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Conducting quantitative synthesis when comparing medical interventions: AHRQ and the Effective Health Care Program
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.
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“Finally, inadequate statistical power for subgroup analyses was noted. Several subgroups (such as intervention durations for ALM) included a small number of RCTs (less than six), which may not have adequate power for detecting differences among subgroups [71,72]; the results of such subgroup analyses should be cautiously interpreted.”
In the citing paper
“Several subgroups (such as participant types for lean body mass) included a small number of RCTs less than six, which may not have adequate power for detecting a difference among subgroups [89,90]; the results of such subgroup analyses should be cautiously interpreted.”
From Effects of Protein Supplementation Combined with Exercise Intervention on Frailty Indices, Body Composition, and Physical Function in Frail Older Adults (2018) · cites this paper as [89]
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Metadata
- Authors
- 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.
- Affiliations
- Oregon Health & Science University (US)
- Universität für Weiterbildung Krems (AT)
- Blue Cross Blue Shield Association (US)
- University of Minnesota (US)
- Agency for Healthcare Research and Quality (US)
- McMaster University (CA)
- Tufts Medical Center (US)
- Corresponding author
- Fu, Rongwei
- ORCID
- Venue
- Journal of Clinical Epidemiology
- Publisher
- Elsevier BV
- Published
- 2011-11
- Volume
- 64
- Issue
- 11
- Pages
- 1187-1197
- ISSN
- 0895-4356 (ISSN-L)
- OpenAlex
- W2145171366
- Cited by
- 730
- References
- 62
- Citations by year
- 2026: 46 · 2025: 64 · 2024: 88 · 2023: 75 · 2022: 99 · 2021: 92 · 2020: 56 · 2019: 50 · 2018: 29 · 2017: 27 · 2016: 33 · 2015: 26 · 2014: 18 · 2013: 13 · 2012: 10
- FWCI
- 14.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality
- H2020 European Research Council
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Social Sciences › Sociology and Political Science › Delphi Technique in Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- meta-analysis, comparative effectiveness research, evidence-based practice centers, Agency for Healthcare Research and Quality, indirect comparison, effect measures, rare events, heterogeneity, sensitivity analysis
- MeSH terms
- Data Interpretation, Statistical, Humans, Review Literature as Topic, Statistics as Topic, United States, Meta-Analysis as Topic, Models, Statistical, Bias, United States Agency for Healthcare Research and Quality, Outcome Assessment, Health Care, Evidence-Based Medicine, Consensus, Comparative Effectiveness Research
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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