Network meta‐analysis of multicomponent interventions

Abstract

In network meta-analysis (NMA), treatments can be complex interventions, for example, some treatments may be combinations of others or of common components. In standard NMA, all existing (single or combined) treatments are different nodes in the network. However, sometimes an alternative model is of interest that utilizes the information that some treatments are combinations of common components, called component network meta-analysis (CNMA) model. The additive CNMA model assumes that the effect of a treatment combined of two components A and B is the sum of the effects of A and B, which is easily extended to treatments composed of more than two components. This implies that in comparisons equal components cancel out. Interaction CNMA models also allow interactions between the components. Bayesian analyses have been suggested. We report an implementation of CNMA models in the frequentist R package netmeta. All parameters are estimated using weighted least squares regression. We illustrate the application of CNMA models using an NMA of treatments for depression in primary care. Moreover, we show that these models can even be applied to disconnected networks, if the composite treatments in the subnetworks contain common components. K E Y W O R D S combination therapies, complex interventions, disconnected networks, multiple interventions, network meta-analysisThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Component network meta‐analysis compared to a matching method in a disconnected network: A case study

“…All approaches are briefly described in the following sections, with technical details of the CNMA method provided in the Appendix. For additional details on the methodology, see Schmitz et al (2018) and Rücker, Petropoulou et al (2020).…”

“…is estimated using weighted least squares regression. For details of the estimation, see Appendix; more information including a generalization to a random effects model is found in Rücker, Petropoulou et al (2020).…”

“…If all existing combinations are added, this leads to the standard NMA model. Nested models can be compared using the multivariate version of Cochran's Q as described in Rücker, Petropoulou et al (2020).…”

Cystic fibrosis – Ten promising therapeutic approaches in the current era of care

“…We followed the frequentist CNMA approach for disconnected networks described by Rucker et al (2019). 50…”

Effective SLOPE: EffectS of Lifestyle interventions in Older PEople with obesity: a systematic review and network meta-analysis protocol

“…Additionally, we will analyse the components (eg, of combined interventions using an additive model for multicomponent interventions). 106 Models of this type allow disentangling the effects of all single components (eg, very low caloric diet (A), aerobic exercise (B), behavioural group counselling (C)) of a multicomponent intervention arm consisting of at least two single components (eg, A+B, A+C, B+C or A+B+C). Since we do not believe that lifestyle interventions that are available for treatment of obesity may fulfil the additivity assumption for component NMA (CNMA)-that is, the effect of a multicomponent intervention equals the sum of their components without any interactions-we will use the interaction CNMA model which is implemented in the function netcomb() of netmeta.…”