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Background:  Randomised controlled trials are the most effective way to differentiate between the effects of competing interventions. However, head‐to‐head studies are unlikely to have been conducted for all competing interventions.

Aim:  Evaluation of different methodologies used to indirectly compare interventions based on meta analyses of randomised controlled trials.

Methods:  Systematic review of Cochrane Database of Systematic Reviews, Cochrane Methodology Register, EMBASE and MEDLINE for reports including meta analyses that contained an indirect comparison. Searching was completed in July 2007. No restriction was placed on language or year of publication.

Results:  Sixty‐two papers identified contained indirect comparisons of treatments. Five different methodologies were employed: comparing point estimates (1/62); comparing 95% confidence intervals (26/62); performing statistical tests …