Georgia Salanti, Julian P.T. Higgins
Health care practitioners, decision-makers, and consumers want to know which treatment is preferable among many competing options. Network meta-analysis is an extension of meta-analysis that allows the simultaneous comparison of multiple interventions. It combines the results of studies that compare two or more interventions for the same condition; it is not necessary for all of the treatments to have been compared within any of the studies. The name network meta-analysis derives from a representation of the different within-study comparisons as a network of evidence linking each intervention with every other in the network. The validity of network meta-analysis rests on an assumption of consistency or transitivity, requiring that the studies comparing different interventions have similar variables that modify effects. The standard output of a network meta-analysis is a set of estimates of relative effects for all pairs of interventions. Network meta-analysis can also provide a hierarchy of all the interventions.
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See practicals below.
We use the R package netmeta (Rücker G et al. netmeta: Network Meta-Analysis using Frequentist Methods. R package version 2.7-0. Available from: https://CRAN.R-project.org/package=netmeta).
The file AcuteMania.xls comprises data from the secondary efficacy outcome of the network meta-analysis published in Cipriani A et al. (2011): Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis. The Lancet, 378(9799), 1306-15. This is a connected network including 47 studies comparing the efficacy of active drugs and placebo. The outcome is response to treatment (number of responders out of patients randomized).
The instruction file and R script take you through the analysis, including synthesis of data, presentation of results, and exploration of the inconsistency assumption.
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
Julian P.T. Higgins
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
National Institute of Health Research, Applied Research Collaboration West, University Hospital Bristol and Weston NHS Foundation Trust, Bristol, UK
How to cite this chapter?
For the printed version of the book
Salanti, G. and Higgins, J.P.T. (2022). Chapter 13. Network meta-analysis. In: Systematic Reviews in Health Research: Meta-analysis in Context (eds M. Egger, J.P.T. Higgins and G. Davey Smith), pp 238-257. Hoboken, NJ : Wiley.
For the electronic version of the book
Salanti, G. and Higgins, J.P.T. (2022). Chapter 13. Network meta-analysis. In: Systematic Reviews in Health Research: Meta-analysis in Context (eds M. Egger, J.P.T. Higgins and G. Davey Smith). https://doi.org/10.1002/9781119099369.ch13