesize evidence for Decision Making

NETWORK META-ANALYSIS (NMA): A TECHNIQUE TO SYNTHESIZE EVIDENCE FOR DECISION MAKING

Tags: Multi-treatment meta-analysis | Multi-arm meta-analysis | Multivariable m e t a analysis | Network meta-analysis | Bayesian framework | Bayesian Publication Support | Research Services | Physician Writing | Scientific C o m m u n i c a t i o n Solution | Editing &Peer-Reviewing

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INTRODUCTION Clinical decision requires balanced decision a m o n g resources, tasks, skills and values. It relies on external aspects that are not easily modulated ( s u c h as religious beliefs or economic resources) and largely beyond the reach of most researchers.

Meta-analysis service plays an important role in clinical decision making.

The meta-analysis involves in pair meta-analysis ( g o e s from a 2-D to a multidimensional analytical framework) and network meta-analysis (several processes are being generated, like the adjusted indirect comparison, mixedtreatment comparison, multi-treatment meta-analysis, m u l t i - a rm meta-analysis and multivariable meta-analysis).

The key features of network meta-analysis must be as evidence-based (From pairwise meta-analysis to network meta-analysis) and reviewing process also should be designed (before the d a t a are effectively retrieved) and registered ( t h e evaluation protocol should be published immediately after finalizing an o u t - a n d - o u t repository site) as per the guidelines at hand for plan, carry out, and reporting of a network meta-analysis.

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NETWORK METAANALYSIS Network meta-analysis is a unique and powerful tool for enhancing clinical decision making. When converting to action, knowledge that rapid systematic reviewing processes yield could be advantageous.

The preliminary assessment results suggest that gold standard NMAs might be replaced by a modified rapid NMA approach. Evaluation of judgement could be used to compare summery methods of proof.

Network meta-analysis with modest improvements might replace gold standard network meta-analysis.

The researchers with execution tools might use a more advanced network meta-analysis technique to lower the time and resources required for knowledge transfer to practice while creating more patient-based tools.

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NETWORK METAANALYSIS

I M P O RT A NT FA CT O RS FO R T HE NE T W O RK ME T A - A NA LY S IS Search: There are several available databases such as MEDLINE/PubMed, Cochrane Library, Europe PubMed Central, SciELO, LILACS, Embase, etc. must be used for the searching process to lead the appropriate evidence.

Selection: The selection of the study being an important step towards the network meta-analysis.

Choosing the framework: Among all frameworks, Bayesian framework is considered to be the most popular and accepted framework for NMA. It allows more robust modeling that can easily adjustable for simpler evidence networks.

Choosing the statistical package: There are several statistical packages available. The WinBUGS tool is one of the most commonly used packages. It is quite easy to c o m m a n d and can be used with ease by R and other packages for the Bayesian modeling and analysis.

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Choosing the suitable statistics: Binomial model generates relative risks, risk differences, odds ratios, probabilities of being best, numbers needed to treat, rankograms, and the surface under the cumulative

NETWORK META ANALYSIS

ranking curves.

Numerous methods have been suggested for evaluating small-research results, including funnel plots inspection after rectifying summary estimates of the subgroup, the Copas m et hod and regression testing.

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Future perceptions of t h e network m e t a - a n a l y s i s CON V ERTI N G SYN THESI S OF EV I DEN CE TO ACTI ON :

All the findings of a network meta-analysis should be applied to direct decision making, determine how to best interpret the assessment results and apply them in clinical practice, and to incorporate the intervention thoroughly in depth with the most desirable risk-benefit balance.

The best possible way to do this is by absolute risk measurements, numbers required to be treated, and rankograms, making decision on credible or confidence intervals, instead of point estimates, while identifying the parallel effect of a specific intervention on different endpoints.

Therefore, when multiple interventions hold an analogous beneficial risk-benefit profile, it is important to choose the one which is easier or cost effective to execute.

