Network Meta-Analysis: Evidence Synthesis with Mixed Treatment Comparison


Giuseppe Biondi-Zoccai, MD (Editor)
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy

Series: Medical Procedures, Testing and Technology
BISAC: MED090000

Network meta-analyses and mixed treatment comparisons represent the uppermost level in the evidence hierarchy for decision making, in medicine as well as in other scholarly fields. They combine and exploit data from direct (i.e. head-to-head) randomized trials and combine them, when appropriate, with indirect estimates, in order to obtain more precise and robust estimates of effect to determine which management strategy is the safest, most effective or cost-effective. They have been developed recently thanks to the current widespread availability of high power computers, but have already succeeded in becoming a highly read and impactful type of research design. Several important examples of network meta-analyses with pivotal practical implications are available, spanning from stents for coronary revascularization to psychiatric drugs.

This book, the first devoted solely to this topic, aims to cover briefly, but poignantly, the main topics which should be mastered to critically read and interpret, as well as, if deemed worthwhile, perform and report independently a network meta-analysis and mixed treatment comparison. The editorial team represents a veritable Who’s Who of worldwide experts in these topics, and everyone involved in the collection has strived to provide correct and sound yet practical advice. This book includes dozens of tables and illustrations to guide visually the reader in understanding the basics as well as the more refined details of network meta-analyses. Quoted references are per se a uniquely useful component of this book, as they provide a commented guidance to the best and most informative papers on mixed treatment comparisons. Thus, this book will be uniquely useful to students or scholars interested in these topics, including clinical researchers and practitioners, as well as statisticians, epidemiologists, psychologists and sociologists. (Imprint: Nova)

Table of Contents

Table of Contents

Giuseppe Biondi-Zoccai, M.D.

1st Section

Foreword: The Statistician’s Perspective
Mauro Gasparini, Ph.D.

Foreword: The Epidemiologist’s Perspective
Gordon H. Guyatt, M.D.

Foreword: The Translational Researcher’s Perspective
Giacomo Frati, M.D.

Foreword: The Clinician-Investigator’s Perspective
Antonio Abbate, M.D., Ph.D.

Giuseppe Biondi-Zoccai, M.D.

2nd Section

Chapter 1 – The Hierarchy of Evidence (pp. 3-20)
Oscar L. Morey-Vargas, M.D., Claudia Zeballos-Palacios, M.D., Michael R. Gionfriddo, Pharm.D. and Victor M. Montori, M.D.,M.Sc. (Mayo Clinic, Rochester, MN, USA)

Chapter 2 – From Pairwise to Network Meta-Analyses (pp. 21-42)
Sonya J. Snedecor, Ph.D., Dipen A. Patel, Ph.D. and Joseph C. Cappelleri, Ph.D. (Health Economics, Pharmerit International, Bethesda, MD, USA and others)

3rd Section

Chapter 3 – Designing and Registering the Review (pp. 45-62)
Alison Booth, M.Sc. and Dawn Craig, M.Sc. (NIHR Centre for Reviews and Dissemination, University of York, Heslington, York, UK)

Chapter 4 – Searching for Evidence (pp. 63-76)
Su Golder, Ph.D. and Kath Wright (Centre for Reviews and Dissemination, University of York, York, UK)

Chapter 5 – Abstracting Evidence (pp. 77-88)
Joey Nicholson, M.L.I.S., M.P.H. and Sripal Bangalore, M.D., M.H.A. (New York University School of Medicine, New York, NY, USA)

Chapter 6 – Appraising Evidence (pp. 88-100)
Partha Sardar, M.D., Anasua Chakraborty, M.D. and Saurav Chatterjee, M.D. (Texas Tech University Health Sciences Center, El Paso, TX, USA and others)

4th Section

Chapter 7 – Choosing between Frequentist and Bayesian Frameworks and the Corresponding Statistical Package (pp. 103-116)
Giuseppe Biondi-Zoccai, M.D. and Fabrizio D’Ascenzo, M.D. (Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, and Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy)

Chapter 8 – Choosing the Statistical Model and between Fixed and Random Effects (pp. 117-140)
Joseph Beyene, Ph.D., Ashley Bonner, M.Sc. and Binod Neupane, Ph.D. (McMaster University, Hamilton, Ontario, Canada)

