A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis

Network meta-analysis (NMA), combining direct and indirect comparisons, is increasingly being used to examine the comparative effectiveness of medical interventions. Minimal guidance exists on how to rate the quality of evidence supporting treatment effect estimates obtained from NMA. We present a f...

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Bibliographic Details
Published in:BMJ (Online) 2014-09, Vol.349 (sep24 5), p.g5630-g5630
Main Authors: Puhan, Milo A, Schünemann, Holger J, Murad, Mohammad Hassan, Li, Tianjing, Brignardello-Petersen, Romina, Singh, Jasvinder A, Kessels, Alfons G, Guyatt, Gordon H
Format: Article
Language:English
Subjects:
Cardiovascular disease
Confidence
Coronary vessels
Estimates
Evidence-Based Medicine - standards
Guideline Adherence
Heart surgery
Humans
Medical treatment
Meta-analysis
Meta-Analysis as Topic
Mortality
Observational studies
Practice Guidelines as Topic - standards
Quality Assurance, Health Care - standards
Ratings & rankings
RESEARCH METHODS & REPORTING
Working groups
Citations: Items that cite this one
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Summary:Network meta-analysis (NMA), combining direct and indirect comparisons, is increasingly being used to examine the comparative effectiveness of medical interventions. Minimal guidance exists on how to rate the quality of evidence supporting treatment effect estimates obtained from NMA. We present a four-step approach to rate the quality of evidence in each of the direct, indirect, and NMA estimates based on methods developed by the GRADE working group. Using an example of a published NMA, we show that the quality of evidence supporting NMA estimates varies from high to very low across comparisons, and that quality ratings given to a whole network are uninformative and likely to mislead.
ISSN:0959-8138
1756-1833
1756-1833
DOI:10.1136/bmj.g5630