Network Meta-analysis to Evaluate the Effectiveness of Interventions to Increase the Uptake of Smoke Alarms

Cooper, Nicola J.; Kendrick, Denise; Achana, Felix; Dhiman, Paula; He, Zhimin; Wynn, Persephone; Cozannet, Elodie Le; Saramago, Pedro; Sutton, Alex J.

doi:10.1093/epirev/mxr015

Cited by 45 publications

(35 citation statements)

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“…109 Another important strength of the network meta-analysis is that it treats all comparators as separate treatments while gaining statistical power from including all available data. 109 The Bayesian approach has the additional advantage of being able to provide probability statements for which exercise intervention is the most effective, even when standard methods might determine no significant difference between them. In addition, we calculated alternative rankings (second, third best, etc), because in some cases the best exercise intervention might be unavailable, more costly, or contraindicated in some patients.…”

Section: Study Strengths and Limitationsmentioning

confidence: 99%

Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis

et al. 2014

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Objective To determine whether there is sufficient evidence to conclude that exercise interventions are more effective than no exercise control and to compare the effectiveness of different exercise interventions in relieving pain and improving function in patients with lower limb osteoarthritis. Data sources Nine electronic databases searched from inception to March 2012.Study selection Randomised controlled trials comparing exercise interventions with each other or with no exercise control for adults with knee or hip osteoarthritis.Data extraction Two reviewers evaluated eligibility and methodological quality. Main outcomes extracted were pain intensity and limitation of function. Trial sequential analysis was used to investigate reliability and conclusiveness of available evidence for exercise interventions. Bayesian network meta-analysis was used to combine both direct (within trial) and indirect (between trial) evidence on treatment effectiveness.Results 60 trials (44 knee, two hip, 14 mixed) covering 12 exercise interventions and with 8218 patients met inclusion criteria. Sequential analysis showed that as of 2002 sufficient evidence had been accrued to show significant benefit of exercise interventions over no exercise control. For pain relief, strengthening, flexibility plus strengthening, flexibility plus strengthening plus aerobic, aquatic strengthening, and aquatic strengthening plus flexibility, exercises were significantly more effective than no exercise control. A combined intervention of strengthening, flexibility, and aerobic exercise was also significantly more effective than no exercise control for improving limitation in function (standardised mean difference −0.63, 95% credible interval −1.16 to −0.10). ConclusionsAs of 2002 sufficient evidence had accumulated to show significant benefit of exercise over no exercise in patients with osteoarthritis, and further trials are unlikely to overturn this result. An approach combining exercises to increase strength, flexibility, and aerobic capacity is likely to be most effective in the management of lower limb osteoarthritis. The evidence is largely from trials in patients with knee osteoarthritis. PROSPERO (www.crd.york.ac.uk/prospero/) No CRD42012002267. Protocol registration IntroductionOsteoarthritis is the most common form of arthritis and one of the leading causes of pain and disability worldwide.1 The lifetime prevalence of symptomatic hip osteoarthritis is estimated at 25.3%, 2 while that of knee osteoarthritis is even higher at 44.7%. 3 The economic burden of osteoarthritis is substantial and consists of both direct costs (such as drugs, Between 1999 and 2000 in the United Kingdom, about 36 million working days were lost because of osteoarthritis alone, leading to an estimated £3.2bn (€3.8bn, $5.1bn) in productivity losses, with the total cost to the UK economy being estimated at 1% of gross national product per year. 1 In the United States, the estimated incremental cost of medical care expenditures and earnings losses for people ...

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Section: Study Strengths and Limitationsmentioning

confidence: 99%

Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis

et al. 2014

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“…This study evaluated the cost-effectiveness of alternative interventions to increase the household uptake of ‘functioning’ smoke alarms and, consequently, reduce the number and severity of home fire-related injuries in pre-school children. The results of a previous synthesis of evidence on the effectiveness of interventions of interest [16] were used to populate the model. The authors used a mixed treatment comparisons d framework to synthesise evidence.…”

Section: Discussionmentioning

confidence: 99%

“…These were identified from a recently published mixed treatment comparison meta-analysis [16] as: (1) Usual care (UC); (2) Education (E); (3) Education + free/low cost equipment (E + FE); (4) Education + free/low cost equipment + home safety inspection (E + FE + HI); (5) Education + free/low cost equipment + fitting (E + FE + F); (6) Education + home safety inspection (E + HI); (7) Education + free/low cost equipment + fitting + home safety inspection (E + FE + F + HI).…”

