Inconsistency between direct and indirect comparisons of competing interventions: meta-epidemiological study

Song, Fujian, Xiong, Tengbin, Parekh-Bhurke, Sheetal, Loke, Yoon K., Sutton, Alex J., Eastwood, Alison J., Holland, Richard, Chen, Yen-Fu, Glenny, Anne-Marie, Deeks, Jonathan J. and Altman, Doug G. (2011) Inconsistency between direct and indirect comparisons of competing interventions: meta-epidemiological study. British Medical Journal (BMJ) (343). d4909. ISSN 0959-8138

Full text not available from this repository. (Request a copy)

Abstract

Objective To investigate the agreement between direct and indirect comparisons of competing healthcare interventions. Design Meta-epidemiological study based on sample of meta-analyses of randomised controlled trials. Data sources Cochrane Database of Systematic Reviews and PubMed. Inclusion criteria Systematic reviews that provided sufficient data for both direct comparison and independent indirect comparisons of two interventions on the basis of a common comparator and in which the odds ratio could be used as the outcome statistic. Main outcome measure Inconsistency measured by the difference in the log odds ratio between the direct and indirect methods. Results The study included 112 independent trial networks (including 1552 trials with 478?775 patients in total) that allowed both direct and indirect comparison of two interventions. Indirect comparison had already been explicitly done in only 13 of the 85 Cochrane reviews included. The inconsistency between the direct and indirect comparison was statistically significant in 16 cases (14%, 95% confidence interval 9% to 22%). The statistically significant inconsistency was associated with fewer trials, subjectively assessed outcomes, and statistically significant effects of treatment in either direct or indirect comparisons. Owing to considerable inconsistency, many (14/39) of the statistically significant effects by direct comparison became non-significant when the direct and indirect estimates were combined. Conclusions Significant inconsistency between direct and indirect comparisons may be more prevalent than previously observed. Direct and indirect estimates should be combined in mixed treatment comparisons only after adequate assessment of the consistency of the evidence.

Item Type:	Article
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research (former - to 2023) Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Centres > Population Health Faculty of Medicine and Health Sciences > Research Centres > Lifespan Health
Depositing User:	Rhiannon Harvey
Date Deposited:	07 Dec 2011 16:56
Last Modified:	24 Sep 2024 08:58
URI:	https://ueaeprints.uea.ac.uk/id/eprint/35617
DOI:	10.1136/bmj.d4909

Actions (login required)

View Item