Dr Huseyin Naci COW 3.01

This course is compulsory on the Executive MSc in Health Economics, Outcomes and Management in Cardiovascular Sciences. This course is not available as an outside option.

Systematic review and meta-analysis methods are increasingly used to evaluate the relative benefits and harms of healthcare interventions. A broad range of decision making bodies across the health care sector (including health technology assessment bodies, drug and medical device licensing agencies, biopharmaceutical industry, and hospitals) need experts equipped with the methods of reviewing and synthesizing the existing body of evidence.

This course will be focused on the principles of reviewing and synthesizing the existing body of literature. The course will first provide the rationale for adopting a systematic approach for evidence review and synthesis. It will then equip students with the methods to undertake risk of bias assessments of individual randomized controlled trials and also collections of randomized controlled trials. In addition to providing an overview of methods for quantitatively synthesizing multiple randomized controlled trials in meta-analysis, the course will present the opportunities and challenges of using evidence for decision-making in health care.

Learning outcomes:

• Describe the rationale for adopting a systematic approach to literature review
• Define the principal threats to validity both in individual randomized controlled trials and collections of randomized controlled trials
• Critically evaluate the internal validity of randomized controlled trials
• Assess heterogeneity in a collection of randomized controlled trials
• Critically appraise a systematic review and meta-analysis evaluating a health care intervention in a group setting
• Describe the opportunities and challenges of using systematic review and meta-analysis findings for decision making

This course will be delivered through a combination of lectures and seminars totalling a minimum 22 hours. As well as access to lectures, students will also work in small groups to complete weekly self-directed learning activities and meet with seminar leads for feedback on their progress. Computer workshops will be held to introduce students to systematic review and meta analysis software.

• Course convener will provide written feedback on project outlines

Cochrane Handbook for Systematic Reviews of Inter ventions (version 5.1.0, updated March 2011).

Institute of Medicine. Finding what works in health care: standards for systematic reviews. 23 March 2011.

Sutton AJ et al. Methods for Meta-analysis in Medical Research. Wiley, Chichester, UK, 2000.

Cook DJ. Systematic reviews: synthesis of best evidence for clinical decisions. Annals of internal medicine 1997;126(5):376–80.

Jansen JP et al. Is network meta-analysis as valid as standard pair wise meta- analysis? It all depends on the distribution of effect modifiers. BMC medicine 2013;11(1):159.

Jansen JP et al. Interpreting indirect treatment comparisons and network meta- analysis for health-care decision making: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 1. Value Health 2011;14(4):417–28.

Essay (80%, 3000 words) and continuous assessment (20%).

Students will work in small groups to design a systematic review and meta analysis protocol. The assignment will then be written up and submitted individually. The word count is 3000 words (80% of the final mark).

Students will also undertake continuous assessment during the course in the form of quizzes (20% of the final mark)