Estimating and visualising the trade-off between benefits and harms on multiple clinical outcomes in network meta-analysis

Abstract

Abstract Background The relative treatment effects estimated from network meta-analysis can be employed to rank treatments from the most preferable to the least preferable option. These treatment hierarchies are typically based on ranking metrics calculated from a single outcome. Some approaches have been proposed in the literature to account for multiple outcomes and individual preferences, such as the coverage area inside a spie chart, that, however, does not account for a trade-off between efficacy and safety outcomes. We present the net-benefit standardised area within a spie chart, $$SAWIS$$ SAWIS to explore the changes in treatment performance with different trade-offs between benefits and harms, according to a particular set of preferences. Methods We combine the standardised areas within spie charts for efficacy and safety/acceptability outcomes with a value λ specifying the trade-off between benefits and harms. We derive absolute probabilities and convert outcomes on a scale between 0 and 1 for inclusion in the spie chart. Results We illustrate how the treatments in three published network meta-analyses perform as the trade-off λ varies. The decrease of the $$SAWIS$$ SAWIS quantity appears more pronounced for some drugs, e.g. haloperidol. Changes in treatment performance seem more frequent when SUCRA is employed as outcome measures in the spie charts. Conclusions $$SAWIS$$ SAWIS should not be interpreted as a ranking metric but it is a simple approach that could help identify which treatment is preferable when multiple outcomes are of interest and trading-off between benefits and harms is important.

Keywords

• Network meta-analysis
• Treatment performance
• Multiple outcomes
• Benefits
• Harms
• Trade-off