Comparison of meta-analytic results of indirect, direct, and combined comparisons of drugs for chronic insomnia in adults: a case study.
BACKGROUND
Our Center recently conducted a systematic review of the manifestations and management of chronic insomnia in adults. The efficacy and safety of benzodiazepines and nonbenzodiazepines, relative to placebo, were compared indirectly.


OBJECTIVE
Determine how the results of indirect comparisons made in the review compare with the results of direct comparisons, as well as with estimates derived from Bayesian mixed treatment comparisons. Establish general appropriateness of the use of results of indirect or mixed treatment comparisons.


METHODS
Treatments were compared using frequentist direct, indirect, and combined methods, as well as Bayesian direct and mixed methods.


RESULTS
Estimates for comparisons tended to be clinically and statistically similar across methods. Estimates obtained through indirect comparisons were not biased and were similar to those obtained through direct analysis.


CONCLUSIONS
Results of indirect comparisons made in the review, accurately reflected the current evidence. Frequentist and Bayesian methods of analysis of indirect comparisons should be considered when performing meta-analyses.
Vandermeer
Ben W
BW
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. bv1@ualberta.ca
Buscemi
Nina
N
Liang
Yuanyuan
Y
Witmans
Manisha
M
D000328:Adult; D001499:Bayes Theorem; D001569:Benzodiazepines / Q000008:administration & dosage / Q000627:therapeutic use; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015201:Meta-Analysis as Topic; D015233:Models, Statistical; D009010:Monte Carlo Method; D012196:Review Literature as Topic; D012680:Sensitivity and Specificity; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*
D006993:Hypnotics and Sedatives; D001569:Benzodiazepines