Introducing the Treatment Hierarchy Question in Network Meta-Analysis.
Introducing the Treatment Hierarchy Question in Network Meta-Analysis.
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DOI：
10.1093/aje/kwab278
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发表时间：
2022-03-24
影响因子：
5
通讯作者：
White, Ian R.
中科院分区：
文献类型：
--
作者：
Salanti, Georgia;Nikolakopoulou, Adriani;Efthimiou, Orestis;Mavridis, Dimitris;Egger, Matthias;White, Ian R.
关键词：
使用网络荟萃分析的比较有效性研究可以呈现一个竞争治疗的层次结构，从最优选的选择到最不优选的选择。然而，在已发表的综述中，与多种干预措施的层次结构相关的研究问题通常没有明确定义。在这里，我们介绍了一个治疗层次问题，描述了一个或多个竞争的替代品选择一个特定的治疗标准的新概念。例如，利益相关者可能会问，哪种治疗最有可能将平均生存期提高至少2年，或者哪种治疗与最长的平均生存期相关。我们讨论了最常用的排名指标（比较估计的治疗特异性效应的数量），排名指标如何产生治疗层次，以及每个排名指标可以回答的治疗层次问题的类型。我们发现，排名指标包括以不同的方式，从而导致在不同的治疗层次的治疗效果的估计的不确定性。当使用网络荟萃分析对治疗进行排序时，研究者应该说明他们要解决的治疗层次问题，并采用适当的排序指标来回答它。
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.
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