Systematic reviews, meta analyses, and cost effectiveness studies Paul K. Crane, MD MPH General Internal Medicine Harborview Medical Center

Types of review articles Expert opinion Generally commissioned or specifically requested Based on literature and experience in the field Systematic reviews Can be done be anyone Avoid biases of experts; seeks out all data Economics papers – cost effectiveness studies Specifically relate to money

Systematic reviews “systematic” part is the science part – the search strategy and specific criteria are specified, so it could be replicated Work best (as we’ll see) with a specific question, the more specific the better A great idea if you have a pre-specified niche and you know what that is Downside: tedium. Make sure it’s an area you want to spend time with

Meta-analysis Mathematical technique for combining data from multiple studies Applied to systematic reviews if combining data is used; systematic reviews need have no numerical results, though

Economics papers Cost-effectiveness studies and their ilk Develop an economic model of a population with various outcomes and the costs of each of those outcomes Thought experiment: what would outcomes be if we did an intervention instead Often expressed as cost per life year saved, or cost per QALY Models only as good as primary data

General points on these designs Require little funding Great way to get published in an area as a junior person and obtain a reputation Great way to systematically read the literature, but there’s a lot of garbage; need to consider study quality Those expert review articles aren’t so bad after all!