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Ranking treatments in frequentist network meta-analysis works without resampling methods
Open accessAbstract
BACKGROUND: Network meta-analysis is used to compare three or more treatments for the same condition. Within a Bayesian framework, for each treatment the probability of being best, or, more general, the probability that it has a certain rank can be derived from the posterior distributions of all treatments. The treatments can then be ranked by the surface under the cumulative ranking curve (SUCRA). For comparing treatments in a network meta-analysis, we propose a frequentist analogue to SUCRA which we call P-score that works without resampling. METHODS: P-scores are based solely on the point estimates and standard errors of the frequentist network meta-analysis estimates under normality assumption and can easily be calculated as means of one-sided p-values. They measure the mean extent of certainty that a treatment is better than the competing treatments. RESULTS: Using case studies of network meta-analysis in diabetes and depression, we demonstrate that the numerical values of SUCRA and P-Score are nearly identical. CONCLUSIONS: Ranking treatments in frequentist network meta-analysis works without resampling. Like the SUCRA values, P-scores induce a ranking of all treatments that mostly follows that of the point estimates, but takes precision into account. However, neither SUCRA nor P-score offer a major advantage compared to looking at credible or confidence intervals.
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“This approach is often misleading, as it considers only the point estimate of effect and not the associated precision or certainty of evidence and ignores absolute differences between treatment alternatives.[56][57][58]”
From Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials (2023) · cites this paper as [57]
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“Mean ranks are transformations of SUCRAs (Mean R i = T − ( T − 1 ) × SUCRA i ) and can be estimated via P-scores.”
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“SUCRA reflects the mean certainty that an individual treatment is better than any other treatment.(44) Pooled event risks of the outcome measures are summarized in Figure 6 to provide information about absolute expected real-life outcomes (random effects model).”
BackgroundOmar, D., Chen, Y., Cong, Y., & Dong, L. (2019) · Rheumatology · doi:10.1093/rheumatology/kez380 · Cited by 114
Petit, C., Lacas, B., Pignon, J., Le, Q., Grégoire, V., Grau, C., Hackshaw, A. K., Zackrisson, B., Parmar, M., Lee, J., et al. (2021) · The Lancet Oncology · doi:10.1016/s1470-2045(21)00076-0 · Cited by 117
netmeta: Network Meta-Analysis using Frequentist Methods
Rücker, G., Krahn, U., König, J., Efthimiou, O., Davies, A. L., Papakonstantinou, T., & Schwarzer, G. (2013) · doi:10.32614/cran.package.netmeta · Cited by 117
Self-citationSun, M., Lai, H., Na, F., Li, S., Qiu, X., Tian, J., Zhang, Z., & Ge, L. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.0023 · Cited by 122
Weibel, S., Schaefer, M. S., Raj, D., Rücker, G., Pace, N. L., Schlesinger, T., Meybohm, P., Kienbaum, P., Eberhart, L. H. J., & Kranke, P. (2020) · Anaesthesia · doi:10.1111/anae.15295 · Cited by 110
“Multi-arm studies were included in the dataset as a series of two-arm comparisons with adjusted standard errors [25, 27, 29].”
BackgroundMethodSelf-citationFeng, J., Wang, F., Qiu, X., McFarland, L. V., Chen, P., Zhou, R., Liu, J., Zhao, Q., & Li, J. (2017) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-017-2291-6 · Cited by 112
“We calculated the summary effect sizes as relative ratios (RRs) with 95% confidence intervals (CIs) and relative ranks using P scores with a higher value indicating greater effectiveness [20].”
MethodZhang, M., Murphy, B., Cabanilla, A., & Yidi, C. (2021) · Journal of Occupational Health · doi:10.1002/1348-9585.12243 · Cited by 125
Veroniki, A. A., Hutton, B., Stevens, A., McKenzie, J. E., Page, M. J., Moher, D., McGowan, J., Straus, S. E., Li, T., Munn, Z., et al. (2025) · JBI Evidence Synthesis · doi:10.11124/jbies-24-00308 · Cited by 110
Heger, P., Probst, P., Hüttner, F. J., Gooßen, K., Proctor, T., Müller-Stich, B. P., Strobel, O., Büchler, M. W., & Diener, M. K. (2017) · World Journal of Surgery · doi:10.1007/s00268-017-4095-3 · Cited by 107
Probiotics for Preventing Necrotizing Enterocolitis in Preterm Infants: A Network Meta-Analysis
Beghetti, I., Panizza, D., Lenzi, J., Gori, D., Martini, S., Corvaglia, L., & Aceti, A. (2021) · Nutrients · doi:10.3390/nu13010192 · Cited by 132
“All analyses were duplicated in the frequentist framework using the netmeta package in R [27].”
