Network meta-analysis: A Technique to Synthesize Evidence for Decision Making
                     NETWORK META-ANALYSIS 
 (NMA): A TECHNIQUE TO  
SYNTHESIZE EVIDENCE FOR 
 DECISION MAKING
Tags: Multi-treatment meta-analysis | Multi-arm meta-analysis | Multivariable 
meta -   analysis | Network meta-analysis | Bayesian framework | Bayesian
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INTRODUCTION
Clinical decision requires balanced decision among resources, tasks, skills and values. It relies on external aspects 
 that are not easily modulated (such as religious beliefs or economic resources) and largely beyond the reach of 
 most researchers.
Meta-analysis service plays an important role in clinical decision making.
The meta-analysis involves in pair meta-analysis (goes from a 2-D to a multidimensional analytical framework) and 
 network meta-analysis (several processes are being generated, like the adjusted indirect comparison, mixed-  
treatment comparison, mult i-treatment meta-analysis, mul t i -arm meta-analysis and multivariable meta-analysis).
The key features of network meta-analysis must be as evidence-based (From pairwise meta-analysis to network  
meta-analysis) and reviewing process also should be designed (before the data are effectively retrieved) and  
registered ( the evaluation protocol should be published immediately after finalizing an out -and-out  repository site) 
 as per the guidelines at hand for plan, carry out, and reporting of a network meta-analysis.
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NETWORK META-  
ANALYSIS
Network meta-analysis is a unique and powerful tool for enhancing clinical decision  
making. When converting to action, knowledge that rapid systematic reviewing 
processes  yield could be advantageous.
The preliminary assessment results suggest that gold standard NMAs might be replaced 
 by a modified rapid NMA approach. Evaluation of judgement could be used to compare 
 summery methods of proof.
Network meta-analysis with modest improvements might replace gold standard network 
 meta-analysis.
The researchers with execution tools might use a more advanced network meta-
analysis  technique to lower the time and resources required for knowledge transfer to 
practice  while creating more pat ient-based tools.
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IMP O R T A NT F A CT O 
R S F O R T HE  NE 
TS eWarch:O The reR are  Kseveral avaiMlableE da taTba sAes  su-ch  aAs M ENDLINAE/P uLbMe dY, C ocShra nIeS Library, Europe 
 PubMed Central, SciELO, LILACS, Embase, etc. must be used for the searching process to lead the  
appropriate evidence.
Selection: The selection of the study being an important step towards the network meta-analysis.
Choosing the framework: Among all frameworks, Bayesian framework is considered to be the most  
popular and accepted framework for NMA. It allows more robust modeling that can easily adjustable 
for  simpler evidence networks.
Choosing the statistical package: There are several statistical packages available. The WinBUGS tool is  
one of the most commonly used packages. It is quite easy to command and can be used with ease by R 
 and other packages for the Bayesian modeling and analysis.
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NETWORK META-
ANALYSIS
Choosing the suitable statistics: Binomial model generates relative risks, risk differences, odds ratios, 
 probabilities of being best, numbers needed to treat, rankograms, and the surface under the 
cumulative  ranking curves.
Numerous methods have been suggested for evaluating small-research results, including funnel plots  
inspection after rectifying summary estimates of the subgroup, the Copas method and regression testing.
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NETWORK META-
ANALYSIS
Future perceptions of the 
 network meta -ana lys is
CONVERTING SYNTHESIS OF EVIDENCE TO ACTION:
All the findings of a network meta-analysis should be applied to direct decision making, determine how to best  
interpret the assessment results and apply them in clinical practice, and to incorporate the intervention thoroughly 
 in depth with the most desirable risk-benefit  balance.
The best possible way to do this is by absolute risk measurements, numbers required to be treated, and  
rankograms, making decision on credible or confidence intervals, instead of point estimates, while identifying the 
 parallel effect of a specific intervention on different endpoints.
Therefore, when multiple interventions hold an analogous beneficial risk-benefit profile, it is important to choose the 
 one which is easier or cost effective to execute.
