![]() Empirical studies have suggested it yields more precise estimates of the intervention effects in comparison with a single direct or indirect estimate (Cooper et al 2011, Caldwell et al 2015). Further discussion of displaying networks is available in Section 11.6.1.įigure 11.1.a Example of network diagram with four competing interventions and information on the presence of multi-arm randomized trialsġ1.1.2 Advantages of network meta-analysisĪ network meta-analysis exploits all available direct and indirect evidence. Note that for large and complex networks, such presentation of multi-arm studies may give complicated and unhelpful network diagrams in this case it might be preferable to show multi-arm studies in a tabular format. In this example, distinct lines forming a closed triangular loop have been added to illustrate the presence of a three-arm study. An example of a network diagram with four interventions is given in Figure 11.1.a. It consists of nodes representing the interventions in the network and lines showing the available direct comparisons between pairs of interventions. 11.1.1 Network diagramsĪ network diagram is a graphical depiction of the structure of a network of interventions (Chaimani et al 2013). Synonymous terms, less often used, are mixed treatment comparisons and multiple treatments meta-analysis. Network meta-analysis combines direct and indirect estimates across a network of interventions in a single analysis. These are comparisons that have not been made directly within studies, and they can be estimated using mathematical combinations of the direct intervention effect estimates available. In a network of interventions there can be multiple ways to make indirect comparisons between the interventions. Network meta-analysis provides an analysis option for such a review.Īny set of studies that links three or more interventions via direct comparisons forms a network of interventions. People who need to decide between alternative interventions would benefit from a single review that includes all relevant interventions, and presents their comparative effectiveness and potential for harm. However, it is usually the case that several, perhaps even numerous, competing interventions are available for any given condition. Most Cochrane Reviews present comparisons between pairs of interventions (an experimental intervention and a comparator intervention) for a specific condition and in a specific population or setting. Available from 11.1 What is network meta-analysis? Cochrane Handbook for Systematic Reviews of Interventions version 6.4 (updated August 2023). In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Chapter 11: Undertaking network meta-analyses. ![]() Domain-specific assessments are combined to determine the overall confidence in the evidence.Ĭite this chapter as: Chaimani A, Caldwell DM, Li T, Higgins JPT, Salanti G. Grading confidence in evidence from a network meta-analysis begins by evaluating confidence in each direct comparison. direct and indirect) about a particular intervention comparison disagree. Incoherence (also called inconsistency) occurs when different sources of information (e.g. It also allows estimation of the ranking and hierarchy of interventions.Ī valid network meta-analysis relies on the assumption that the different sets of studies included in the analysis are similar, on average, in all important factors that may affect the relative effects. Network meta-analysis produces estimates of the relative effects between any pair of interventions in the network, and usually yields more precise estimates than a single direct or indirect estimate. ![]() Network meta-analysis is a technique for comparing three or more interventions simultaneously in a single analysis by combining both direct and indirect evidence across a network of studies. ![]()
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