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The Exchangeability Assumption in Network Meta-Analysis: Its Meaning and Evaluation
1Institute of Health Data Analytics and Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan; Health Data Research Center, National Taiwan University, Taipei, Taiwan.
Summary
Network meta-analysis (NMA) relies on exchangeable treatment contrasts. We propose a graphical method to assess this assumption, aiding interpretation of NMA results and informing study design for better generalizability.
Area of Science:
- Biostatistics
- Evidence Synthesis
- Meta-Analysis
Background:
- Network meta-analysis (NMA) validity hinges on homogeneity, consistency, and transitivity assumptions.
- These assumptions can be unified under the concept of exchangeability.
- Clarifying what is exchangeable in NMA and how to assess it is crucial.
Purpose of the Study:
- To demonstrate that the contrast-based model in NMA assumes exchangeable treatment contrasts across studies.
- To introduce a graphical method for assessing the validity of the exchangeability assumption in NMA.
- To explore the relationship between exchangeable treatment contrasts, consistency, transitivity, and the impact of violating exchangeability.
Main Methods:
- Proposed a graphical approach plotting absolute treatment effects against potential effect modifiers to assess exchangeability.
- Utilized this graphical method to differentiate between absolute and relative effect modifiers.
- Demonstrated the link between exchangeable treatment contrasts and the consistency/transitivity assumptions in NMA.
Main Results:
- Applied the graphical method to a real NMA in dentistry, evaluating the validity of exchangeable treatment contrasts.
- The method provided insights into interpreting NMA results when exchangeability is met or uncertain.
- Illustrated the consequences of violating the exchangeability assumption.
Conclusions:
- The proposed approach validates the assumption of exchangeable treatment contrasts in NMA.
- Highlights a key NMA design consideration: balancing study selection for exchangeability versus generalizability.
- Offers guidance on selecting studies to ensure valid NMA results and appropriate interpretation.
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