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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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Kim, S. M., Jeon, E., Jung, J., & Lee, J. S. (2021) · Medicine · doi:10.1097/md.0000000000026883 · Cited by 16
“For each outcome, the interventions with higher P scores were considered more desirable compared to the others.([21]) The hierarchy of the treatments was determined using the P score, where a larger P score value represented a better rank.”
Single-injection regional analgesia techniques for mastectomy surgery
CASSAI, A. D., Zarantonello, F., Geraldini, F., Boscolo, A., Pasin, L., Pinto, S. D., Leardini, G., Basile, F., Disarò, L., Sella, N., et al. (2021) · European Journal of Anaesthesiology · doi:10.1097/eja.0000000000001644 · Cited by 16
Carrano, F. M., Iossa, A., Lorenzo, N. D., Silecchia, G., Kontouli, K., Mavridis, D., Alarcón, I., Felsenreich, D. M., Sánchez-Cordero, S., Vincenzo, A. D., et al. (2022) · Surgical Endoscopy · doi:10.1007/s00464-022-09008-0 · Cited by 16
“We ranked all treatments in each outcome using p-scores [28].”
MethodShi, J., Lu, D., Chen, H., Shu, M., Xu, Y., Qian, J., Ouyang, K., Huang, H., Luo, Z., Wang, C., et al. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.868121 · Cited by 15
“NMA estimated the overall rankings of treatments by calculating the surface under the cumulative ranking curve (SUCRA) for each, which approaches one when a treatment is certain to be the best and zero when treatment is the worst (21).”
MethodTsai, S. H. L., Lau, N. C., Chen, W., Chien, R.-S., Tischler, E. H., Fu, T., & Chen, D. W.-C. (2022) · Journal of Orthopaedic Surgery and Research · doi:10.1186/s13018-022-03237-8 · Cited by 16
“Network meta-analysis is an advanced form of meta-analysis in which three or more multiple comparisons are being compared with a common comparator [17].”
Nyaaba, N., Andoh, N. E., Amoh, G. K. A., Amuzu, D. S. Y., Ansong, M., Ordóñez-Mena, J. M., & Hirst, J. A. (2022) · PLoS ONE · doi:10.1371/journal.pone.0269391 · Cited by 16
“We chose not to use the Hasse diagram to combine rankings as prespecified in our protocol because it is not possible to give weight to most important outcomes and it compounds the limitations of the p-scores [38,75].”
Lei, Q., Yan, X. C., Zou, H., Jiang, Y., Lai, Y., Ung, C. O. L., & Hu, H. (2022) · Discover Oncology · doi:10.1007/s12672-022-00559-1 · Cited by 16
“The P-score depended on the estimating result and confidence interval of the effect value, from 0 to 1, indicating a progressive increase in the efficacy of the included drugs [30].”
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“The comparative effectiveness of the treatments were ranked by using P-score, an index of the mean probability that a treatment is the most efficacious treatment in all of the included treatments.[10] The consistency of the network meta-analysis was checked by comparing the estimates from indirect evidence with those…”
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“A higher SUCRA value denotes a higher ranking ( Rücker & Schwarzer, 2015 ; Trinquart et al., 2016 ).”
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“The relative ranking of each intervention was performed using a P-score, with higher P-scores indicating greater effectiveness (Rücker & Schwarzer, 2015).”
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“The higher the SUCRA score, the larger the area under the curve, indicating a higher likelihood that the intervention method was the best [32].”
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Efficacy and safety of non-pharmacological interventions for irritable bowel syndrome in adults
Dai, Y., Wu, Y., Li, R., Chen, W., Tang, C., Lu, L., & Hu, L. (2020) · World Journal of Gastroenterology · doi:10.3748/wjg.v26.i41.6488 · Cited by 17
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“P-scores reflect the certainty that one treatment protocol is better than another strategy, averaged over all competing therapies, a method that is equivalent to the surface under the cumulative ranking curve (SUCRA) [20].”
MethodYang, J., Dhital, S., & Naderer, T. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8122182 · Cited by 16
“They measure the extent of certainty that a treatment is better than another treatment, averaged over all competing treatments [26].”
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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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