Simultaneous comparison of multiple treatments: combining direct and indirect evidence

We describe comparisons of three or more treatments, based on pair-wise or multi-arm comparative studies, as a multiple treatment comparison evidence structure

Deborah M Caldwell; A E Ades; J P T Higgins

2005

Scholarcy highlights

  • We describe comparisons of three or more treatments, based on pair-wise or multi-arm comparative studies, as a multiple treatment comparison evidence structure
  • Suitable statistical methods for comparing multiple treatments that fully respect randomisation have been available for some time
  • The multiple treatment analysis provides a full set of odds ratios for all the 21 comparisons, effectively combining all the direct and indirect evidence for each comparison
  • Healthcare decisions often involve choosing from a selection of treatment options Most systematic reviews and meta-analyses focus on pair-wise comparisons, forcing reliance on indirect comparisons
  • Statistical methods for comparing multiple treatments that combine direct and indirect evidence in a single analysis are available. These methods make the similar assumptions to standard pair-wise meta-analyses but require that they hold over the entire set of trials
  • The precepts of systematic review enjoin us to put all the available evidence together, to avoid selection bias, increase precision, and examine generalisability. A unified, coherent analysis can be achieved only by analysing the entire collection of relevant randomised controlled trials while respecting randomisation

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