CINeMA: An approach for assessing confidence in the results of a network meta-analysis

PLoS Med. 2020 Apr 3;17(4):e1003082. doi: 10.1371/journal.pmed.1003082. eCollection 2020 Apr.


Background: The evaluation of the credibility of results from a meta-analysis has become an important part of the evidence synthesis process. We present a methodological framework to evaluate confidence in the results from network meta-analyses, Confidence in Network Meta-Analysis (CINeMA), when multiple interventions are compared.

Methodology: CINeMA considers 6 domains: (i) within-study bias, (ii) reporting bias, (iii) indirectness, (iv) imprecision, (v) heterogeneity, and (vi) incoherence. Key to judgments about within-study bias and indirectness is the percentage contribution matrix, which shows how much information each study contributes to the results from network meta-analysis. The contribution matrix can easily be computed using a freely available web application. In evaluating imprecision, heterogeneity, and incoherence, we consider the impact of these components of variability in forming clinical decisions.

Conclusions: Via 3 examples, we show that CINeMA improves transparency and avoids the selective use of evidence when forming judgments, thus limiting subjectivity in the process. CINeMA is easy to apply even in large and complicated networks.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Confidence Intervals
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / epidemiology
  • Electrocardiography / methods
  • Electrocardiography / standards*
  • Exercise Test / methods
  • Exercise Test / standards*
  • Humans
  • Magnetic Resonance Imaging, Cine / methods
  • Magnetic Resonance Imaging, Cine / standards*
  • Network Meta-Analysis*
  • Randomized Controlled Trials as Topic / methods
  • Randomized Controlled Trials as Topic / standards*

Grants and funding

The development of the software and part of the presented work was supported by the Cochrane Collaboration and the Campbell Collaboration. GS, AN, TP were supported by project funding (Grant No. 179158) from the Swiss National Science Foundation. ME was supported by special project funding (Grant No. 174281) from the Swiss National Science Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.