Graphs of study contributions and covariate distributions for network meta-regression

TY - JOUR

T1 - Graphs of study contributions and covariate distributions for network meta-regression

AU - Donegan, Sarah

AU - Dias, Sofia

AU - Tudor-Smith, Catrin

AU - Marinho, Valeria C C

AU - Welton, Nicky J.

N1 - © 2018 The Authors. Research Synthesis Methods Published by John Wiley & Sons Ltd.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - BackgroundMeta-regression results must be interpreted taking into account the range of covariate values of the contributing studies. Results based on interpolation or extrapolation may be unreliable. In network meta-regression (NMR) models, which include covariates in network meta-analyses, results are estimated using direct and indirect evidence, therefore it may be unclear which studies and covariate values contribute to which result. We propose graphs to help understand which trials and covariate values contribute to each NMR result and to highlight extrapolation or interpolation.MethodsWe introduce methods to calculate the contribution that each trial and covariate value makes to each result and compare them with existing methods. We show how to construct graphs including a network covariate distribution diagram, covariate-contribution plot, heat plot, contribution-NMR plot, and heat-NMR plot. We demonstrate the methods using a dataset with treatments for malaria using the covariate average age and a dataset of topical fluoride interventions for preventing dental caries using the covariate randomisation year.ResultsFor the malaria dataset, no contributing trials had an average age between 7-25 years and therefore results were interpolated within this range. For the fluoride dataset, there are no contributing trials randomised between 1954-1959 for most comparisons therefore, within this range, results would be extrapolated.ConclusionsEven in a fully connected network, an NMR result may be estimated from trials with a narrower covariate range than the range of the whole dataset. Calculating contributions and graphically displaying them aids interpretation of NMR result by highlighting extrapolated or interpolated results.

AB - BackgroundMeta-regression results must be interpreted taking into account the range of covariate values of the contributing studies. Results based on interpolation or extrapolation may be unreliable. In network meta-regression (NMR) models, which include covariates in network meta-analyses, results are estimated using direct and indirect evidence, therefore it may be unclear which studies and covariate values contribute to which result. We propose graphs to help understand which trials and covariate values contribute to each NMR result and to highlight extrapolation or interpolation.MethodsWe introduce methods to calculate the contribution that each trial and covariate value makes to each result and compare them with existing methods. We show how to construct graphs including a network covariate distribution diagram, covariate-contribution plot, heat plot, contribution-NMR plot, and heat-NMR plot. We demonstrate the methods using a dataset with treatments for malaria using the covariate average age and a dataset of topical fluoride interventions for preventing dental caries using the covariate randomisation year.ResultsFor the malaria dataset, no contributing trials had an average age between 7-25 years and therefore results were interpolated within this range. For the fluoride dataset, there are no contributing trials randomised between 1954-1959 for most comparisons therefore, within this range, results would be extrapolated.ConclusionsEven in a fully connected network, an NMR result may be estimated from trials with a narrower covariate range than the range of the whole dataset. Calculating contributions and graphically displaying them aids interpretation of NMR result by highlighting extrapolated or interpolated results.

KW - Meta-regression, network meta-analysis, extrapolation, contribution, weight, treatment by covariate interactions

U2 - 10.1002/jrsm.1292

DO - 10.1002/jrsm.1292

M3 - Article

SN - 1759-2879

VL - 9

SP - 243

EP - 260

JO - Research Synthesis Methods

JF - Research Synthesis Methods

IS - 2

ER -