Cited by 1,812Meta-analysis and systematic reviewsDelphi Technique in ResearchClinical practice guidelines implementation

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

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Puhan, M. A., Schunemann, H. J., Murad, M. H., Li, T., Brignardello-Petersen, R., Singh, J. A., Kessels, A. G., Guyatt, G. H. +1 more·2014·BMJ

Abstract

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.

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Authors
Puhan, M. A., Schunemann, H. J., Murad, M. H., Li, T., Brignardello-Petersen, R., Singh, J. A., Kessels, A. G., Guyatt, G. H., & for the GRADE Working Group
Affiliations
  • University of Zurich (CH)
  • Mayo Clinic (US)
  • Johns Hopkins University (US)
  • University of Alabama (US)
  • Maastricht University (NL)
  • McMaster University (CA)
Corresponding author
Puhan, M. A.
Venue
BMJ
Publisher
BMJ
Published
2014-09-24
Volume
349
Issue
sep24 5
Pages
g5630-g5630
ISSN
1756-1833 (ISSN-L)
OpenAlex
W2155798268
Cited by
1,812
References
39
Citations by year
2026: 160 · 2025: 177 · 2024: 216 · 2023: 175 · 2022: 205 · 2021: 276 · 2020: 201 · 2019: 128 · 2018: 96 · 2017: 72 · 2016: 63 · 2015: 36 · 2014: 4 · 2013: 1
FWCI
57.15
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, other-oa)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
  • HighWire Press Open Archive (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
  • Zurich Open Repository and Archive (University of Zurich)
Topics
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
  • Social Sciences › Sociology and Political Science › Delphi Technique in Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords
network meta-analysis, quality of evidence, GRADE, treatment effect estimates, comparative effectiveness
MeSH terms
Humans, Quality Assurance, Health Care, Meta-Analysis as Topic, Practice Guidelines as Topic, Evidence-Based Medicine, Guideline Adherence

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