ROB-MEN: a tool to assess risk of bias due to missing evidence in network meta-analysis

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dc.contributor.authorChiocchia, Virginia
dc.contributor.authorNikolakopoulou, Adriani
dc.contributor.authorHiggins, Julian P T
dc.contributor.authorPage, Matthew J
dc.contributor.authorPapakonstantinou, Theodoros
dc.contributor.authorCipriani, Andrea
dc.contributor.authorFurukawa, Toshi A
dc.contributor.authorSiontis, George C M
dc.contributor.authorEgger, Matthias
dc.contributor.authorSalanti, Georgia
dc.date.accessioned2021-11-29T17:51:17Z
dc.date.available2021-11-29T17:51:17Z
dc.date.issued2021-11-23
dc.date.updated2021-11-28T04:14:02Z
dc.description.abstractBackground Selective outcome reporting and publication bias threaten the validity of systematic reviews and meta-analyses and can affect clinical decision-making. A rigorous method to evaluate the impact of this bias on the results of network meta-analyses of interventions is lacking. We present a tool to assess the Risk Of Bias due to Missing Evidence in Network meta-analysis (ROB-MEN). Methods ROB-MEN first evaluates the risk of bias due to missing evidence for each of the possible pairwise comparison that can be made between the interventions in the network. This step considers possible bias due to the presence of studies with unavailable results (within-study assessment of bias) and the potential for unpublished studies (across-study assessment of bias). The second step combines the judgements about the risk of bias due to missing evidence in pairwise comparisons with (i) the contribution of direct comparisons to the network meta-analysis estimates, (ii) possible small-study effects evaluated by network meta-regression, and (iii) any bias from unobserved comparisons. Then, a level of “low risk”, “some concerns”, or “high risk” for the bias due to missing evidence is assigned to each estimate, which is our tool’s final output. Results We describe the methodology of ROB-MEN step-by-step using an illustrative example from a published NMA of non-diagnostic modalities for the detection of coronary artery disease in patients with low risk acute coronary syndrome. We also report a full application of the tool on a larger and more complex published network of 18 drugs from head-to-head studies for the acute treatment of adults with major depressive disorder. Conclusions ROB-MEN is the first tool for evaluating the risk of bias due to missing evidence in network meta-analysis and applies to networks of all sizes and geometry. The use of ROB-MEN is facilitated by an R Shiny web application that produces the Pairwise Comparisons and ROB-MEN Table and is incorporated in the reporting bias domain of the CINeMA framework and software.en_US
dc.identifier.apacitationChiocchia, V., Nikolakopoulou, A., Higgins, J. P. T., Page, M. J., Papakonstantinou, T., Cipriani, A., ... Salanti, G. (2021). ROB-MEN: a tool to assess risk of bias due to missing evidence in network meta-analysis. <i>BMC Medicine</i>, 19(1), 304. http://hdl.handle.net/11427/35403en_ZA
dc.identifier.chicagocitationChiocchia, Virginia, Adriani Nikolakopoulou, Julian P T Higgins, Matthew J Page, Theodoros Papakonstantinou, Andrea Cipriani, Toshi A Furukawa, George C M Siontis, Matthias Egger, and Georgia Salanti "ROB-MEN: a tool to assess risk of bias due to missing evidence in network meta-analysis." <i>BMC Medicine</i> 19, 1. (2021): 304. http://hdl.handle.net/11427/35403en_ZA
dc.identifier.citationChiocchia, V., Nikolakopoulou, A., Higgins, J.P.T., Page, M.J., Papakonstantinou, T., Cipriani, A., Furukawa, T.A. & Siontis, G.C.M. et al. 2021. ROB-MEN: a tool to assess risk of bias due to missing evidence in network meta-analysis. <i>BMC Medicine.</i> 19(1):304. http://hdl.handle.net/11427/35403en_ZA
