Abstract
BackgroundIn the appraisal of clinical interventions, complex evidence synthesis methods, such as network meta-analysis (NMA), are commonly used to investigate the effectiveness of multiple interventions in a single analysis. The results from a NMA can inform clinical guidelines directly or be used as inputs into a decision-analytic model assessing the cost-effectiveness of the interventions. However, there is hesitancy in using complex evidence synthesis methods when evaluating public health interventions. This is due to significant heterogeneity across studies investigating such interventions and concerns about their quality. Threshold analysis has been developed to help assess and quantify the robustness of recommendations made based on results obtained from NMAs to potential limitations of the data. Developed in the context of clinical guidelines, the method may prove useful also in the context of public health interventions. In this paper, we illustrate the use of the method in the study investigating the effectiveness of interventions aiming to increase the uptake of poison prevention behaviours in homes with children aged 0-5.MethodsRandom effects NMA was carried out to assess the effectiveness of several interventions for increasing the uptake of poison prevention behaviours, focusing on the safe storage of other household products outcome. Threshold analysis was then applied to the NMA to assess the robustness of the intervention recommendations made based on the NMA.Results15 studies assessing seven interventions were included in the NMA. The results of the NMA indicated that complex intervention, including Education, Free/low-cost equipment, Fitting equipment and Home safety inspection, was the most effective intervention at promoting poison prevention behaviours. However, the threshold analyses highlighted that this intervention recommendation was not robust.Conclusions In our case study, threshold analysis allowed us to demonstrate that the intervention recommendation for promoting poison prevention behaviours was not robust to changes in the evidence due to potential bias. Therefore, caution should be taken when considering such interventions in practice. We have illustrated the potential benefit of threshold analysis and, therefore, encourage the use of the method in practice as a sensitivity analysis for NMA of public health interventions.
Using Threshold Analysis to Assess the Robustness of Public Health Intervention Recommendations from Network Meta-Analyses: Application to Poison Prevention in Households with Children Under Five
