Simultaneous comparison of multiple treatments: combining direct and indirect evidence

Top Cited Papers
Publisher Website
Google Scholar
Abstract
Introduction Several possible treatments are often available to treat patients with the same condition. Decisions about optimal care, and the clinical practice guidelines that inform these decisions, rely on evidence based evaluation of the different treatment options.1 2 Systematic reviews and meta-analyses of randomised controlled trials are the main sources of evidence. However, most systematic reviews focus on pair-wise, direct comparisons of treatments (often with the comparator being a placebo or control group), which can make it difficult to determine the best treatment. In the absence of a collection of large, high quality, randomised trials comparing all eligible treatments (which is invariably the situation), we have to rely on indirect comparisons of multiple treatments. For example, an indirect estimate of the benefit of A over B can be obtained by comparing trials of A v C with trials of B v C,3–5 even though indirect comparisons produce relatively imprecise estimates.6 We describe comparisons of three or more treatments, based on pair-wise or multi-arm comparative studies, as a multiple treatment comparison evidence structure. Angioplasty balloon device used to unblock and widen arteriesCredit: WILL AND DENI McINTYRE/SPL