Section: Methodsmentioning

confidence: 99%

“…Results of a previous synthesis of evidence on effectiveness of interventions to promote smoke alarm ownership and function [16] were used to inform this model section. This model accounted for existing prevalence of installed functioning smoke alarms and uptake rate for the intervention amongst those in the modelled population who did not have a functioning smoke alarm installed.…”

Section: Methodsmentioning

confidence: 99%

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Cost-effectiveness of interventions for increasing the possession of functioning smoke alarms in households with pre-school children: a modelling study

et al. 2014

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BackgroundThe UK has one of the highest rates for deaths from fire and flames in children aged 0–14 years compared to other high income countries. Evidence shows that smoke alarms can reduce the risk of fire-related injury but little exists on their cost-effectiveness. We aimed to compare the cost effectiveness of different interventions for the uptake of ‘functioning’ smoke alarms and consequently for the prevention of fire-related injuries in children in the UK.MethodsWe carried out a decision model-based probabilistic cost-effectiveness analysis. We used a hypothetical population of newborns and evaluated the impact of living in a household with or without a functioning smoke alarm during the first 5 years of their life on overall lifetime costs and quality of life from a public health perspective. We compared seven interventions, ranging from usual care to more complex interventions comprising of education, free/low cost equipment giveaway, equipment fitting and/or home safety inspection.ResultsEducation and free/low cost equipment was the most cost-effective intervention with an estimated incremental cost-effectiveness ratio of £34,200 per QALY gained compared to usual care. This was reduced to approximately £4,500 per QALY gained when 1.8 children under the age of 5 were assumed per household.ConclusionsAssessing cost-effectiveness, as well as effectiveness, is important in a public sector system operating under a fixed budget restraint. As highlighted in this study, the more effective interventions (in this case the more complex interventions) may not necessarily be the ones considered the most cost-effective.

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“…The number of applications to complex social interventions remains small (Bafeta, Trinquart, Seror, & Ravaud, 2013), but is likely to grow rapidly as statistical methods afford greater flexibility, software implementations become increasingly accessible, and more social researchers learn about the method and its advantages. Three of the five examples of which we are aware were published in the past 2 years (Barth et al, 2013;Chen et al, 2012;Cooper et al, 2012;Hasselblad, 1998;Welton, Caldwell, Adamopoulos, & Vedhara, 2009), and network metaanalysis was proposed in a recently published Campbell Collaboration protocol (Wilen, Littell, & Salanti, 2013).…”

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confidence: 99%

Network Meta-Analysis for Complex Social Interventions: Problems and Potential

Grant

Calderbank-Batista

2013

Journal of the Society for Social Work and Research

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When multiple interventions exist for the same problem, evidence-based decision making requires clear and systematic syntheses of available evidence to determine which interventions are most effective. Network meta-analysis extends standard pairwise meta-analytic models to allow direct and indirect evidence from primary studies comparing alternative interventions to be statistically combined in a single analysis. The use of indirect evidence can increase the precision of estimates and allow the relative effectiveness of interventions to be estimated even if particular interventions have never been directly compared in primary studies. The validity of network meta-analyses requires assumptions that may be difficult to verify in reviews of complex social interventions, and the method has rarely been applied outside of medicine. This paper provides a nontechnical introduction to network meta-analysis and to some of the advantages and challenges involved in its application to complex social interventions. We conclude that network meta-analysis is an important and needed tool for social researchers. However, we also find that applications to complex social interventions require more extensive and theory-driven assessments of validity than those needed for either pairwise meta-analyses or for applications to biomedical treatments. Existing guidance on reporting of network meta-analyses could be usefully expanded to require more detailed reporting of these additional measures in the case of complex interventions.

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Network Meta-analysis to Evaluate the Effectiveness of Interventions to Increase the Uptake of Smoke Alarms

Cited by 45 publications

References 35 publications

Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis

Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis

Cost-effectiveness of interventions for increasing the possession of functioning smoke alarms in households with pre-school children: a modelling study

Network Meta-Analysis for Complex Social Interventions: Problems and Potential

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