Systematic Review and Network Meta-Analysis in Health Technology Assessment
Nathorn Chaiyakunapruk PharmD, PhD*,**,***,****, Surasak Saokaew PharmD*,*****, Rosarin Sruamsiri BPharm, MBA*,******, Piyameth Dilokthornsakul PharmD*,*******
Affiliation : * Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand ** School of Population Health, Public Health Building, University of Queensland, Australia *** School of Pharmacy, Monash University Malaysia, Malaysia **** School of Pharmacy, University of Wisconsin, Madison, WI, USA ***** Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand ****** Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, MA, USA ******* Center for Pharmacoepidemiology and Pharmacoeconomic Research and Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, USA
Conducting systematic review and meta-analysis (SR/MA) is a standard process for establishing evidences for health technology assessment. Quality assessment of studies included in SR/MA and SR/MA studies should be considered. This article provides recommendations on tools used for assessing the quality of studies included in each SR/MA and the quality of SR/MA. For assessing the quality of randomized controlled trial, we recommend a tool called “Risk of Bias”, which focuses on random generation, allocation concealment, blinding and outcome reporting. For assessing the quality of observational study, the Newcastle Ottawa Scale (NOS) is recommended. The NOS consists of three different dimensions- selection, comparability, and outcomes or exposure. Another tool which is recommended is the Down and Black scale. It focuses on the quality of reporting, validity, bias and confounding, and power of study. For assessing the quality of SR/MA, we recommend to use a checklist developed by Klassen et al, covering well-defined question, inclusion criteria, comprehensiveness, quality of included studies, reproducibility, and external validity. This article also provides a fundamental of network meta- analysis that should be considered where no direct evidence exists or when there is a need to compare multiple interventions at the same time.
Keywords : Systematic review, Meta-analysis, Network meta-analysis, Quality assessment, Health technology assessment
