Use this URL to cite or link to this record in EThOS: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.553861
Title: Systematic review based on individual patient data : a case study in surgery
Author: McCormack, Kirsty
Awarding Body: University of Aberdeen
Current Institution: University of Aberdeen
Date of Award: 2010
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Abstract:
IPD meta-analyses have putative benefits but require greater expertise, more time to complete, and are resource intensive. Aim: To determine whether the extra investment is justified by greater reliability, usefulness and health gain by means of a case study in surgery. Methods: A systematic review of published data for laparoscopic versus open repair of inguinal hernia was first conducted. The review was then augmented using, where possible, the results of IPD analyses. The approaches to meta-analysis were then compared in terms of the number of trials and number of participants included, differences in statistical significance and statistical precision, and differences in results that might result in different clinical decisions. Key reasons for any differences were identified. Finally, the impact of the added value of IPD on UK NHS health policy was described. Results: The systematic review of published data was difficult and exemplified the problems of using this approach. Through the formal structure of the EU Hernia Trialists Collaboration it was possible to collect IPD for 25 out of 41 trials and supplemented aggregate data for seven trials. Overall, the meta-analyses based on IPD resulted in more conservative treatment effects with narrower CIs and more precise estimates of effectiveness, and led to fundamentally different conclusions about the effects of laparoscopic surgery on persisting pain. Conclusions: The extra investment required for the collection and re-analysis of IPD enhanced the amount of data available, improved the quality of that data and resulted in estimates of effectiveness that were more precise and generalisable. The finding of less reported persisting pain following laparoscopic repair (although methods used to assess pain were unclear for the majority of trials raising questions about validity and freedom from bias), a key determinant of long-term quality of life, led to a change of UK NHS health policy.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.553861  DOI: Not available
Keywords: Surgery
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