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BMC Medicine

, 15:3

First Online: 05 January 2017Received: 12 August 2016Accepted: 02 December 2016DOI: 10.1186-s12916-016-0764-6

Cite this article as: Zarin, W., Veroniki, A.A., Nincic, V. et al. BMC Med 2017 15: 3. doi:10.1186-s12916-016-0764-6


BackgroundNetwork meta-analysis NMA has become a popular method to compare more than two treatments. This scoping review aimed to explore the characteristics and methodological quality of knowledge synthesis approaches underlying the NMA process. We also aimed to assess the statistical methods applied using the Analysis subdomain of the ISPOR checklist.

MethodsComprehensive literature searches were conducted in MEDLINE, PubMed, EMBASE, and Cochrane Database of Systematic Reviews from inception until April 14, 2015. References of relevant reviews were scanned. Eligible studies compared at least four different interventions from randomised controlled trials with an appropriate NMA approach. Two reviewers independently performed study selection and data abstraction of included articles. All discrepancies between reviewers were resolved by a third reviewer. Data analysis involved quantitative frequencies and qualitative content analysis methods. Quality was evaluated using the AMSTAR tool for the conduct of knowledge synthesis and the ISPOR tool for statistical analysis.

ResultsAfter screening 3538 citations and 877 full-text papers, 456 NMAs were included. These were published between 1997 and 2015, with 95% published after 2006. Most were conducted in Europe 51% or North America 31%, and approximately one-third reported public sources of funding. Overall, 84% searched two or more electronic databases, 62% searched for grey literature, 58% performed duplicate study selection and data abstraction independently, and 62% assessed risk of bias. Seventy-eight 17% NMAs relied on previously conducted systematic reviews to obtain studies for inclusion in their NMA. Based on the AMSTAR tool, almost half of the NMAs incorporated quality appraisal results to formulate conclusions, 36% assessed publication bias, and 16% reported the source of funding. Based on the ISPOR tool, half of the NMAs did not report if an assessment for consistency was conducted or whether they accounted for inconsistency when present. Only 13% reported heterogeneity assumptions for the random-effects model.

ConclusionsThe knowledge synthesis methods and analytical process for NMAs are poorly reported and need improvement.

KeywordsMixed-treatment Multiple treatments Research reporting ISPOR AMSTAR AbbreviationsAMSTARA Measurement Tool to Assess Systematic Reviews

ISPORInternational Society of Pharmacoeconomics and Outcomes Research

NMAnetwork meta-analysis

PRISMAPreferred Reporting Items for Systematic Reviews and Meta-analyses

RCTrandomised controlled trial

Electronic supplementary materialThe online version of this article doi:10.1186-s12916-016-0764-6 contains supplementary material, which is available to authorized users.

An erratum to this article is available at

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Autor: Wasifa Zarin - Areti Angeliki Veroniki - Vera Nincic - Afshin Vafaei - Emily Reynen - Sanober S. Motiwala - Jesmin Antony


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