Evidence Synthesis for Decision Making 1

Dias, Sofia; Welton, Nicky J; Sutton, Alex J.; Ades, A E

doi:10.1177/0272989x13487604

Cited by 149 publications

(131 citation statements)

References 28 publications

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“…The main assumption made in NMA is that the intervention effects would be expected to be similar in all trials if they had all included all interventions (the consistency assumption). 172 In other words, the populations included in each study should be similar. Importantly for reviews of complex interventions, there is also an assumption that interventions of the same 'type' are similar across studies.…”

Section: Methods: Short-term Modellingmentioning

confidence: 99%

“…Recently, NMA methods [171][172][173][174][175][176][177][178] have been extended to combine evidence on trials of complex interventions, where the interventions can be categorised using a taxonomy, that is, a categorisation of interventions into groups (as we have done here; see Chapter 3). This makes it possible to pool evidence when interventions are heterogeneous, as long as the different intervention categories have been compared, either directly or indirectly, in the trial evidence.…”

Section: Introductionmentioning

confidence: 99%

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IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

et al. 2016

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BackgroundExposure to domestic violence and abuse (DVA) during childhood and adolescence increases the risk of negative outcomes across the lifespan.ObjectivesTo synthesise evidence on the clinical effectiveness, cost-effectiveness and acceptability of interventions for children exposed to DVA, with the aim of making recommendations for further research.Design(1) A systematic review of controlled trials of interventions; (2) a systematic review of qualitative studies of participant and professional experience of interventions; (3) a network meta-analysis (NMA) of controlled trials and cost-effectiveness analysis; (4) an overview of current UK provision of interventions; and (5) consultations with young people, parents, service providers and commissioners.SettingsNorth America (11), the Netherlands (1) and Israel (1) for the systematic review of controlled trials of interventions; the USA (4) and the UK (1) for the systematic review of qualitative studies of participant and professional experience of interventions; and the UK for the overview of current UK provision of interventions and consultations with young people, parents, service providers and commissioners.ParticipantsA total of 1345 children for the systematic review of controlled trials of interventions; 100 children, 202 parents and 39 professionals for the systematic review of qualitative studies of participant and professional experience of interventions; and 16 young people, six parents and 20 service providers and commissioners for the consultation with young people, parents, service providers and commissioners.InterventionsPsychotherapeutic, advocacy, parenting skills and advocacy, psychoeducation, psychoeducation and advocacy, guided self-help.Main outcome measuresInternalising symptoms and externalising behaviour, mood, depression symptoms and diagnosis, post-traumatic stress disorder symptoms and self-esteem for the systematic review of controlled trials of interventions and NMA; views about and experience of interventions for the systematic review of qualitative studies of participant and professional experience of interventions and consultations.Data sourcesMEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, EMBASE, Cochrane Central Register of Controlled Trials, Science Citation Index, Applied Social Sciences Index and Abstracts, International Bibliography of the Social Sciences, Social Services Abstracts, Social Care Online, Sociological Abstracts, Social Science Citation Index, World Health Organization trials portal and clinicaltrials.gov.Review methodsA narrative review; a NMA and incremental cost-effectiveness analysis; and a qualitative synthesis.ResultsThe evidence base on targeted interventions was small, with limited settings and types of interventions; children were mostly < 14 years of age, and there was an absence of comparative studies. The interventions evaluated in trials were mostly psychotherapeutic and psychoeducational interventions delivered to the non-abusive parent and child, usually based on the child’s exposure to DVA (not specific clinical or broader social needs). Qualitative studies largely focused on psychoeducational interventions, some of which included the abusive parent. The evidence for clinical effectiveness was as follows: 11 trials reported improvements in behavioural or mental health outcomes, with modest effect sizes but significant heterogeneity and high or unclear risk of bias. Psychoeducational group-based interventions delivered to the child were found to be more effective for improving mental health outcomes than other types of intervention. Interventions delivered to (non-abusive) parents and to children were most likely to be effective for improving behavioural outcomes. However, there is a large degree of uncertainty around comparisons, particularly with regard to mental health outcomes. In terms of evidence of cost-effectiveness, there were no economic studies of interventions. Cost-effectiveness was modelled on the basis of the NMA, estimating differences between types of interventions. The outcomes measured in trials were largely confined to children’s mental health and behavioural symptoms and disorders, although stakeholders’ concepts of success were broader, suggesting that a broader range of outcomes should be measured in trials. Group-based psychoeducational interventions delivered to children and non-abusive parents in parallel were largely acceptable to all stakeholders. There is limited evidence for the acceptability of other types of intervention. In terms of the UK evidence base and service delivery landscape, there were no UK-based trials, few qualitative studies and little widespread service evaluation. Most programmes are group-based psychoeducational interventions. However, the funding crisis in the DVA sector is significantly undermining programme delivery.ConclusionsThe evidence base regarding the acceptability, clinical effectiveness and cost-effectiveness of interventions to improve outcomes for children exposed to DVA is underdeveloped. There is an urgent need for more high-quality studies, particularly trials, that are designed to produce actionable, generalisable findings that can be implemented in real-world settings and that can inform decisions about which interventions to commission and scale. We suggest that there is a need to pause the development of new interventions and to focus on the systematic evaluation of existing programmes. With regard to the UK, we have identified three types of programme that could be justifiably prioritised for further study: psycho-education delivered to mothers and children, or children alone; parent skills training in combination with advocacy: and interventions involving the abusive parent/caregiver. We also suggest that there is need for key stakeholders to come together to explicitly identify and address the structural, practical and cultural barriers that may have hampered the development of the UK evidence base to date.Future work recommendationsThere is a need for well-designed, well-conducted and well-reported UK-based randomised controlled trials with cost-effectiveness analyses and nested qualitative studies. Development of consensus in the field about core outcome data sets is required. There is a need for further exploration of the acceptability and effectiveness of interventions for specific groups of children and young people (i.e. based on ethnicity, age, trauma exposure and clinical profile). There is also a need for an investigation of the context in which interventions are delivered, including organisational setting and the broader community context, and the evaluation of qualities, qualifications and disciplines of personnel delivering interventions. We recommend prioritisation of psychoeducational interventions and parent skills training delivered in combination with advocacy in the next phase of trials, and exploratory trials of interventions that engage both the abusive and the non-abusive parent.Study registrationThis study is registered as PROSPERO CRD42013004348 and PROSPERO CRD420130043489.FundingThe National Institute for Health Research Public Health Research programme.

