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A method for comparing multiple therapies within a single analysis, a Network Meta-Analysis (NMA), makes use of direct and indirect evidence within a network of randomized controlled studies.

While randomized controlled trials (RCTs) generally provide higher-quality evidence than NMAs, head-to-head RCTs are often slow and expensive.

Payers worldwide have turned to NMAs in recent years to assess the value of various treatment options, according to Dr. Philip J. Mease, a rheumatologist affiliated with the Swedish Medical Center/Providence St. Joseph Health and the University of Washington in Seattle.

In the United States, insurance companies wanting to ascertain the value of various medications for a single indication have turned to NMAs.

“In the absence of head-to-head trials, NMAs are needed for insurers and payers to figure out a drug’s value proposition,” Mease said.

Independent evaluation agencies have also turned to NMAs as they survey the landscape for various diseases with an increasing number of treatment options. “They base their independent analysis on NMAs,” Mease said.

Mease was involved in an American College of Rheumatology (ACR) group that drafted a set of treatment guidelines for psoriatic arthritis in the absence of head-to-head trials. NMAs proved vital for that endeavor, he said.

ACR statisticians did their own NMAs to determine the relative efficacy of tumor necrosis factor (TNF) inhibitors, interleukin 17 (IL-7) inhibitors and other treatment options.

Mease notes that guidelines are emerging to ensure that NMAs are accurate. “As you do the analysis, it’s very important not to do things statistically that can skew the outcome of the NMA to one particular product that happens to belong to the company sponsoring the exercise.”

NMAs are likely to continue gaining in popularity, Mease predicted. “Both clinicians and patients need NMAs as we get more and more treatment options,” he said.

As patients continue to become more involved in their care, they could discuss NMAs with their physicians in the course of discussing treatment options. “I actually have brought my computer into the exam room with my patients who insist on seeing metrics when assessing the safety and efficacy of treatment options.”