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EBM Verdict
General medicine
Network meta-analysis for diagnostic tests
  1. Jack W O’Sullivan1,2,3
  1. 1 Division of Cardiovascular Medicine and Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, California, USA, Stanford University, Palo Alto, California, USA
  2. 2 Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
  3. 3 Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
  1. Correspondence to Dr Jack W O’Sullivan, Division of Cardiology, Department of Medicine, Stanford University, Stanford CA 94305, USA; jackos{at}stanford.edu

https://doi.org/10.1136/bmjebm-2019-111179

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    Network meta-analysis (NMA) has enabled the comparison of numerous interventions in the absence of direct head-to-head randomised controlled trials. A new technique describes NMA for diagnostic tests, an approach that can facilitate a similar comparison between different diagnostic tests at different diagnostic thresholds.

    Globally, the provision of healthcare is aided by clinical practice guidelines.1 Healthcare organisations, such as the UK’s National Institute for Health and Care Excellence (NICE), routinely provide healthcare workers with advice about what works for which patients in which particular setting.

    To do this, NICE, as does the WHO and various American professional societies, conducts systematic reviews and meta-analyses on the available evidence. The recent methodological creation of NMA has enabled these organisations to explicitly compare the effectiveness of different interventions even if they have not been directly compared in the same randomised controlled trial. NMA has facilitated organisations to determine, for instance, that apixaban 5 mg twice daily is the most efficacious novel oral anticoagulant ‘for …

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    Footnotes

    • Contributors JOS devised the idea for the paper and also was the sole author.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Patient consent for publication Not required.