Trends in Meta-Analysis
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Trends in Meta-analysis
Susan D. Ross, MD, FRCPC
SDRoss Consulting. Cohasset. Massachusetts
Key Words Meta-analysis; Evidencebased medicine Correspondence Address Susan D. Ross, MD. SDRoss Consulting, 720Jerusalem Rd., Cohasset. MA 02025 (ernail: [email protected]).
While meta-analysis is a well-accepted t d in evidence-based medicine, both the science and the utility of meta-analysiscontinue to evolve in response to the empirical demands of health care praiders, researchers, payers, and pdicymakers. Three important developments in metaanalysisare summarized, with relevant examples provided for illustration. First, the indications for performing metaanalyses using aggregate data versus individual patient data are discussed. Second, the advantages of cumulating data in real time as new
INTRODUCTION Meta-analysis, a statistical method of combining data from multiple sources, has been used for many decades in the social sciences, environmental science, and agriculture. In the early 1990s, meta-analysis also started to gain traction in medicine as a valid and useful way to combine the results of clinical studies. Today it is a well-accepted and necessary tool to produce the best available evidence for evidence-based decisions in health care (1-4). The field continues to evolve in several fascinating ways in response to the empirical demands of health care providers, researchers, payers, and policymakers. This article from the cofounder of MetaWorks, an original AHRQ Evidence-Based Practice Center, describes a few of the more important developments in this regard. It is aimed at nonstatistician audiences who nevertheless are frequent consumers of these kinds of evidence syntheses. Meta-analysis is only one step near the end of the long journey of a systematic review of clinical studies. The systematic formulation of a research question, identification and retrieval of appropriate studies to help answer that question, critical appraisal of each of those studies, data extraction, and database development all precede any effort to synthesize data, whether that effort is qualitative or quantitative. Once
studies are finished, that is, cumulative metaanalysis, are reviewed. Third, we desm'be the use of meta-analyses to provide indirect comparisons of various interventions when no head-to-head trials exist. NetwoA meta-analyses, in particulal; are a valid way to rank order the efficacyor safety of multiple interventionssimultaneously. Those who use clinical research syntheses should appreciate these highly relevant developments in the field of meta-analysis, developments that hddgrmt promise for all who wish to use information better in health care.
the statistical syntheses are done, the results still need to be presented in an intelligible and defensible way, with exploration of strengths and weaknesses, and, most important, the clinical meaning of it all. To keep the meta-analysis activity in proper perspective, it is helpful to see data like those presented by Allen and Olkin (5), where the statistical ana
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