Network Meta-analysis to Synthesize Evidence for Decision Making in Cardiovascular Research

Abstract

Clinical decision-making requires synthesis of evidence from literature reviews focused on a specific theme. Evidence synthesis is performed with qualitative assessments and systematic reviews of randomized clinical trials, typically covering statistical pooling with pairwise meta-analyses. These methods include adjusted indirect comparison meta-analysis, network meta-analysis, and mixed-treatment comparison. These tools allow synthesis of evidence and comparison of effectiveness in cardiovascular research.

A mixed treatment comparison meta-analysis of metaphylaxis treatments for bovine respiratory disease in beef cattle1,2

“…The indirect comparison have been proven to be realistic estimates of disease risk when direct estimates are not available (O'Connor et al, 2016). The MTC of meta-analysis has been done frequently in the human medical field (Mills et al, 2009;Roever and Biondi-Zoccai, 2016;Shao et al, 2016), and has previously evaluated antimicrobial efficacy for treatment of BRD (O'Connor et al, 2013). The objective of this research was to evaluate the effect of parenterally administered metaphylactic antimicrobials approved for feeder and stocker calves on morbidity and mortality due to BRD using a MTC meta-analysis.…”

“Addressing the core trait of bipolar disorder”: a concept analysis of mood stabilizing drugs

“…We are aware, as Malhi et al (2018) notes, that other dimensions such as activation are involved as well, but this is clearly how authors tend to conceptualize response and how studies are conducted. Whenever possible, we drew on network meta-analysis of monotherapy trials as the most comprehensive and simplest methodology to determine efficacy in such phases, following evidence hierarchy (Roever and Biondi-Zoccai 2016). This supplied data referring to the treatment of acute depression (Bahji et al 2020a), acute mania (Yildiz et al 2015), and maintenance treatment (Miura et al 2014).…”

Network meta-analysis in health psychology and behavioural medicine: a primer

“…Another characteristic of NMA that may limit its usefulness in health psychology, as in other areas of psychology, is the predominance of small studies (Crutzen & Peters, 2017). These may suffer from methodological limitations usually associated with small sample sizes which can lead to biased estimates (Roever & Biondi-Zoccai, 2016). This issue applies equally to pairwise meta-analysis, but bias can propagate through a network and affect different parts of the network in different ways (Li, Puhan, Vedula, Singh, & Dickersin, 2011).…”

“…It is due to these advantages that NMA has become a key component of the development of clinical guidelines and reimbursement recommendations by national health technology assessment agencies and the World Health Organisation (Kanters et al, 2016). The utility of NMA in clinical medicine has resulted in some scholars, suggesting that it could constitute a higher level in the hierarchy of evidence than traditional systematic reviews and pairwise meta-analyses (Leucht et al, 2016;Roever & Biondi-Zoccai, 2016). However, while there has been a significant and rapid increase in the use of the method in health research more broadly over the last 10 years (Lee, 2014), uptake in the field of Health Psychology has been more limited.…”