Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, Ontario L8S 4L8, Canada; Evidence-Based Dentistry Unit, Faculty of Dentistry, University of Chile, Sergio Livingstone 943, Independencia, Santiago, Chile.
Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada; Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Rm 11.9859 West, Toronto, Ontario M5G 0A4, Canada; Department of Anesthesia and Pain Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
J Clin Epidemiol. 2018 Jun;98:62-69. doi: 10.1016/j.jclinepi.2018.02.008. Epub 2018 Feb 14.
To evaluate how the rank probabilities obtained from network meta-analysis (NMA) change with the use of increasingly stringent criteria for the relative effect comparing two treatments which ranks one treatment better than the other.
Systematic survey and reanalysis of published data. We included all systematic reviews (SRs) with NMA from the field of cardiovascular medicine that had trial-level data available, published in Medline up to February 2015. We reran all the NMAs and determined the probabilities of each treatment being the best. For the best treatment, we examined the effect on these probabilities of varying, what we call the decision threshold, the relative effect required to declare two treatments different.
We included 14 SRs, having a median of 20 randomized trials and 9 treatments. The best treatments had probabilities of being best that ranged from 38% to 85.3%. The effect of changing the decision thresholds on the probability of a treatment being best varied substantially across reviews, with relatively little decrease (∼20 percentage points) in some settings but a decline to near 0% in others.
Rank probabilities can be fragile to increases in the decision threshold used to claim that one treatment is more effective than another. Including these thresholds into the calculation of rankings may aid their interpretation and use in clinical practice.
评估在使用更严格的标准比较两种治疗方法的相对效果时，网络荟萃分析（NMA）得到的等级概率如何变化，即一种治疗方法优于另一种治疗方法。
系统调查和已发表数据的重新分析。我们纳入了心血管医学领域中所有具有试验水平数据的、发表在 Medline 上的包含 NMA 的系统综述，其截止日期为 2015 年 2 月。我们重新运行了所有的 NMA，并确定了每种治疗方法成为最佳治疗方法的概率。对于最佳治疗方法，我们研究了改变决策阈值（即需要宣布两种治疗方法不同的相对效果）对这些概率的影响。
我们纳入了 14 项系统综述，这些综述中位数包含 20 项随机试验和 9 种治疗方法。最佳治疗方法的最佳治疗概率范围从 38%到 85.3%。改变决策阈值对治疗方法成为最佳治疗方法的概率的影响在各综述之间差异很大，在某些情况下相对较小（约 20 个百分点），而在其他情况下则下降到接近 0%。
等级概率可能对用于声称一种治疗方法比另一种治疗方法更有效的决策阈值的增加很敏感。将这些阈值纳入排名计算中可能有助于解释和在临床实践中使用。
