Characteristics and knowledge synthesis approach for 456 network meta-analyses: a scoping review

BACKGROUND

Network meta-analysis (NMA) has become a popular method to compare more than two treatments. This scoping review aimed to explore the characteristics and methodological quality of knowledge synthesis approaches underlying the NMA process. We also aimed to assess the statistical methods applied using the Analysis subdomain of the ISPOR checklist.

METHODS

Comprehensive literature searches were conducted in MEDLINE, PubMed, EMBASE, and Cochrane Database of Systematic Reviews from inception until April 14, 2015. References of relevant reviews were scanned. Eligible studies compared at least four different interventions from randomised controlled trials with an appropriate NMA approach. Two reviewers independently performed study selection and data abstraction of included articles. All discrepancies between reviewers were resolved by a third reviewer. Data analysis involved quantitative (frequencies) and qualitative (content analysis) methods. Quality was evaluated using the AMSTAR tool for the conduct of knowledge synthesis and the ISPOR tool for statistical analysis.

RESULTS

After screening 3538 citations and 877 full-text papers, 456 NMAs were included. These were published between 1997 and 2015, with 95% published after 2006. Most were conducted in Europe (51%) or North America (31%), and approximately one-third reported public sources of funding. Overall, 84% searched two or more electronic databases, 62% searched for grey literature, 58% performed duplicate study selection and data abstraction (independently), and 62% assessed risk of bias. Seventy-eight (17%) NMAs relied on previously conducted systematic reviews to obtain studies for inclusion in their NMA. Based on the AMSTAR tool, almost half of the NMAs incorporated quality appraisal results to formulate conclusions, 36% assessed publication bias, and 16% reported the source of funding. Based on the ISPOR tool, half of the NMAs did not report if an assessment for consistency was conducted or whether they accounted for inconsistency when present. Only 13% reported heterogeneity assumptions for the random-effects model.

CONCLUSIONS

The knowledge synthesis methods and analytical process for NMAs are poorly reported and need improvement.

Predictors of place of death for seniors in Ontario: a population-based cohort analysis

Place of death was determined for all 58,689 seniors (age > or = 66 years) in Ontario who died during fiscal year 2001/2002. The relationship of place of death to medical and socio-demographic characteristics was examined using a multinomial logit model. Half (49.2 %) of these individuals died in hospital, 30.5 per cent died in a long-term care facility, 9.6 per cent died at home while receiving home care, and 10.7 per cent died at home without home care. Co-morbidities were the strongest predictors of place of death (p < 0.0001). A cancer diagnosis increased the chances of death at home while receiving home care; seniors with dementia were most likely to die in LTC facilities; and those with major acute conditions were most likely to die in hospitals. Higher socio-economic status was associated with greater probability of dying at home but contributed little to the model. Appropriate planning and resource allocation may help move place of death from hospitals to nursing homes or the community, in accordance with individual preferences.

Advancing the health care supply chain and promoting leadership through strategic partnerships with industry

While supply chain partnerships are common in the private industry, they are unique in health care. This article looks at the novel partnership between St. Michael's Hospital and Baxter Canada. By sharing information and working together, these organizations evaluated and tackled service disruptions caused by backorders. Their formal collaboration has resulted in a streamlined backorder management process, and more importantly, better and timelier patient care.

The cost-effectiveness of expanding intensive behavioural intervention to all autistic children in Ontario: in the past year, several court cases have been brought against provincial governments to increase funding for Intensive Behavioural Intervention (IBI). This economic evaluation examines the costs and consequences of expanding an IBI program

Intensive Behavioural Intervention (IBI) describes behavioural therapies provided to autistic children to overcome intellectual and functional disabilities. The high cost of IBI has caused concern regarding access, and recently, several court cases have been brought against provincial governments to increase funding for this intervention. This economic evaluation assessed the costs and consequences of expanding an IBI program from current coverage for one-third of children to all autistic children aged two to five in Ontario, Canada. Data on the hours and costs of IBI, and costs of educational and respite services, were obtained from the government. Data on program efficacy were obtained from the literature. These data were modelled to determine the incremental cost savings and gains in dependency-free life years. Total savings from expansion of the current program were $45,133,011 in 2003 Canadian dollars. Under our model parameters, expansion of IBI to all eligible children represents a cost-saving policy whereby total costs of care for autistic individuals are lower and gains in dependency-free life years are higher. Sensitivity analyses carried out to address uncertainty and lack of good evidence for IBI efficacy and appropriate discount rates yielded mixed results: expansion was not cost saving with discount rates of 5% or higher and with lower IBI efficacy beyond a certain threshold. Further research on the efficacy of IBI is recommended.