Cited by 202Meta-analysis and systematic reviewsDelphi Technique in ResearchStatistical Methods in Clinical Trials

Uncertainty in Treatment Rankings: Reanalysis of Network Meta-analyses of Randomized Trials

Trinquart, Ludovic, Attiche, Nassima, Bafeta, Aïida, Porcher, Raphaël, Ravaud, Philippe·2016·Annals of Internal Medicine

Abstract

BACKGROUND: Ranking of interventions is one of the most appealing elements of network meta-analysis. There is, however, little evidence about the reliability of these rankings. PURPOSE: To empirically evaluate the extent of uncertainty in intervention rankings from network meta-analysis. DATA SOURCES: Two previous systematic reviews that involved searches of the Cochrane Library, MEDLINE, and Embase up to July 2012 for articles that included networks of at least 3 interventions. STUDY SELECTION: 58 network meta-analyses involving 1308 randomized trials and 404 interventions with available aggregated outcome data. DATA ANALYSIS: Each network was analyzed with a Bayesian approach. For each intervention, the surface under the cumulative ranking curve (SUCRA) and its 95% credible interval (95% CrI) were estimated. Through use of the SUCRA values, the interventions were then rank-ordered between 0% (worst) and 100% (best). DATA SYNTHESIS: The median width of the 95% CrIs of the SUCRA was 65% (first to third quartile, 38% to 80%). In 28% of networks, there was a 50% or greater probability that the best-ranked treatment was actually not the best. No evidence showed a difference between the best-ranked intervention and the second and third best-ranked interventions in 90% and 71% of comparisons, respectively. In 39 networks with 6 or more interventions, the median probability that 1 of the top 2 interventions was among the bottom 2 was 35% (first to third quartile, 14% to 59%). LIMITATION: This analysis did not consider such factors as the risk of bias within trials or small-study effects that may affect the reliability of rankings. CONCLUSION: Treatment rankings derived from network meta-analyses have a substantial degree of imprecision. Authors and readers should interpret such rankings with great caution. PRIMARY FUNDING SOURCE: Cochrane France.

Integrity signals

Registry

Crossref · 10.7326/m15-2521

Cites

99 of 99 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Authors
Trinquart, L., Attiche, N., Bafeta, A., Porcher, R., & Ravaud, P.
Affiliations
  • Inserm (FR)
  • From INSERM U1153, Université Paris Descartes–Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu, Centre d'Epidémiologie Clinique, and Cochrane France, Paris, France, and Columbia University Mailman School of Public Health, New York, New York.
Venue
Annals of Internal Medicine
Published
2016-05-17
Volume
164
Issue
10
Pages
666-673
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
OpenAlex
W2339783374
Cited by
202
References
99
Citations by year
2026: 30 · 2025: 28 · 2024: 26 · 2023: 16 · 2022: 11 · 2021: 23 · 2020: 26 · 2019: 14 · 2018: 12 · 2017: 12 · 2016: 4
FWCI
13.00
Type
journal article
Language
en
Open access
closed
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
  • Social Sciences › Sociology and Political Science › Delphi Technique in Research
  • Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
Keywords
network meta-analysis, treatment ranking, surface under the cumulative ranking curve, Bayesian ranking
MeSH terms
Network Meta-Analysis as Topic, Bayes Theorem, Humans, Randomized Controlled Trials as Topic

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review