Use of network meta-analyses in WHO guideline recommendations

Article type
Authors
Ling J1, Pan Y2, Ge L3, Tian J1, Liu G4, Yang K1
11. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China 2. Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
23. Second clinical medical college of Lanzhou University, Lanzhou, China
31. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China 2. Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China 3. First clinical medical college of Lanzhou U
4School of Law of Lanzhou University, , Lanzhou, China
Abstract
Background: Clinical practice guidelines (CPGs) are defined as “statements that include recommendations intended to optimize patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options”. Currently, guidelines have increasingly used systematic reviews and meta-analyses of randomised-controlled trials (RCTs) to form the basis of recommendations. Standard meta-analytic techniques can be used if the guideline addresses pairwise comparisons, for example, treatment A versus treatment B. If a guideline is attempting to address the question of which treatment is best among multiple options, however, standard meta-analysis may not be adequate. By contrast, network meta-analysis (NMA), a method that uses information from both direct and indirect comparisons and makes inferences about the comparative effectiveness of all the treatments of interest in a single analysis, is particularly suited in such situations. Although NMA offered several advantages to the process of developing clinical guidelines, only 8% of 138 NICE guidelines had used NMA in 2012. NMA is expected increasingly to use and adapt for develop clinical guidelines in the future.

Objectives: To investigate how many guideline recommendations were based on NMA. And what advantages have been provided for guidelines based-on NMA when compared to pairwise meta-analysis.

Methods: WHO (http://www.who.int/en/) was searched to identify all published CPGs from inception to February, 2017. We collected the general information of included CPGs, recommendations from each guideline, and compared the recommendations with previous one based-on pairwise meta-analysis. Comparison analysis was used to explore the advantages of NMA to form the recommendations.

Results and Conclusions: This study is ongoing and results will be presented at the Summit as available.