dc.identifier.ris TY - Journal Article AU - Chiocchia, Virginia AU - Nikolakopoulou, Adriani AU - Higgins, Julian P T AU - Page, Matthew J AU - Papakonstantinou, Theodoros AU - Cipriani, Andrea AU - Furukawa, Toshi A AU - Siontis, George C M AU - Egger, Matthias AU - Salanti, Georgia AB - Background Selective outcome reporting and publication bias threaten the validity of systematic reviews and meta-analyses and can affect clinical decision-making. A rigorous method to evaluate the impact of this bias on the results of network meta-analyses of interventions is lacking. We present a tool to assess the Risk Of Bias due to Missing Evidence in Network meta-analysis (ROB-MEN). Methods ROB-MEN first evaluates the risk of bias due to missing evidence for each of the possible pairwise comparison that can be made between the interventions in the network. This step considers possible bias due to the presence of studies with unavailable results (within-study assessment of bias) and the potential for unpublished studies (across-study assessment of bias). The second step combines the judgements about the risk of bias due to missing evidence in pairwise comparisons with (i) the contribution of direct comparisons to the network meta-analysis estimates, (ii) possible small-study effects evaluated by network meta-regression, and (iii) any bias from unobserved comparisons. Then, a level of “low risk”, “some concerns”, or “high risk” for the bias due to missing evidence is assigned to each estimate, which is our tool’s final output. Results We describe the methodology of ROB-MEN step-by-step using an illustrative example from a published NMA of non-diagnostic modalities for the detection of coronary artery disease in patients with low risk acute coronary syndrome. We also report a full application of the tool on a larger and more complex published network of 18 drugs from head-to-head studies for the acute treatment of adults with major depressive disorder. Conclusions ROB-MEN is the first tool for evaluating the risk of bias due to missing evidence in network meta-analysis and applies to networks of all sizes and geometry. The use of ROB-MEN is facilitated by an R Shiny web application that produces the Pairwise Comparisons and ROB-MEN Table and is incorporated in the reporting bias domain of the CINeMA framework and software. DA - 2021-11-23 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Medicine KW - Risk of bias KW - Missing evidence KW - Network meta-analysis KW - Evidence synthesis KW - Publication bias KW - Selective outcome reporting KW - Reporting bias LK - https://open.uct.ac.za PY - 2021 T1 - ROB-MEN: a tool to assess risk of bias due to missing evidence in network meta-analysis TI - ROB-MEN: a tool to assess risk of bias due to missing evidence in network meta-analysis UR - http://hdl.handle.net/11427/35403 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12916-021-02166-3
dc.identifier.urihttp://hdl.handle.net/11427/35403
dc.identifier.vancouvercitationChiocchia V, Nikolakopoulou A, Higgins JPT, Page MJ, Papakonstantinou T, Cipriani A, et al. ROB-MEN: a tool to assess risk of bias due to missing evidence in network meta-analysis. BMC Medicine. 2021;19(1):304. http://hdl.handle.net/11427/35403.en_ZA
dc.language.isoenen_US
dc.language.rfc3066en
dc.publisher.departmentCentre for Infectious Disease Epidemiology and Research (CIDER)en_US
dc.publisher.facultyFaculty of Health Sciencesen_US
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourceBMC Medicineen_US
dc.source.journalissue1en_US
dc.source.journalvolume19en_US
dc.source.pagination304en_US
dc.source.urihttps://bmcmedicine.biomedcentral.com/
dc.source.urihttps://bmcmedicine.biomedcentral.com/
dc.subjectRisk of biasen_US
dc.subjectMissing evidenceen_US
dc.subjectNetwork meta-analysisen_US
dc.subjectEvidence synthesisen_US
dc.subjectPublication biasen_US
dc.subjectSelective outcome reportingen_US
dc.subjectReporting biasen_US
dc.titleROB-MEN: a tool to assess risk of bias due to missing evidence in network meta-analysisen_US
dc.typeJournal Articleen_US
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