MethodNetwork Meta-Analysis using Frequentist Methods
Rücker, G., Schwarzer, G., Krahn, U., & König, J. (2015) · Cited by 106
Self-citationSingh, H., Knapik, D. M., Polce, E. M., Eikani, C. K., Bjornstad, A. H., Gürsoy, S., Perry, A. K., Westrick, J. C., Yanke, A. B., Verma, N. N., et al. (2021) · The American Journal of Sports Medicine · doi:10.1177/03635465211029659 · Cited by 105
“The efficacy of competing treatments in the network was ranked through computation of the P value, which is representative of the certainty that a given treatment is superior to other treatments.(50) A total of 5 P values were calculated to determine the efficacy of competing treatments in terms of improvement in pain…”
MethodAntipsychotic Drugs and Cognitive Function
Feber, L., Peter, N. L., Chiocchia, V., Schneider‐Thoma, J., Siafis, S., Bighelli, I., Hansen, W., Lin, X., Baldez, D. P., Salanti, G., et al. (2024) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2024.2890 · Cited by 117
Comparison of Cardiovascular Events Among Users of Different Classes of Antihypertension Medications
Wei, J., Galaviz, K. I., Kowalski, A. J., Magee, M. J., HAW, J. S., Narayan, K. M. V., & Ali, M. K. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.21618 · Cited by 101
Pan, B., Wu, Y., Yang, Q., Ge, L., Gao, C., Xun, Y., Tian, J., & Ding, G. (2019) · Journal of Evidence-Based Medicine · doi:10.1111/jebm.12312 · Cited by 99
Yildiz, A., Siafis, S., Mavridis, D., Vieta, E., & Leucht, S. (2023) · The Lancet Psychiatry · doi:10.1016/s2215-0366(23)00199-2 · Cited by 104
Bellos, I., Pergialiotis, V., Papapanagiotou, A., Loutradis, D., & Daskalakis, G. (2020) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2020.03.016 · Cited by 103
Karagiannis, T., Malandris, K., Avgerinos, I., Stamati, A., Kakotrichi, P., Liakos, A., Vasilakou, D., Kakaletsis, N., Tsapas, A., & Bekiari, E. (2024) · Diabetologia · doi:10.1007/s00125-024-06144-1 · Cited by 102
“Moreover, we used P-scores, ranging from 0 to 1, to rank treatments; these can be interpreted as the average degree of certainty for a treatment to be better than the other treatments in the network [21].”
Anti–PD-1 and Anti–PD-L1 in Head and Neck Cancer: A Network Meta-Analysis
Botticelli, A., Cirillo, A., Strigari, L., Valentini, F., Cerbelli, B., Scagnoli, S., Cerbelli, E., Zizzari, I. G., Rocca, C. D., d’Amati, G., et al. (2021) · Frontiers in Immunology · doi:10.3389/fimmu.2021.705096 · Cited by 101
“P scores measure the extent of certainty that a treatment is better than another treatment, averaged over all competing treatments, while taking the precision into account (38).”
BackgroundMethodMandel, P. C., Hoeh, B., Wenzel, M., Preißer, F., Tian, Z., Tilki, D., Steuber, T. P., Karakiewicz, P. I., & Chun, F. K. ‐. (2022) · European Urology Focus · doi:10.1016/j.euf.2022.08.007 · Cited by 103
Twenty years of network meta‐analysis: Continuing controversies and recent developments
Ades, A. E., Welton, N. J., Dias, S., Phillippo, D., & Caldwell, D. M. (2024) · Research Synthesis Methods · doi:10.1002/jrsm.1700 · Cited by 115
“197,198 Rankings based on the SUCRA (Surface under the cumulative ranking curve) statistic, 199 or equivalently on the P-score statistic, 200 reflect both the mean (rank) outcome value and its uncertainty.”
