Critical appraisal of nonrandomized studies—A review of recommended and commonly used tools

Rationale, aims, and objectives When randomized controlled trial data are limited or unavailable, or to supplement randomized controlled trial evidence, health technology assessment (HTA) agencies may rely on systematic reviews of nonrandomized studies (NRSs) for evidence of the effectiveness of hea...

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Veröffentlicht in:Journal of evaluation in clinical practice Jg. 25; H. 1; S. 44 - 52
Hauptverfasser: Quigley, Joan M., Thompson, Juliette C., Halfpenny, Nicholas J., Scott, David A.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Wiley Subscription Services, Inc 01.02.2019
Schlagworte:
Bias
Clinical trials
Content analysis
evaluation
Evaluation Studies as Topic
Evidence-based medicine
Evidence-Based Medicine - methods
health care
health economics
Humans
medical informatics
Non-Randomized Controlled Trials as Topic - methods
Non-Randomized Controlled Trials as Topic - standards
Observer Variation
Systematic review
systematic reviews
Systematic Reviews as Topic
Technology Assessment, Biomedical - methods
evaluation
medical informatics
systematic reviews
evidence-based medicine
health care
health economics
ISSN:1356-1294, 1365-2753, 1365-2753
Online-Zugang:Volltext
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Zusammenfassung:Rationale, aims, and objectives When randomized controlled trial data are limited or unavailable, or to supplement randomized controlled trial evidence, health technology assessment (HTA) agencies may rely on systematic reviews of nonrandomized studies (NRSs) for evidence of the effectiveness of health care interventions. NRS designs may introduce considerable bias into systematic reviews, and several methodologies by which to evaluate this risk of bias are available. This study aimed to identify tools commonly used to assess bias in NRS and determine those recommended by HTA bodies. Methods Appraisal tools used in NRS were identified through a targeted search of systematic reviews (January 2013‐March 2017; MEDLINE and EMBASE [OVID SP]). Recommendations for the critical appraisal of NRS by expert review groups and HTA bodies were reviewed. Results From the 686 studies included in the narrative synthesis, 48 critical appraisal tools were identified. Commonly used tools included the Newcastle‐Ottawa Scale, the methodological index for NRS, and bespoke appraisal tools. Neither the Cochrane Handbook nor the Centre for Reviews and Dissemination recommends a particular instrument for the assessment of risk of bias in NRS, although Cochrane has recently developed their own NRS critical appraisal tool. Among HTA bodies, only the Canadian Agency for Drugs and Technologies in Health recommends use of a specific critical appraisal tool—SIGN 50 (for cohort or case‐control studies). Several criteria including reporting, external validity, confounding, and power were examined. Conclusion There is no consensus between HTA groups on the preferred appraisal tool. Reviewers should select from a suite of tools on the basis of the design of studies included in their review.
Bibliographie:David A. Scott, Honorary Visiting Professor, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.
Present Address: Joan M. Quigley, Health Research Board, Grattan House, 67‐72 Lower Mount Street, Dublin 2, D02 H638, Republic of Ireland.
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ISSN:1356-1294
1365-2753
1365-2753
DOI:10.1111/jep.12889