Systematic reviews, comparative effectiveness reviews, and overviews of reviews: their strengths, limitations, and value for end-users

Article type
Authors
Hartling L1, Fernandes R2, Vandermeer B1, Thomson D1
1Pediatrics, University of Alberta, Edmonton, Alberta, Canada
2Departamento da Crianc¸a e da Fam´ılia, Hospital de Santa Maria, Lisboa, Portugal
Abstract
Background: Several methodologies have emerged within the arena of evidence synthesis, including systematic reviews (SRs), comparative effectiveness reviews (CERs), and overviews of reviews (overviews). A SR collates relevant evidence from individual studies using systematic methods to avoid bias. CERs use SR methodology and seek to describe the relative benefits (or harms) of a range of interventions compiling evidence from all relevant studies. Overviews compile information from multiple SRs relevant to a single health problem. Objectives: Our objective was to compare the methods of these different types of reviews, and discuss their advantages and disadvantages, using interventions for bronchiolitis as an example. Methods: We conducted two Cochrane SRs examining glucocorticoids and epinephrine (respectively) for bronchiolitis. We completed a CER and network analysis to simultaneously examine glucocorticoids and bronchodilators for bronchiolitis. We completed an overview of interventions for bronchiolitis, based on the currently available Cochrane SRs. Results: Each SR provided evidence for a single intervention through pair-wise, direct comparisons. Each review focused on a different intervention; therefore, end users must read each SR to inform decision-making. The overview synthesized data from 7 Cochrane SRs, each of which examined a different intervention. This allows the reader a quick overview of the available Cochrane evidence, but overviews are dependent on the methods and decisions employed at the SR level. The CER allowed us to examine the relative effectiveness of different treatments. Through a network analysis we were able to simultaneously compare multiple treatments by combining direct and indirect evidence. While potentially more expensive and time-consuming to produce, the CER provides a comprehensive synthesis of all available (or promising) interventions for a given condition. Conclusions: We will provide the results and conclusions from each of these syntheses and discuss their relative value and possible shortcomings for the end user.