Wade, R. G., Burr, N. E., McCauley, G., Bourke, G., & Efthimiou, O. (2020) · Annals of Surgery · doi:10.1097/sla.0000000000004076 · Cited by 108
Zamborský, R., & Danišovič, Ľ. (2020) · Arthroscopy The Journal of Arthroscopic and Related Surgery · doi:10.1016/j.arthro.2019.11.096 · Cited by 97
Chambrone, L., Botelho, J., Machado, V., Mascarenhas, P., Mendes, J. J., & Ávila‐Ortiz, G. (2022) · Journal of Periodontology · doi:10.1002/jper.22-0167 · Cited by 103
Roman, M., Abbasciano, R. G., Pathak, S., Oo, S., Yusoff, S., Wozniak, M. J., Qureshi, S. H., Lai, F. Y., Kumar, T., Richards, T., et al. (2020) · British Journal of Anaesthesia · doi:10.1016/j.bja.2020.04.087 · Cited by 95
“To rank the interventions, we reported the P score, whichmeasures the extent of certainty that an intervention is better than the competing interventions.(15) Heterogeneity was evaluated using tau(2), I(2) statistics, and Cochran’s Q test.”
MethodChen, X., He, H., Xie, K., Zhang, L., & Cao, C. (2023) · Obesity Reviews · doi:10.1111/obr.13666 · Cited by 110
“38 Transitivity is a key assumption of NMA and refers to the belief that indirect comparisons are valid estimates of unobserved direct comparisons 37 and that all studies have homogenously distributed effect modifiers.”
BackgroundResolve conflicting rankings of outcomes in network meta‐analysis: Partial ordering of treatments
Rücker, G., & Schwarzer, G. (2017) · Research Synthesis Methods · doi:10.1002/jrsm.1270 · Cited by 94
“We found 5 levels of treatments, and these are in decreasing order: (1) CRT-AC, (2) IC-CRT and CRT, (3) IC-RT and IC-RT-AC, (4) RT-AC, and (5) RT alone.”
MethodSelf-citationMasarwa, R., Bar‐Oz, B., Gorelik, E., Reif, S. S., Perlman, A., & Matok, I. (2018) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2018.08.030 · Cited by 106
“The P score of a treatment can be interpreted as the mean extent of certainty that the treatment is better than another treatment, and can be used to rank a treatment within a range of treatments, measured on a scale from 0 (worst) to 1 (best).(42)”
BackgroundLee, P. J., Podugu, A., Wu, D., Lee, A. C.-L., Stevens, T., & Windsor, J. A. (2018) · HPB · doi:10.1016/j.hpb.2017.12.007 · Cited by 94
Maintenance Treatment and Survival in Patients With Myeloma
Gay, F., Jackson, G. H., Rosiñol, L., Holstein, S. A., Moreau, P., Spada, S., Davies, F. E., Lahuerta, J. J., Leleu, X. P., Bringhen, S., et al. (2018) · JAMA Oncology · doi:10.1001/jamaoncol.2018.2961 · Cited by 94
“informative, we adopted also this approach using package “netmeta” to confirm the results of the NMA obtained with the Bayesian method.(3)”
Metadata
- Authors
- Rücker, G., & Schwarzer, G.
- Affiliations
- University of Freiburg (DE)
- Corresponding author
- Rücker, Gerta
- Venue
- BMC Medical Research Methodology
- Published
- 2015-07-31
- Volume
- 15
- Issue
- 1
- Pages
- 58-58
- ISSN
- 1471-2288 (ISSN-L)
- PMC
- PMC4521472
- OpenAlex
- W2111999709
- Cited by
- 1,732
- References
- 32
- Citations by year
- 2026: 249 · 2025: 253 · 2024: 267 · 2023: 229 · 2022: 226 · 2021: 191 · 2020: 148 · 2019: 76 · 2018: 52 · 2017: 32 · 2016: 8 · 2015: 1
- FWCI
- 28.58
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Medical Research Methodology (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- FreiDok plus (Universitätsbibliothek Freiburg) (submittedVersion)
- Funders
- Deutsche Forschungsgemeinschaft (RU1747/1-1)
- 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 › Sociology and Political Science › Delphi Technique in Research
- Keywords
- treatment ranking, P-score, surface under the cumulative ranking curve, confidence intervals, diabetes mellitus, depression
- MeSH terms
- Algorithms, Bayes Theorem, Biometry, Data Interpretation, Statistical, Humans, Review Literature as Topic, Meta-Analysis as Topic, Reproducibility of Results, Biomedical Research
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