Evidence map›Paper›PMID 21846695›Full record

ArticleBMJ (Clinical research ed.)2011

Inconsistency between direct and indirect comparisons of competing interventions: meta-epidemiological study.

Fujian Song, Tengbin Xiong, Sheetal Parekh-Bhurke, Yoon K Loke, Alex J Sutton, Alison J Eastwood, Richard Holland, Yen-Fu Chen, Anne-Marie Glenny, Jonathan J Deeks and 1 more

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In one paragraph

Article in BMJ (Clinical research ed.), 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 91 papers, 26 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
91citing papers in PubMed, 26 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

91 citing papers in PubMed, 26 syntheses or guidelines pooled it.

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31 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Fujian SongFaculty of Medicine and Health Science, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK. fujian.song@uea.ac.uk
Tengbin Xiong
Sheetal Parekh-Bhurke
Yoon K Loke
Alex J Sutton
Alison J Eastwood
Richard Holland
Yen-Fu Chen
Anne-Marie Glenny
Jonathan J Deeks
Doug G Altman

Funding

Medical Research Council G0701607Medical Research Council G0800808
6 · The paper itself

Abstract

objectiveTo investigate the agreement between direct and indirect comparisons of competing healthcare interventions.

designMeta-epidemiological study based on sample of meta-analyses of randomised controlled trials. Data sources Cochrane Database of Systematic Reviews and PubMed. Inclusion criteria Systematic reviews that provided sufficient data for both direct comparison and independent indirect comparisons of two interventions on the basis of a common comparator and in which the odds ratio could be used as the outcome statistic.

main outcome measureInconsistency measured by the difference in the log odds ratio between the direct and indirect methods.

resultsThe study included 112 independent trial networks (including 1552 trials with 478,775 patients in total) that allowed both direct and indirect comparison of two interventions. Indirect comparison had already been explicitly done in only 13 of the 85 Cochrane reviews included. The inconsistency between the direct and indirect comparison was statistically significant in 16 cases (14%, 95% confidence interval 9% to 22%). The statistically significant inconsistency was associated with fewer trials, subjectively assessed outcomes, and statistically significant effects of treatment in either direct or indirect comparisons. Owing to considerable inconsistency, many (14/39) of the statistically significant effects by direct comparison became non-significant when the direct and indirect estimates were combined.

conclusionsSignificant inconsistency between direct and indirect comparisons may be more prevalent than previously observed. Direct and indirect estimates should be combined in mixed treatment comparisons only after adequate assessment of the consistency of the evidence.

Indexed as

Comparative Effectiveness ResearchEpidemiologic StudiesMeta-Analysis as TopicRandomized Controlled Trials as TopicBiasHumansReproducibility of ResultsResearch DesignReview Literature as TopicTreatment Outcome

Identifiers

PMID21846695
PMCPMC3156578

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.