Use of network meta-analysis in clinical guidelines

The World Health Organization (WHO) has conducted two major updates to global guidance for the management of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections in 2016.1,2 Recommendations made by WHO can have an important effect on policy and practice, particularly for low- and middle-income countries. For instance, a 2014 survey found that over three-quarters of all 158 recommendations for HIV and tuberculosis were incorporated into national guidelines.3 Clinical guidelines are developed through multi-step processes that ensure that guidelines are feasible within the current clinical environment and that they are based on the best available evidence. For the latest HIV and HCV guidelines, WHO used network meta-analysis to inform treatment recommendations. An expansion of conventional pairwise meta-analysis, network meta-analysis includes multiple interventions within a single analysis and estimates the relative treatment effect between each two treatments compared using direct or indirect evidence. Although it is often acknowledged that having the most up-to-date evidence is critical to the development of clinical guidelines, it is equally important that the optimal analytical methods are used to appraise the evidence. We explain here why network meta-analysis lends itself to the development of clinical guidelines and why it may be used more often in this context.

Authors: S Kanters, E Druyts, K Thorlund, E Mills, et al

Source: Bulletin of the World Health Organization

Publication Year: 2016