Conducting quantitative synthesis when comparing medical interventions: AHRQ and the Effective Health Care Program
Conducting quantitative synthesis when comparing medical interventions: AHRQ and the Effective Health Care Program
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DOI：
10.1016/j.jclinepi.2010.08.010
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发表时间：
2011-11-01
影响因子：
7.2
通讯作者：
Trikalinos, Thomas A.
中科院分区：
文献类型：
--
作者：
Fe, Rongwei;Gartlehner, Gerald;Trikalinos, Thomas A.
目的：本文旨在为医疗保健研究与质量局循证实践中心（EPC）项目的比较有效性评价（CERs）中使用研究水平的数据建立定量综合或荟萃分析的建议。研究设计和设置：我们关注EPC项目中反复出现的问题，并根据文献中的当前知识通过小组讨论和共识制定建议。结果：我们首先讨论了决定是否合并研究的考虑因素，然后讨论了间接比较和间接证据的纳入。然后，我们描述了我们在选择效应测度和统计模型方面的建议，特别注意将研究与罕见事件结合起来；以及测试和探索异质性。最后，我们简要地提出了结合混合设计研究和敏感性分析的建议。结论：定量合成应透明、一致地进行。在CER中纳入多种替代干预措施增加了定量综合的复杂性，而定量综合的基本问题仍然是CER定量综合的关键考虑因素。我们将在未来的版本中涵盖更多的问题，并通过积累新的研究来更新和改进建议，以推进透明度和一致性的目标。(C) 2011爱思唯尔公司版权所有。
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. (C) 2011 Elsevier Inc. All rights reserved.