A simulation study to compare different estimation approaches for network meta-analysis and corresponding methods to evaluate the consistency assumption

BMC Medical Research Methodology

Ralf Bender¹  Corinna Kiefer¹  Sibylle Sturtz¹ 

[1] Institute for Quality and Efficiency in Health Care (IQWiG);

关键词: Consistency assumption;    Indirect comparison;    Mixed treatment comparison;    Multiple treatments meta-analysis;    Network meta-analysis;    Simulation study;   

DOI  :  10.1186/s12874-020-0917-3

来源: DOAJ

【 摘 要 】

Abstract Background Network meta-analysis (NMA) is becoming increasingly popular in systematic reviews and health technology assessments. However, there is still ambiguity concerning the properties of the estimation approaches as well as for the methods to evaluate the consistency assumption. Methods We conducted a simulation study for networks with up to 5 interventions. We investigated the properties of different methods and give recommendations for practical application. We evaluated the performance of 3 different models for complex networks as well as corresponding global methods to evaluate the consistency assumption. The models are the frequentist graph-theoretical approach netmeta, the Bayesian mixed treatment comparisons (MTC) consistency model, and the MTC consistency model with stepwise removal of studies contributing to inconsistency identified in a leverage plot. Results We found that with a high degree of inconsistency none of the evaluated effect estimators produced reliable results, whereas with moderate or no inconsistency the estimator from the MTC consistency model and the netmeta estimator showed acceptable properties. We also saw a dependency on the amount of heterogeneity. Concerning the evaluated methods to evaluate the consistency assumption, none was shown to be suitable. Conclusions Based on our results we recommend a pragmatic approach for practical application in NMA. The estimator from the netmeta approach or the estimator from the Bayesian MTC consistency model should be preferred. Since none of the methods to evaluate the consistency assumption showed satisfactory results, users should have a strong focus on the similarity as well as the homogeneity assumption.

【 授权许可】

Unknown