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Methods for network meta-analysis of continuous outcomes using individual patient data : a case study in acupuncture for chronic pain
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Saramago, Pedro, Woods, Beth, Weatherly, Helen, Manca, Andrea, Sculpher, Mark, Khan, Kamran, Vickers, Andrew J. and MacPherson, Hugh (2016) Methods for network meta-analysis of continuous outcomes using individual patient data : a case study in acupuncture for chronic pain. BMC Medical Research Methodology, 16 (1). doi:10.1186/s12874-016-0224-1
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Official URL: http://dx.doi.org/10.1186/s12874-016-0224-1
Abstract
Network meta-analysis methods, which are an extension of the standard pair-wise synthesis framework, allow for the simultaneous comparison of multiple interventions and consideration of the entire body of evidence in a single statistical model. There are well-established advantages to using individual patient data to perform network meta-analysis and methods for network meta-analysis of individual patient data have already been developed for dichotomous and time-to-event data. This paper describes appropriate methods for the network meta-analysis of individual patient data on continuous outcomes.
Methods
This paper introduces and describes network meta-analysis of individual patient data models for continuous outcomes using the analysis of covariance framework. Comparisons are made between this approach and change score and final score only approaches, which are frequently used and have been proposed in the methodological literature. A motivating example on the effectiveness of acupuncture for chronic pain is used to demonstrate the methods. Individual patient data on 28 randomised controlled trials were synthesised. Consistency of endpoints across the evidence base was obtained through standardisation and mapping exercises.
Results
Individual patient data availability avoided the use of non-baseline-adjusted models, allowing instead for analysis of covariance models to be applied and thus improving the precision of treatment effect estimates while adjusting for baseline imbalance.
Conclusions
The network meta-analysis of individual patient data using the analysis of covariance approach is advocated to be the most appropriate modelling approach for network meta-analysis of continuous outcomes, particularly in the presence of baseline imbalance. Further methods developments are required to address the challenge of analysing aggregate level data in the presence of baseline imbalance.
| Item Type: | Journal Article | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Subjects: | R Medicine > R Medicine (General) | ||||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > ( - July 2016) Health Education Hub Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Acupuncture, Clinical trials | ||||||||
| Journal or Publication Title: | BMC Medical Research Methodology | ||||||||
| Publisher: | BioMed Central Ltd. | ||||||||
| ISSN: | 1471-2288 | ||||||||
| Official Date: | 6 October 2016 | ||||||||
| Dates: |
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| Volume: | 16 | ||||||||
| Number: | 1 | ||||||||
| DOI: | 10.1186/s12874-016-0224-1 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access | ||||||||
| Funder: | National Institute for Health Research (Great Britain) (NIHR) | ||||||||
| Grant number: | RP-PG-0707-10186 | ||||||||
| Adapted As: |
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