%0 Journal Article
%T A Primer on Network Meta-Analysis for Dental Research
%A Yu-Kang Tu
%A Clovis Mariano Faggion Jr.
%J ISRN Dentistry
%D 2012
%R 10.5402/2012/276520
%X In the last decade, a new statistical methodology, namely, network meta-analysis, has been developed to address limitations in traditional pairwise meta-analysis. Network meta-analysis incorporates all available evidence into a general statistical framework for comparisons of all available treatments. A further development in the network meta-analysis is to use a Bayesian statistical approach, which provides a more flexible modelling framework to take into account heterogeneity in the evidence and complexity in the data structure. The aim of this paper is therefore to provide a nontechnical introduction to network meta-analysis for dental research community and raise the awareness of it. An example was used to demonstrate how to conduct a network meta-analysis and the differences between it and traditional meta-analysis. The statistical theory behind network meta-analysis is nevertheless complex, so we strongly encourage close collaboration between dental researchers and experienced statisticians when planning and conducting a network meta-analysis. The use of more sophisticated statistical approaches such as network meta-analysis will improve the efficiency in comparing the effectiveness between multiple treatments across a set of trials. 1. Introduction With the rise of evidence-based medicine movement in the last two decades, systematic reviews and meta-analyses have been widely used for synthesis of evidence on beneficial and/or harmful effects of different treatments. Results from those reviews and meta-analyses provide important information for drawing clinical guidelines and making health policy recommendations. For most clinical conditions, several interventions (which may be drugs, medical devices, surgeries, or a combination of them) are usually available, but most systematic reviews of randomised controlled trials (RCTs) tend to limit their scopes by only evaluating two active treatments or comparing one treatment to a control. Even if a systematic review evaluates multiple treatments, traditional meta-analysis can only perform pairwise comparisons. There are several limitations to this approach [1¨C4]. For instance, suppose there are three new and more expensive treatments A, B, and C and a standard treatment D, six pair-wise metaanalyses (A-B, B-C, A¨CC, A¨CD, B¨CD, and C-D) may be undertaken to compare the differences for pairs of the four treatments. None or few of included RCTs in the paper would have compared all four treatments, and most RCTs compared only 2 or 3 of them. Consequently, those pairwise meta-analyses use different sets of
%U http://www.hindawi.com/journals/isrn.dentistry/2012/276520/