Cited by 198Meta-analysis and systematic reviewsStatistical Methods in Clinical TrialsMental Health Research Topics

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A primer on network meta-analysis with emphasis on mental health

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Mavridis, Dimitris, Giannatsi, Myrsini, Cipriani, Andrea, Salanti, Georgia·2015·Evidence Based Mental Health

DOI 10.1136/eb-2015-102088PMC PMC11234956

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Abstract

Objective: A quantitative synthesis of evidence via standard pair-wise meta-analysis lies on the top of the hierarchy for evaluating the relative effectiveness or safety between two interventions. In most healthcare problems, however, there is a plethora of competing interventions. Network meta-analysis allows to rank competing interventions and evaluate their relative effectiveness even if they have not been compared in an individual trial. The aim of this paper is to explain and discuss the main features of this statistical technique. Methods: We present the key assumptions underlying network meta-analysis and the graphical methods to visualise results and information in the network. We used one illustrative example that compared the relative effectiveness of 15 antimanic drugs and placebo in acute mania. Results: A network plot allows to visualise how information flows in the network and reveals important information about network geometry. Discrepancies between direct and indirect evidence can be detected using inconsistency plots. Relative effectiveness or safety of competing interventions can be presented in a league table. A contribution plot reveals the contribution of each direct comparison to each network estimate. A comparison-adjusted funnel plot is an extension of simple funnel plot to network meta-analysis. A rank probability matrix can be estimated to present the probabilities of all interventions assuming each rank and can be represented using rankograms and cumulative probability plots. Conclusions: Network meta-analysis is very helpful in comparing the relative effectiveness and acceptability of competing treatments. Several issues, however, still need to be addressed when conducting a network meta-analysis for the results to be valid and correctly interpreted.

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Authors: Mavridis, D., Giannatsi, M., Cipriani, A., & Salanti, G.
Affiliations: University of Ioannina (GR)
Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece;
University of Oxford (GB)
Corresponding author: Mavridis, Dimitris
ORCID: Mavridis, Dimitris
Cipriani, Andrea
Salanti, Georgia
Venue: Evidence Based Mental Health
Publisher: BMJ
Published: 2015-04-23
Volume: 18
Issue: 2
Pages: 40-46
ISSN: 1362-0347 (ISSN-L)
1468-960X
DOI: 10.1136/eb-2015-102088
PMC: PMC11234956
OpenAlex: W2085805157
Cited by: 198
References: 31
Citations by year: 2026: 9 · 2025: 8 · 2024: 13 · 2023: 14 · 2022: 24 · 2021: 29 · 2020: 21 · 2019: 22 · 2018: 23 · 2017: 11 · 2016: 22 · 2015: 1
FWCI: 17.31
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Evidence-Based Mental Health (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
HighWire Press Open Archive (submittedVersion)
Funders: National Institute for Health and Care Research
FP7 Ideas: European Research Council (260559)
Topics: Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Keywords: network meta-analysis, mental health interventions, acute mania, antimanic drugs, relative effectiveness, league tables, contribution plots, placebo comparison
MeSH terms: Data Interpretation, Statistical, Humans, Mental Health, Meta-Analysis as Topic, Evidence-Based Medicine

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A primer on network meta-analysis with emphasis on mental health

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