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Section: Methods: Short-term Modellingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

et al. 2016

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“…This prior distribution provides the appropriate weight to the possibility of small or zero variance. For the continuous outcome (percent days abstinent), we use the specification of program 5a, 22,23 with a normal likelihood, identity link, and normal random effects (we refer the reader to the original paper for the model set up). We specify the prior distribution for between trial variance as a Uniform(0, 10).…”

Section: Methodsmentioning

confidence: 99%

A Bayesian Mixed-Treatment Comparison Meta-analysis of Treatments for Alcohol Dependence and Implications for Planning Future Trials

DeSantis

Zhu

2014

Med Decis Making

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Background Several treatments for alcohol dependence have been tested in randomized clinical trials, giving rise to systematic reviews with a network of evidence, or mixed treatment comparisons, structure. Within the network, there are few direct comparisons of active treatments. Thus far, this network has not been adequately analyzed. For example, “indirect comparisons” between treatments (e.g., the comparison of treatments B:C obtained via estimates from A:B and A:C trials) have not been incorporated into estimates of treatment effects. This has implications for the planning of future randomized controlled trials. Methods We apply recent developments in Bayesian mixed treatment comparisons (MTC) meta-analysis to analyze the network of evidence. Using these results, we propose a methodology to inform, design, and power a hypothetical trial in the context of an updated meta-analysis, for treatments that have been infrequently compared, and therefore whose effects sizes are not well informed by meta-analysis. Results MTC meta-analysis provides more accurate estimates than pairwise meta-analysis and uncovers decisive differences between active treatments that have been infrequently directly compared. Weighting across all outcomes indicates that combination (naltrexone+acamprosate) treatment has the highest posterior probability of being the “best” treatment. If a new clinical trial were to be performed of combination therapy versus acamprosate alone, there is no feasible sample size that would result in a decisive meta-analysis. Conclusions MTC meta-analysis should be used to estimate treatment effects in networks where direct and indirect evidence are consistent, and to inform the design of future studies.

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“…The NMA methodology suffers from several limitations due to the assumptions necessary to conduct the indirect comparisons 39,67 . Fixed effects models must assume that the relative treatment effect across studies is the same and this may not be the case due to heterogeneity 38,40 .…”

Section: Limitationsmentioning

confidence: 99%

Comparative efficacy of antibiotics for the treatment of acute bacterial skin and skin structure infections (ABSSSI): a systematic review and network meta-analysis

Thom

Thompson²,

Scott³

et al. 2015

Current Medical Research and Opinion

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Objective:The objective was to conduct a systematic review and network meta-analysis (NMA) of existing treatments for ABSSSI focusing on the novel lipoglycopeptide oritavancin. Methods:EMBASE, MEDLINE, MEDLINE in Process, CENTRAL (Cochrane), and select conferences were searched for randomized controlled trials investigating antimicrobial agents for the treatment of ABSSSI. NMA was used to estimate the odds ratios of the Test-Of-Cure (TOC) and Early Clinical Response (ECR) outcomes for treatments relative to vancomycin in the ITT populations. Sub-group analyses in MRSA and MSSA populations were conducted for TOC; sensitivity analyses investigated the use of the clinically evaluable (CE) populations and the restriction to trials following the recent FDA guidelines for clinical trials. Results:The systematic review identified 52 trials. The most commonly investigated treatments were vancomycin and linezolid; most trials reported TOC, but not ECR. The posterior mean and 95% credible intervals for odds ratios of TOC for antimicrobial agents relative to vancomycin were: linezolid (1.55; 0.91-2.57), daptomycin (2.18; 0.90-5.42), and oritavancin 1200 mg (1.06; 0.80-1.43). The odds ratio of ECR for oritavancin 1200 mg was 1.02 (0.23-4.33). In the MRSA sub-group the odds ratios relative to vancomycin for TOC were: linezolid (1.55; 0.96-2.46), daptomycin (0.74; 0.13-3.66), and oritavancin 1200 mg (0.94; 0.44-2.02). In the MSSA sub-group they were linezolid (1.36; 0.15-13.34) and oritavancin 1200 mg (0.82; 0.08-7.83). These results were robust to the sensitivity analyses. Conclusions:This NMA provides a unified framework for the comparison of all available antimicrobial agents used in the treatment of ABSSSI and is the first to assess the ECR end-point. The results suggest equivalence of clinical efficacy between vancomycin, daptomycin, linezolid, and novel antimicrobial agents including oritavancin for the treatment of ABSSSI at TOC. The wide uncertainty margins indicate the heterogeneity of the available evidence and the need for further research.

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Evidence Synthesis for Decision Making 1

Cited by 149 publications

References 28 publications

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

A Bayesian Mixed-Treatment Comparison Meta-analysis of Treatments for Alcohol Dependence and Implications for Planning Future Trials

Comparative efficacy of antibiotics for the treatment of acute bacterial skin and skin structure infections (ABSSSI): a systematic review and network meta-analysis

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