Conducting quantitative synthesis when comparing medical interventions: AHRQ and the Effective Health Care Program

Rongwei Fu, Gerald Gartlehner, Mark Grant, Tatyana Shamliyan, Art Sedrakyan, Timothy J. Wilt, Lauren Griffith, Mark Oremus, Parminder Raina, Afisi Ismaila, Pasqualina Santaguida, Joseph Lau, Thomas A. Trikalinos

Research output: Contribution to journalReview article

174 Scopus citations

Abstract

Objective: This article is to establish recommendations for conducting quantitative synthesis, or meta-analysis, using study-level data in comparative effectiveness reviews (CERs) for the Evidence-based Practice Center (EPC) program of the Agency for Healthcare Research and Quality. Study Design and Setting: We focused on recurrent issues in the EPC program and the recommendations were developed using group discussion and consensus based on current knowledge in the literature. Results: We first discussed considerations for deciding whether to combine studies, followed by discussions on indirect comparison and incorporation of indirect evidence. Then, we described our recommendations on choosing effect measures and statistical models, giving special attention to combining studies with rare events; and on testing and exploring heterogeneity. Finally, we briefly presented recommendations on combining studies of mixed design and on sensitivity analysis. Conclusion: Quantitative synthesis should be conducted in a transparent and consistent way. Inclusion of multiple alternative interventions in CERs increases the complexity of quantitative synthesis, whereas the basic issues in quantitative synthesis remain crucial considerations in quantitative synthesis for a CER. We will cover more issues in future versions and update and improve recommendations with the accumulation of new research to advance the goal for transparency and consistency.

Original languageEnglish (US)
Pages (from-to)1187-1197
Number of pages11
JournalJournal of Clinical Epidemiology
Volume64
Issue number11
DOIs
StatePublished - Nov 1 2011

Keywords

  • Effect measure
  • Fixed/random effects model
  • Heterogeneity
  • Indirect comparison
  • Meta-analysis
  • Mixed design

ASJC Scopus subject areas

  • Epidemiology

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    Fu, R., Gartlehner, G., Grant, M., Shamliyan, T., Sedrakyan, A., Wilt, T. J., Griffith, L., Oremus, M., Raina, P., Ismaila, A., Santaguida, P., Lau, J., & Trikalinos, T. A. (2011). Conducting quantitative synthesis when comparing medical interventions: AHRQ and the Effective Health Care Program. Journal of Clinical Epidemiology, 64(11), 1187-1197. https://doi.org/10.1016/j.jclinepi.2010.08.010