title: Characteristics and knowledge synthesis approach for 456 network meta-analyses: a scoping review.
abstract: Network meta-analysis (NMA) has become a popular method to compare more than two treatments. This scoping review aimed to explore the characteristics and methodological quality of knowledge synthesis approaches underlying the NMA process. We also aimed to assess the statistical methods applied using the Analysis subdomain of the ISPOR checklist.
  
  
  
  Comprehensive literature searches were conducted in MEDLINE, PubMed, EMBASE, and Cochrane Database of Systematic Reviews from inception until April 14, 2015. References of relevant reviews were scanned. Eligible studies compared at least four different interventions from randomised controlled trials with an appropriate NMA approach. Two reviewers independently performed study selection and data abstraction of included articles. All discrepancies between reviewers were resolved by a third reviewer. Data analysis involved quantitative (frequencies) and qualitative (content analysis) methods. Quality was evaluated using the AMSTAR tool for the conduct of knowledge synthesis and the ISPOR tool for statistical analysis.
  
  
  
  After screening 3538 citations and 877 full-text papers, 456 NMAs were included. These were published between 1997 and 2015, with 95% published after 2006. Most were conducted in Europe (51%) or North America (31%), and approximately one-third reported public sources of funding. Overall, 84% searched two or more electronic databases, 62% searched for grey literature, 58% performed duplicate study selection and data abstraction (independently), and 62% assessed risk of bias. Seventy-eight (17%) NMAs relied on previously conducted systematic reviews to obtain studies for inclusion in their NMA. Based on the AMSTAR tool, almost half of the NMAs incorporated quality appraisal results to formulate conclusions, 36% assessed publication bias, and 16% reported the source of funding. Based on the ISPOR tool, half of the NMAs did not report if an assessment for consistency was conducted or whether they accounted for inconsistency when present. Only 13% reported heterogeneity assumptions for the random-effects model.
  
  
  
  The knowledge synthesis methods and analytical process for NMAs are poorly reported and need improvement.
authors.affiliation: Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.
authors.forename: Wasifa
authors.initials: W
authors.lastname: Zarin
authors.affiliation: Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.
authors.forename: Areti Angeliki
authors.initials: AA
authors.lastname: Veroniki
authors.affiliation: Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.
authors.forename: Vera
authors.initials: V
authors.lastname: Nincic
authors.affiliation: Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.
authors.forename: Afshin
authors.initials: A
authors.lastname: Vafaei
authors.affiliation: Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.
authors.forename: Emily
authors.initials: E
authors.lastname: Reynen
authors.affiliation: Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.
authors.forename: Sanober S
authors.initials: SS
authors.lastname: Motiwala
authors.affiliation: Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.
authors.forename: Jesmin
authors.initials: J
authors.lastname: Antony
authors.affiliation: Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Sullivan
authors.affiliation: Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Rios
authors.affiliation: Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Daly
authors.affiliation: Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.
authors.forename: Joycelyne
authors.initials: J
authors.lastname: Ewusie
authors.affiliation: Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, 45110, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Petropoulou
authors.affiliation: Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, 45110, Greece.|Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Adriani
authors.initials: A
authors.lastname: Nikolakopoulou
authors.affiliation: Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, 45110, Greece.
authors.forename: Anna
authors.initials: A
authors.lastname: Chaimani
authors.affiliation: Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, 45110, Greece.|Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.|Institute of Primary Health Care, University of Bern, Bern, Switzerland.
authors.forename: Georgia
authors.initials: G
authors.lastname: Salanti
authors.affiliation: Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.|Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, M5S 1A1, Canada.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Straus
authors.affiliation: Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada. triccoa@smh.ca.|Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M7, Canada. triccoa@smh.ca.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Tricco
mesh_terms: D006801:Humans; D015982:Bias; D005060:Europe; D000071076:Network Meta-Analysis as Topic; D009656:North America; D058028:Research Report; D000078202:Systematic Reviews as Topic
keywords: AMSTAR; ISPOR; Mixed-treatment; Multiple treatments; Research reporting