Fragility index of network meta-analysis with application to smoking cessation data

Aiwen Xing, Haitao Chu, Lifeng Lin

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Objectives: The network meta-analysis (NMA) is frequently used to synthesize evidence for multiple treatment comparisons, but its complexity may affect the robustness (or fragility) of the results. The fragility index (FI) is recently proposed to assess the fragility of the results from clinical studies and from pairwise meta-analyses. We extend the FI to NMAs with binary outcomes. Methods: We define the FI for each treatment comparison in NMAs. It quantifies the minimal number of events necessary to be modified for altering the comparison's statistical significance. We introduce an algorithm to derive the FI and visualizations of the process. A worked example of smoking cessation data is used to illustrate the proposed methods. Results: Some treatment comparisons had small FIs; their significance (or nonsignificance) could be altered by modifying a few events’ status. They were related to various factors, such as P-values, event counts, and sample sizes, in the original NMA. After modifying event status, treatment ranking measures were also changed to different extents. Conclusion: Many NMAs include insufficiently compared treatments, small event counts, or small sample sizes; their results are potentially fragile. The FI offers a useful tool to evaluate treatment comparisons’ robustness and reliability.

Original languageEnglish (US)
Pages (from-to)29-39
Number of pages11
JournalJournal of Clinical Epidemiology
Volume127
DOIs
StatePublished - Nov 2020

Bibliographical note

Funding Information:
Financial support: This research was supported in part by the US National Institutes of Health/National Library of Medicine grant R01 LM012982 (HC and LL) and National Institutes of Health/National Center for Advancing Translational Sciences grant UL1 TR001427 (LL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding Information:
Financial support: This research was supported in part by the US National Institutes of Health / National Library of Medicine grant R01 LM012982 (HC and LL) and National Institutes of Health/ National Center for Advancing Translational Sciences grant UL1 TR001427 (LL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2020 Elsevier Inc.

Keywords

  • Fragility index
  • Network meta-analysis
  • Replicability
  • Statistical significance
  • Systematic review
  • Treatment comparison

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

Fingerprint

Dive into the research topics of 'Fragility index of network meta-analysis with application to smoking cessation data'. Together they form a unique fingerprint.

Cite this