Chapter 9 – Choosing the Appropriate Statistics (pp. 141-154)
Jing Zhang, Ph.D. and Lifeng Lin, Ph.D. Student (Division of Biostatistics, School of Public Health, University of Minnesota, MN, USA)

5th Section

Chapter 10 – Incorporating Moderators: Network Meta-Regression (pp. 157-170)
Songfeng Wang, Ph.D. and Neil Hawkins, Ph.D. (Health and Civilian Solutions Division, General Dynamics Information Technology, West Des Moines, IA, USA and others)

Chapter 11 – Appraising Between-Study Heterogeneity (pp. 171-190)
Joel J. Gagnier, Ph.D. (Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA)

Chapter 12 – Appraising Inconsistency between Direct and Indirect Estimates (pp.191-210)
Konstantinos Katsanos, M.D., M.Sc., Ph.D., E.B.I.R. (Department of Interventional Radiology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust, King’s Health Partners, London, UK)

Chapter 13 – Appraising Small Study Effects and Publication Bias (pp. 211-222)
Giuseppe Biondi-Zoccai, M.D. and Fabrizio D’Ascenzo, M.D. (Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, and Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy)

Chapter 14 – Moving from Study-Level to Patient-Level Data: Individual Patient Network Meta-Analysis (pp. 223-244)
Areti Angeliki Veroniki, Ph.D., Tania B. Huedo-Medina, Ph.D. and Kostas N. Fountoulakis, M.D., Ph.D. (Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece and others)

Chapter 15 – State of the Art Reporting of Network Meta-Analyses (pp. 245-262)
Andrea Cipriani, Ph.D., John R. Geddes, M.D., Anna Chaimani, M.Sc., Stefan Leucht, M.D. and Georgia Salanti, Ph.D. (Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK and others)

6th Section

Chapter 16 – Case Study in Anesthesia and Intensive Care (pp. 265-284)
Teresa Greco, M.Sc., Giovanni Landoni, M.D., Omar Saleh, M.D. and Alberto Zangrillo, M.D. (San Raffaele Scientific Institute, Milan, Italy)

Chapter 17 – Case Study in Cardiovascular Medicine (pp. 285-306)
Yulei He, Ph.D., John A. Bittl, M.D., Abera Wouhib, Ph.D. and Sharon-Lise T. Normand, Ph.D. (Office of Research and Methodology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA and others)

Chapter 18 – Case Study in Neurology (pp. 307-324)
Gaetano Zaccara, M.D. and Fabio Giovannelli, Psy.D., Ph.D. (Unit of Neurology, Department of Medicine, Florence Health Authority, and Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Italy)

Chapter 19 – Case Study in Psychiatry (pp. 325-338)
Toshi A. Furukawa, M.D., Ph.D. (Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan)

Chapter 20 – Case Study in Rheumatology (pp. 339-360)
Susanne Schmitz, Ph.D., Roisin Adams, Ph.D., Michael Barry, Ph.D. and Cathal Walsh, Ph.D. (Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Science, St. James’s Hospital, and National Centre for Pharmacoeconomics (NCPE), St. James’s Hospital, Dublin, Ireland)

7th Section

Chapter 21 – Moving from Evidence Synthesis to Action (pp. 363-374)
Fabrizio D’Ascenzo, M.D., Claudio Moretti, M.D., Ph.D., Pierluigi Omedè, M.D. and Fiorenzo Gaita, M.D. (Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy)

Chapter 22 – The Future of Network Meta-Analysis: Toward Accessibility and Integration (pp. 375-392)
Matthew A. Silva, Pharm.D., R.Ph., B.C.P.S. and Gert van Valkenhoef, M.Sc., Ph.D. (MCPHS University, Worcester, MA, USA and others)

Giuseppe Biondi-Zoccai, M.D.



“Systematic reviews and meta-analyses, being at the intersection of clinical medicine, epidemiology, statistics, and translational research, arekeymethodologies for the practice of evidence-based medicine. Traditional meta-analytical methods, however, pertain to pairwise comparisons between 2 interventions, thus only partially providing evidence that patients, clinicians, and policy-makers need in order to make informed decisions or public health recommendations regarding prevention, screening, diagnosis, and treatment.” READ MORE…Reviewed by Orestis A. Panagiotou, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD. Published in the American Journal of Epidemiology

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