A Comparison of National Guidelines for Network Meta-Analysis

Background: Network meta-analysis (NMA) techniques allow the comparison of a complete set of interventions for patient groups. These meta-analysis techniques may be the only source of evidence to underpin estimates of comparative efficacy. Reimbursement agencies around the world are increasingly reliant upon meta-analysis techniques and assess their design and conduct with growing sophistication. Objective: Our objective is to create a superset of requirements collated from available national guidelines for the conduct of network meta-analysis such that a single analysis may be conducted to satisfy all reimbursement bodies that have specified requirements in sufficient detail. Methods: Published and draft guidelines documents from reimbursement bodies and health technology appraisal agencies were examined for their stipulations as to the conduct and design of network meta-analysis and measures to be taken to reduce bias and increase validity. Results: Guidelines from 41 countries were reviewed, yielding a sample size of 13 countries' guideline documents: Australia, Belgium, Canada, China, Ireland, England and Wales, France, Germany, Scotland, South Africa, South Korea, Spain, Thailand, and a guideline document from the European Network of Health Technology Assessment, which contained explicit recommendations or requirements for conduct of NMA. Conclusion: This study expands the range of previous work that reviewed the guidelines for the use of indirect evidence from multiple national jurisdictions. These aggregate guidelines do not include requirements that are mutually prohibitive. It is possible to perform a single NMA for submission to an expanded list of national jurisdictions.