Development and implementation of a living network meta-analysis framework for comparative effectiveness research: a case study in chronic venous insufficiency treatment

Aim: To develop, implement and evaluate a living network meta-analysis (NMA) framework for comparative effectiveness research, using chronic venous insufficiency treatment as a case study. The framework addresses key barriers to sustained evidence synthesis: resource sustainability, methodological consistency and transparent dissemination. Materials & methods: A four-phase living NMA framework was established with prospective protocol registration, quarterly literature surveillance and annual update cycles. The baseline systematic review, registered in PROSPERO, searched English-language publications (2000–2023) per PRISMA guidelines. Eligible studies included randomized and non-randomized comparisons of polidocanol 1% endovenous microfoam (PEM) or endovenous thermal ablation versus any comparator. Network connectivity relied on common comparators (surgery, physician-compounded foam) and head-to-head PEM versus endovenous thermal ablation studies. The protocol specifies predetermined eligibility criteria, standardized data extraction and consistent statistical methods, with results posted to a publicly accessible website. Results: The baseline NMA (13 studies; 233,801 patients) was published in a peer-reviewed journal and simultaneously posted publicly. The first update identified seven new eligible studies, expanding the evidence base to 20 studies and 235,093 patients. Effect estimates remained stable with no change in primary conclusions, demonstrating robustness to new evidence incorporation. Update-cycle workload was substantially less than the initial NMA effort, with efficiency gains attributable to team continuity, accrued clinical expertise and stable data definitions. Conclusion: This living NMA framework balances scientific rigor with practical sustainability through industry partnership and transparent dissemination. The successful first update confirms feasibility, though the framework was developed with a single sponsor in one clinical area and transferability to other contexts has not been tested.