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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Introducing the Treatment Hierarchy Question in Network Meta-Analysis
American Journal of Epidemiology, Volume 191, No. 5, Year 2022
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Description
Comparative effectiveness research using network meta-analysis can present a hierarchy of competing treatments, from the most to the least preferable option. However, in published reviews, the research question associated with the hierarchy of multiple interventions is typically not clearly defined. Here we introduce the novel notion of a treatment hierarchy question that describes the criterion for choosing a specific treatment over one or more competing alternatives. For example, stakeholders might ask which treatment is most likely to improve mean survival by at least 2 years, or which treatment is associated with the longest mean survival. We discuss the most commonly used ranking metrics (quantities that compare the estimated treatment-specific effects), how the ranking metrics produce a treatment hierarchy, and the type of treatment hierarchy question that each ranking metric can answer. We show that the ranking metrics encompass the uncertainty in the estimation of the treatment effects in different ways, which results in different treatment hierarchies. When using network meta-analyses that aim to rank treatments, investigators should state the treatment hierarchy question they aim to address and employ the appropriate ranking metric to answer it. Following this new proposal will avoid some controversies that have arisen in comparative effectiveness research. © 2021 The Author(s) 2022. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.
Authors & Co-Authors
Salanti, Georgia
Switzerland, Bern
University of Bern
Nikolakopoulou, Adriani
Switzerland, Bern
University of Bern
Germany, Freiburg Im Breisgau
Universität Freiburg
Efthimiou, Orestis
Switzerland, Bern
University of Bern
United Kingdom, Oxford
University of Oxford
Mavridis, Dimitrios
Greece, Ioannina
University of Ioannina
Egger, Matthias
Switzerland, Bern
University of Bern
United Kingdom, Bristol
University of Bristol
Statistics
Citations: 13
Authors: 5
Affiliations: 5
Identifiers
Doi:
10.1093/aje/kwab278
ISSN:
00029262
Study Approach
Systematic review