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

Abstract 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 pr...

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Autores principales:	Virginia Chiocchia, Adriani Nikolakopoulou, Julian P. T. Higgins, Matthew J. Page, Theodoros Papakonstantinou, Andrea Cipriani, Toshi A. Furukawa, George C. M. Siontis, Matthias Egger, Georgia Salanti
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Risk of bias Missing evidence Network meta-analysis Evidence synthesis Publication bias Selective outcome reporting Medicine R
Acceso en línea:	https://doaj.org/article/af7fbc13918d4832b3b3f478dd49a8f1
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spelling	oai:doaj.org-article:af7fbc13918d4832b3b3f478dd49a8f12021-11-28T12:15:16ZROB-MEN: a tool to assess risk of bias due to missing evidence in network meta-analysis10.1186/s12916-021-02166-31741-7015https://doaj.org/article/af7fbc13918d4832b3b3f478dd49a8f12021-11-01T00:00:00Zhttps://doi.org/10.1186/s12916-021-02166-3https://doaj.org/toc/1741-7015Abstract 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bias due to the presence of studies with unavailable results (within-study assessment of bias) and the potential for unpublished studies (across-study assessment of bias).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.Virginia ChiocchiaAdriani NikolakopoulouJulian P. T. HigginsMatthew J. PageTheodoros PapakonstantinouAndrea CiprianiToshi A. FurukawaGeorge C. M. SiontisMatthias EggerGeorgia SalantiBMCarticleRisk of biasMissing evidenceNetwork meta-analysisEvidence synthesisPublication biasSelective outcome reportingMedicineRENBMC Medicine, Vol 19, Iss 1, Pp 1-13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Risk of bias Missing evidence Network meta-analysis Evidence synthesis Publication bias Selective outcome reporting Medicine R
spellingShingle	Risk of bias Missing evidence Network meta-analysis Evidence synthesis Publication bias Selective outcome reporting Medicine R Virginia Chiocchia Adriani Nikolakopoulou Julian P. T. Higgins Matthew J. Page Theodoros Papakonstantinou Andrea Cipriani Toshi A. Furukawa George C. M. Siontis Matthias Egger Georgia Salanti ROB-MEN: a tool to assess risk of bias due to missing evidence in network meta-analysis
description	Abstract 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.
format	article
author	Virginia Chiocchia Adriani Nikolakopoulou Julian P. T. Higgins Matthew J. Page Theodoros Papakonstantinou Andrea Cipriani Toshi A. Furukawa George C. M. Siontis Matthias Egger Georgia Salanti
author_facet	Virginia Chiocchia Adriani Nikolakopoulou Julian P. T. Higgins Matthew J. Page Theodoros Papakonstantinou Andrea Cipriani Toshi A. Furukawa George C. M. Siontis Matthias Egger Georgia Salanti
author_sort	Virginia Chiocchia
title	ROB-MEN: a tool to assess risk of bias due to missing evidence in network meta-analysis
title_short	ROB-MEN: a tool to assess risk of bias due to missing evidence in network meta-analysis
title_full	ROB-MEN: a tool to assess risk of bias due to missing evidence in network meta-analysis
title_fullStr	ROB-MEN: a tool to assess risk of bias due to missing evidence in network meta-analysis
title_full_unstemmed	ROB-MEN: a tool to assess risk of bias due to missing evidence in network meta-analysis
title_sort	rob-men: a tool to assess risk of bias due to missing evidence in network meta-analysis
publisher	BMC
publishDate	2021
url	https://doaj.org/article/af7fbc13918d4832b3b3f478dd49a8f1
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ROB-MEN: a tool to assess risk of bias due to missing evidence in network meta-analysis

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