Abstract
BackgroundThe use of network meta-analysis has increased dramatically in recent years. WinBUGS, a freely available Bayesian software package, has been the most widely used software package to conduct network meta-analyses. However, the learning curve for WinBUGS can be daunting, especially for new users. Furthermore, critical appraisal of network meta-analyses conducted in WinBUGS can be challenging given its limited data manipulation capabilities and the fact that generation of graphical output from network meta-analyses often relies on different software packages than the analyses themselves.MethodsWe developed a freely available Microsoft-Excel-based tool called NetMetaXL, programmed in Visual Basic for Applications, which provides an interface for conducting a Bayesian network meta-analysis using WinBUGS from within Microsoft Excel. . This tool allows the user to easily prepare and enter data, set model assumptions, and run the network meta-analysis, with results being automatically displayed in an Excel spreadsheet. It also contains macros that use NetMetaXL’s interface to generate evidence network diagrams, forest plots, league tables of pairwise comparisons, probability plots (rankograms), and inconsistency plots within Microsoft Excel. All figures generated are publication quality, thereby increasing the efficiency of knowledge transfer and manuscript preparation.ResultsWe demonstrate the application of NetMetaXL using data from a network meta-analysis published previously which compares combined resynchronization and implantable defibrillator therapy in left ventricular dysfunction. We replicate results from the previous publication while demonstrating result summaries generated by the software.ConclusionsUse of the freely available NetMetaXL successfully demonstrated its ability to make running network meta-analyses more accessible to novice WinBUGS users by allowing analyses to be conducted entirely within Microsoft Excel. NetMetaXL also allows for more efficient and transparent critical appraisal of network meta-analyses, enhanced standardization of reporting, and integration with health economic evaluations which are frequently Excel-based.
Highlights
The use of network meta-analysis has increased dramatically in recent years
The objectives of this paper are to use an illustrative example to demonstrate how our Microsoft-Excel-based Network Meta-analysis Tool (NetMetaXL) can be used to simplify running and reporting network meta-analyses and to highlight how NetMetaXL can be used to facilitate consistent reporting and more efficient and transparent critical appraisal of network meta-analyses submitted to health technology assessment (HTA) organizations such as the Canadian Agency for Drugs and Technologies in Health (CADTH) and the National Institute for Health and Care Excellence (NICE), as well as to journals which publish network meta-analyses
The user should carefully review the geometry of the evidence network, which provides information related to the number of studies performed comparing the different treatments, the numbers of patients who have been studied for each treatment, and so forth
Summary
The use of network meta-analysis has increased dramatically in recent years. Critical appraisal of network meta-analyses conducted in WinBUGS can be challenging given its limited data manipulation capabilities and the fact that generation of graphical output from network meta-analyses often relies on different software packages than the analyses themselves. New meta-analytic methods have emerged which permit simultaneous comparison of multiple treatments. This new method is referred to as network meta-analysis (NMA) (other terms such as mixed-treatment comparison metaanalysis and multiple treatments meta-analysis have been used) [1,2]. The increasing need to compare multiple treatments for medical conditions has been mirrored by the dramatic rise in the use of network meta-analysis in recent years [3,4]
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