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NETWORK METAANALYSIS

T O W A RD A CCE S S IB IL IT Y AND I N T EG RA T IO N: Th e f u t u r e o f n e t w o r k m e t a - a n a l ys i s l i es i n t h e t h o r n y p r o c e s s o f s t e e r i n g b e t w e e n t h e S c y l l a o f s t a t e - o f - t h e - a r t p r o c e ss e s o f p e r f o r m in g a n a c c e p t a b le s y s t e m a t ic r e v ie w a n d t h e C h a r y b d is o f e f f e c t i ve di s s e m i n a t i on a n d thri v in g a c c o m p l is h m e n t by s tak ehol d e r s a n d d e c i s io n - m a k ers .

Cl e a r a n d e a s y t o o l s c a t e r i n g i n n o v a t i v e s ol u t i o n s t o t h e c o m p l ex i s s u e s h a v e b e e n d o m i n a t i n g t h e c l i ni c a l p r a c t i c e a n d Res e a r c h i n t h e l a s t f e w d e c a d e s .

A b r i l l i a n t r e s o u r c e f o r c l i ni c a l r e s e a r c h p r o c e s s es i s K a p l a n - M e i e r m e t h o d b a c k e d su rv iv a l a n a ly s is w it h it s c o n c ise , p e rf e c t , a n d ro b u st f in d in g s in d a ily re se a rc h , in sp it e o f its a p p l ic a t i on in a m a s s ive a m o u n t of di vers if ie d a n d o c c a s io n a l ly t r ick y c o n t e x ts .

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LIMITATIONS OF NETWORK META- ANALYSIS O nl y s p e c i f i c s i t u a t i o n s r e q u i re t h e n e t w o r k m e t a - a n a l ys i s a n d i n a p p r o p r i a t e us e o f n e t w o r k m e t a - a n a l ys i s c a n l e a d t o m i s l e a d i n g r e s ul t s s u c h a s Li m i t e d n e t w o r k c o n n e c t i v i t y ( M o s t o f t h e a v a i l a b l e r e s e a r c h e s h a v e u n - c o m p a r e d al l a v a i la b l e t r e a t m e n t s d u e to t im e or f in a n c i al res t rai nts ; lim i t e d in t e r p r e t a t i on of indi r e c t evi d e n c e Li m i t e d i n t e r p r e t a t i o n o f r a n k i n g a n a l y s i s Li m i t e d e xp e r i e n c e o f c l i n i c i a n s w i t h t h e s t a t i s t i c s o f n e t w o r k m e t a a n a l ys i s ( d u e t o s t u d y c o n d u c t i o n b y Un - t r a i n e d c l i ni c i a n s a n d st at i st ici a n ) .

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SUM M ARY Ne t w o r k m e t a - a n a l ys i s a n d s y n t h e s i s e v i d e n c e wi l l b e a r e a l i t y b y t h e r e l a t e d a p p l icati on of st rai g h t f o r w a r d but v igorous p a c k a g e s to im p l e m e n t network m e t a - a n a l ys i s o n n u m e r o u s p l a t f o r m s l i k e s m a r t p h o n e s a n d t a b l e t s .

M o r e o v e r, i t i s a l s o a p r o b a b i l i t y t o c r e a t e i n t e l l i g e n t t r i a l d a t a b a s e s w h i c h wi l l a u t o m a t i cal ly upl o a d the d a t a recei ved f r o m indi v id u a l d a t a in a sort of c o l l e c t i v e n e t w o r k m e t a - a n a l ys i s .

No s i n g l e m e t a - a n a l y s i s s h o u l d b e v i e w e d a s t h e f i n a l , b u t r a t h e r a s a t o o l t h a t m a k es a r e f i n e d f o r m o f e v i d e n c e a v a i l a b l e t o l e a d m o r e a c c u r a t e c l i ni c a l p r a c t i ce.

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