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T O WA R D A 
CCE S S IB IL IT Y A 
ND  INT E G R A T IO N:
T he f u t u r e of n e t w o r k m e t a -  a n a l  ys i s l i es i n the t h o r n y p r o c e s  s o f s t ee r i  ng
b e t w e e n t he S cy l  l a o f
s t a t e -  o f -  t h e -  a r tp r o c e s s e s o f p e r f o r m i n g a n a c c e p t a b l e s y s t e m a t i c r e v i e w a n d t h e C h a r y b d i s
o f  e f f e c t i  ve di  s s e m i  n a t i  on a n d th r i  v i ng a c c o m p l  i s h m e n t by s tak  eho l  de r s
a n d d e c i  s i o n -  m a k  ers  .
Cl ea r a n d eas  y t o o l  s c a t e r i  n g i n n o v a t i  ve s ol  u t i  ons to t he c o m p l  ex i s s ues
h a v e b e e n d o m i  n a t i  ng   t he c l  i ni c a l p r a c t i  ce a n d R es e a r c h i n the l as  t f ew
dAebcrai  dl le i sa n. t res  o u r c e fo r c l  i ni c a l res  e a r c h p r o c e s  s es i s K a p l a n -  
M e ie r m e t h o d b a c k  ed
s u r v i v a l a n a l y s i sw i t h i t s c o n c i s e , p e r f e c t , a n d r o b u s t f i n d i n g s i n d a i l y r e s e a r c h , i n s p i t e
o f  i ts a p p l  i c a t i  on i n a m a s  s i ve a m o u n t o f d i  ve rs  i f i ed a n d o c c a s  i 
o n a l  l y t r i ck y c o n t e x  ts  .
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NETWORK META-
ANALYSIS
LIMITATIONS OF NETWORK 
 META- ANALYSIS
O nl y s p e c i  f i c s i t u a t i  ons r e q u i  re
the n e t w o r k m e t a -  a n a l  ys i s
a n d
i n a p p r o p r i  a t e us e o f n e t w o r k m e t a -  a n a l  ys 
i s c a n l e a d to m i  s l e a d i  ng   res  ul ts
s u c h as
L i m i t e d n e t w o r k c o n n e c t i v i t y (  M o s t o f t h e
a v a i l a b l e r e s e a r c h e s h a v e  u n -  
c o m p a r e d al  l a v a i  l a b l  e t r e a t m e n t s d u e
to t i m e or f i n a n c i  a l
res  t ra i  n t s  ; l i m i  t e d i n t e r p r e t a t i  on o f i nd i  r e c t
ev i  d e n c e
L i m i  t e d i n t e r p r e t a t i  on o f r a n k  i n g a n a l y s i s
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L i m i t e d e x p e r i e n c e o f c l i n i c i a n s w i t h
t h e s t a t i s t i c s o f n e t w o r k m e t a -   
a n a l  ys i s (  d u e to s t u d y c o n d u c t i  on by U n -  t 
ra i  n e d c l  i ni c i  an s a n d
s t a t i  s t i c i  a n ) .
SUM M ARY
N e t w o r k m e t a -  a n a l  ys i s a n d s y n t h e s  i s ev i  d e n c e wi l l b e a re a l  i ty
by th e re l  a t e d   a p p l  i c a t i  on o f s t ra i  g h t f o r w a r d b u t v i g o r o u s p a c k  
a g e s to i m p l  e m e n t n e t w o r k   m e t a -  a n a l  ys i s on n u m e r o u s p l  
a t f o r m s l i k e s m a r t p h o n e s a n d t a b l  e ts  .
M o re o v e r , i t i s a l  s o a p r o b a b i  l i ty to c r e a t e i n t e l l i g e n t t r  i a l d a t a b a s e s wh i  c h wi l 
l  a u t o m a t i  c a l  l y u p l  o a d th e d a t a r e c e i  v e d f r o m i n d i  v i d u a l
d a t a i n a s o r t o f
c o l  l e c t i  ve n e t w o r k m e t a -  a n a l  ys i s .
N o s i n g l e m e t a -  a n a l y s i s s h o u l d b e v i e w e d a s t h e f i n a l , b u t
r a t h e r a s a t o o l t h a t  m a k  es a re f i  n e d f o r m of ev i  d e n c e
a v a i  l a b l  e to l e a d m o r e a c c u r a t e c l  i ni  c a l
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