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Extensions of the probabilistic ranking metrics of competing treatments in network meta‐analysis to reflect clinically important relative differences on many outcomes
Author(s) -
Mavridis Dimitris,
Porcher Raphaël,
Nikolakopoulou Adriani,
Salanti Georgia,
Ravaud Philippe
Publication year - 2020
Publication title -
biometrical journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.108
H-Index - 63
eISSN - 1521-4036
pISSN - 0323-3847
DOI - 10.1002/bimj.201900026
Subject(s) - ranking (information retrieval) , meta analysis , discontinuation , psychological intervention , medicine , computer science , statistics , psychology , econometrics , machine learning , mathematics , psychiatry
One of the key features of network meta‐analysis is ranking of interventions according to outcomes of interest. Ranking metrics are prone to misinterpretation because of two limitations associated with the current ranking methods. First, differences in relative treatment effects might not be clinically important and this is not reflected in the ranking metrics. Second, there are no established methods to include several health outcomes in the ranking assessments. To address these two issues, we extended the P‐score method to allow for multiple outcomes and modified it to measure the mean extent of certainty that a treatment is better than the competing treatments by a certain amount, for example, the minimum clinical important difference. We suggest to present the tradeoff between beneficial and harmful outcomes allowing stakeholders to consider how much adverse effect they are willing to tolerate for specific gains in efficacy. We used a published network of 212 trials comparing 15 antipsychotics and placebo using a random effects network meta‐analysis model, focusing on three outcomes; reduction in symptoms of schizophrenia in a standardized scale, all‐cause discontinuation, and weight gain.