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J Clin Epidemiol. 2018 Jan;93:36-44. doi: 10.1016/j.jclinepi.2017.10.005. Epub 2017 Oct 17.

Advances in the GRADE approach to rate the certainty in estimates from a network meta-analysis.

Author information

1
Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4K1, Canada; Evidence Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Sergio Livingstone Pohlhammer 943, Independencia, Santiago, Chile.
2
Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4K1, Canada.
3
Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4K1, Canada; The Infectious Diseases Society of America, 1300 Wilson Boulevard, Suite 300, Arlington, VA 22209, USA.
4
Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, University of Toronto, 190 Elizabeth Street. R. Fraser Elliott Building, 3-805, Toronto, Ontario M5G 2C4, Canada.
5
Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida-honmachi, Sakyo-ku, Kyoto 606-8501, Japan; Department of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida-honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
6
Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada.
7
Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada.
8
Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4K1, Canada; Division of Nephrology and Hypertension, Department of Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
9
Mayo Clinic Evidence Based Practice Center, Harwick Building, Room 2-54, Rochester, MN 55905, USA.
10
Epidemiology, Biostatistics und Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, Zurich 8001, Switzerland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, W6508, Baltimore, MD 21205, USA.
11
Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4K1, Canada. Electronic address: guyatt@mcmaster.ca.

Abstract

This article describes conceptual advances of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group guidance to evaluate the certainty of evidence (confidence in evidence, quality of evidence) from network meta-analysis (NMA). Application of the original GRADE guidance, published in 2014, in a number of NMAs has resulted in advances that strengthen its conceptual basis and make the process more efficient. This guidance will be useful for systematic review authors who aim to assess the certainty of all pairwise comparisons from an NMA and who are familiar with the basic concepts of NMA and the traditional GRADE approach for pairwise meta-analysis. Two principles of the original GRADE NMA guidance are that we need to rate the certainty of the evidence for each pairwise comparison within a network separately and that in doing so we need to consider both the direct and indirect evidence. We present, discuss, and illustrate four conceptual advances: (1) consideration of imprecision is not necessary when rating the direct and indirect estimates to inform the rating of NMA estimates, (2) there is no need to rate the indirect evidence when the certainty of the direct evidence is high and the contribution of the direct evidence to the network estimate is at least as great as that of the indirect evidence, (3) we should not trust a statistical test of global incoherence of the network to assess incoherence at the pairwise comparison level, and (4) in the presence of incoherence between direct and indirect evidence, the certainty of the evidence of each estimate can help decide which estimate to believe.

KEYWORDS:

Certainty of evidence; Confidence in estimates of effect; GRADE; Indirect comparisons; Network meta-analysis; Quality of evidence

PMID:
29051107
DOI:
10.1016/j.jclinepi.2017.10.005
[Indexed for MEDLINE]

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