March 2023 PALM: Patient-centered treatment ranking via large-scale multivariate network meta-analysis
Rui Duan, Jiayi Tong, Lifeng Lin, Lisa Levine, Mary Sammel, Joel Stoddard, Tianjing Li, Christopher H Schmid, Haitao Chu, Yong Chen
Author Affiliations +
Ann. Appl. Stat. 17(1): 815-837 (March 2023). DOI: 10.1214/22-AOAS1652


The growing number of available treatment options has led to urgent needs for reliable answers when choosing the best course of treatment for a patient. As it is often infeasible to compare a large number of treatments in a single randomized controlled trial, multivariate network meta-analyses (NMAs) are used to synthesize evidence from trials of a subset of the treatments, where both efficacy and safety related outcomes are considered simultaneously. However, these large-scale multiple-outcome NMAs have created challenges to existing methods due to the increasing complexity of the unknown correlations between outcomes and treatment comparisons. In this paper, we proposed a new framework for PAtient-centered treatment ranking via Large-scale Multivariate network meta-analysis, termed as PALM, which includes a parsimonious modeling approach, a fast algorithm for parameter estimation and inference, a novel visualization tool for presenting multivariate outcomes, termed as the origami plot, as well as personalized treatment ranking procedures taking into account the individual’s considerations on multiple outcomes. In application to an NMA that compares 14 treatment options for labor induction, we provided a comprehensive illustration of the proposed framework and demonstrated its computational efficiency and practicality, and we obtained new insights and evidence to support patient-centered clinical decision making.

Funding Statement

Jiayi Tong and Yong Chen’s efforts were supported in part by National Institutes of Health (1R01LM012607, 1R01AI130460, 1R01AG073435, 1R56AG074604, 1R01LM013519, 1R56AG069880).
This work was supported partially through Patient-Centered Outcomes Research Institute (PCORI) Project Program Awards (ME-2019C3-18315 and ME-2018C3-14899). All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.
Lifeng Lin and Haitao Chu were supported by the National Library of Medicine grant R01LM012982, and Lifeng Lin was supported by the National Institute of Mental Health grant R03 MH128727 of the U.S. National Institutes of Health.
Joel Stoddard was supported by grant K23MH113731 from the National Institute of Mental Health.
Tianjing Li was funded by grant 5UG1EY020522 from the National Eye Institute, National Institutes of Health.


The authors would like to thank the anonymous referees, an Associate Editor and the Editor for their constructive comments that improved the quality of this paper.


Download Citation

Rui Duan. Jiayi Tong. Lifeng Lin. Lisa Levine. Mary Sammel. Joel Stoddard. Tianjing Li. Christopher H Schmid. Haitao Chu. Yong Chen. "PALM: Patient-centered treatment ranking via large-scale multivariate network meta-analysis." Ann. Appl. Stat. 17 (1) 815 - 837, March 2023.


Received: 1 October 2021; Revised: 1 June 2022; Published: March 2023
First available in Project Euclid: 24 January 2023

MathSciNet: MR4539054
zbMATH: 07656999
Digital Object Identifier: 10.1214/22-AOAS1652

Keywords: evidence-based medicine , Multiple outcomes , network meta-analysis , origami plot , treatment ranking

Rights: Copyright © 2023 Institute of Mathematical Statistics


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Vol.17 • No. 1 • March 2023
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