簡介評價網絡統合分析結果可信度的方法

Assessing Confidence in Network Meta-Analysis Results: A Brief Introduction

10.6142/VGHN.202206_39(2).0008

康以諾(Yi-No Kang)；陳可欣(Kee-Hsin Chen)

網絡統合分析 ； 可信度 ； 證據品質 ； 評讀 ； CINeMA Web ； Network meta-analysis (NMA) ； confidence ； quality of evidence ； appraise ； CINeMA (Confidence In Network Meta-Analysis) Web

榮總護理

39卷2期（2022 / 06 / 01）

198 - 205

繁體中文

網絡統合分析透過結合治療或照護措施的直接證據、以及基於共同比較試驗的間接證據，同時比較兩種以上的醫療照護選項的有效性及安全性。在實際臨床工作中，對於協助健康照護者根據證據的有效性和成本效益做出臨床決策以及發展臨床指引，已成為一種越來越流行和具有影響力的工具。因此，評估網絡統合分析結果的可信度，已成為證據整合過程中不可或缺的部分。本文將簡要介紹GRADE工作組提出評估網絡統合分析治療效果證據品質的四步驟方法，包括步驟一、呈現證據網絡中每個直接及間接比較治療效果的估計值；步驟二、評價直接及間接比較估計效果的品質；步驟三、呈現網絡統合分析的估計值；步驟四、評價網絡統合分析效果估計效果的品質。本文提供使用尿毒素吸附劑延緩慢性腎臟病惡化的網絡統合分析作為例子，讓讀者更容易了解網絡統合分析結果可信度評估的精華。此外，本文將介紹一個免費平台CINeMA Web（Confidence In Network Meta-Analysis），通過圖示化的引導，針對研究內偏差、報告偏差、間接性、不精確性、異質性及不連貫性等六個領域進行評估，最終，使用者提出證據的總結判斷（高、中、低或極低）。如果研究者沒有在其發表的研究中提供充足的訊息，臨床健康提供者和病人宜謹慎使用網絡統合分析結果所提出的證據。

Network meta-analysis (NMA) compares effectiveness and/or safety of several interventions by combining both direct comparisons of interventions and indirect comparisons across trials based on a common comparator. In real word practice, NMA has become an increasingly popular and influence tool used for decision making on clinical effectiveness and cost-effectiveness in health care, as well as developing clinical practice. The evaluation of the credibility of results from an NMA has become an important part of the evidence synthesis process. In this article, we brief introducing four steps approach for assessing the quality of treatment effect estimates from NMA by Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group. The 4 steps for rating the quality of NMA estimates including: (I) Present direct and indirect treatment estimates for each comparison of the evidence network, (II) Rate quality of direct and indirect effect estimate, (III) Present NMA estimate, and (IV) Rate quality of NMA effect estimate. In this part, we provide a simple example using AST-120 for patients with chronic kidney disease, which is an NMA of randomized controlled trials to enable readers better understand the essence quality assessment of NMA. Furthermore, we also describing a free, open-source, graphically platform named Confidence In Network Meta-Analysis (CINeMA). Reviewers are guided through a systematic evaluation of the 6 domains, including (1) within-study bias, (2) reporting bias, (3) indirectness, (4) imprecision, (5) heterogeneity and (6) incoherence, to evaluate the confidence of evidence (high, moderate, low, or very low) from NMA using a transparent framework. If authors do not present efficient information, clinical health providers and patients should carful with NMA evidence they trust.

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