Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-16T00:55:57.821Z Has data issue: false hasContentIssue false
  • English
  • Français

Using Research Synthesis in Medical Technology Assessment

Published online by Cambridge University Press:  10 March 2009

Paul M. Wortman  and
William H. Yeaton
Paul M. Wortman
Affiliation:
University of Michigan
William H. Yeaton
Affiliation:
University of Michigan
Get access Rights & Permissions [Opens in a new window]

Abstract

This article describes the use of research synthesis procedures (e.g., meta-analysis) in evaluating medical technologies. The synthesis process involves retrieval, extraction, and analysis of pertinent information from a set of research studies. There are several advantages of research synthesis: determining overall effectiveness, explaining seemingly contradictory findings, providing a standard measure of effect, and increasing statistical power. In addition, such syntheses provide timely results that can assist various policy decisions such as initiating clinical trials at NIH, reimbursement at HCFA, and answering NIH consensus conference questions. The authors' synthesis of the research literature on coronary artery bypass graft surgery (CABGS) illustrates how this method can address the various elements of a technology assessment such as safety, efficacy, and cost-effectiveness. The paper concludes by noting how research synthesis can be particularly advantageous in assessing technologies that are rapidly evolving (e.g., lytic agents for acute myocardial infarction).

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 3 , Issue 4 , October 1987 , pp. 509 - 522
Copyright
Copyright © Cambridge University Press 1987

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Baum, M. L., Anish, D. S., Chalmers, T. C., Sacks, H. S., Smith, H. Jr, & Fagerstrom, R. M.A survey of clinical trials of antibiotic prophylaxis in colon surgery: Evidence against further use of no-treatment controls. New England Journal of Medicine, 1981, 305, 795–799.CrossRefGoogle ScholarPubMed
2.Chalmers, T. C., Block, J. B., & Lee, S.Controlled studies in clinical cancer research. New England Journal of Medicine, 1972, 287, 75–78.Google Scholar
3.Cohen, J.Statistical power analysis for the behavioral sciences (Revised Edition). New York: Academic Press, 1977.Google Scholar
4.Cook, T. D., & Campbell, D. T.Quasi-experimentation. New York: Houghton Mifflin, 1979.Google Scholar
5.Dersimonian, R., Charette, J., McPeek, B., & Mosteller, F.Reporting on methods in clinical trials. New England Journal of Medicine, 1982, 306, 1332–1337.Google Scholar
6.Eysenck, H. J.An exercise in mega-silliness. American Psychologist, 1978, 33, 517.CrossRefGoogle Scholar
7.Fineberg, H. V. Gastric freezing—A study of diffusion of a medical innovation. Medical Technology and the Health Care System, Appendix D. Washington, D.C.: National Academy of Sciences, 1979.Google Scholar
8.Fleiss, J. L.Statistical methods for rates and proportions (2nd edition). New York: John Wiley & Sons, 1981.Google Scholar
9.Freiman, J. A., Chalmers, T. C., Smith, H. Jr, & Kuebler, R. R.The importance of beta, the Type II error and sample size in the design and interpretation of the randomized control trial. New England Journal of Medicine, 1978, 299, 690–694.Google Scholar
10.Gilbert, J. P., McPeek, B., & Mosteller, F. Progress in surgery and anesthesia: Benefits and risks of innovative therapy. In Bunker, J. P., Barnes, B. A., & Mosteller, F. (eds.), Costs, risks, and benefits of surgery. New York: Oxford University Press, 1977.Google Scholar
11.Glass, G. V.Primary, secondary, and meta-analysis of research. Education Researcher, 1976, 5, 3–8.Google Scholar
12.Glass, G. V. Integrating findings: The meta-analysis of research. In Shulman, L. S. (ed.), Review of research in education, Vol. 5. Itasca, IL: Peacock, 1977.Google Scholar
13.Glass, G. V., McGaw, B., & Smith, M. L.Meta-analysis in social research. Beverly Hills, CA: Sage, 1981.Google Scholar
14.Gore, S. M., Jones, I. G., & Rytter, E. C.Misuse of statistical methods: Critical assessment of articles in BMJ from January to March 1976. British Medical Journal, 1977, 1, 85–87.Google Scholar
15.Grac., N. D., Muench, H., & Chalmers, T. C.The present status of shunts for portal hypertension in cirrhosis. Gastroenterology, 1966, 50, 684–691.CrossRefGoogle Scholar
16.Hedges, L. V.Advances in statistical methods for meta-analysis. New Directions for Program Evaluation, 1984, 24, 25–42.Google Scholar
17.Hunter, J. E., Schmidt, F. L., & Jackson, G. B.Meta-analysis: Cumulating research findings across studies. Beverly Hills, CA: Sage, 1982.Google Scholar
18.Institute of Medicine. A consortium for assessing medical technology. Washington, D.C.: National Academy Press, 1983.Google Scholar
19.Jacoby, I.The consensus development program of the National Institutes of Health: Current practices and historical perspectives. International Journal of Technology Assessment in Health Care, 1985, 1, 420–432.Google Scholar
20.Landman, J. J., & Dawes, R. M.Psychotherapy outcome: Smith and Glass' conclusions stand up under scrutiny. American Psychology, 1982, 37, 504–516.Google Scholar
21.Liss, S., & Wortman, P. M.Assessing the effectiveness of home blood glucose monitoring (Technical report). Ann Arbor, MI: University of Michigan, 1984.Google Scholar
22.Louis, T. A., Fineberg, H. V., & Mosteller, F.Findings for public health from meta-analyses. Annual Review of Public Health, 1985, 6, 1–20.CrossRefGoogle ScholarPubMed
23.Mansfield, R. S., & Busse, T. V.Meta-analysis of research: A rejoinder to Glass. Education Researcher, 1972, 6, 3.Google Scholar
24.Mantel, N., & Haenszel, W.Statistical aspects of the analyses of data from retrospective studies of disease. Journal of the National Cancer Institute, 1959, 22, 719–748.Google Scholar
25.McPeek, B., Gilbert, J. P., & Mosteller, F. The end result: Quality of life. In Bunker, J. P., Barnes, B. A., & Mosteller, F. (eds.), Costs, risks, and benefits of surgery. New York: Oxford University Press, 1977.Google Scholar
26.Moore, T. J.Is surgery a necessary fact of life? Detroit Free Press, 09 21, 1986, 13A.Google Scholar
27.Office of Technology Assessment. Development of medical technology: Opportunities for assessment. Washington, DC: U.S. Government Printing Office, 1976.Google Scholar
28.Office of Technology Assessment. Strategies for medical technology assessment. Washington, DC: U.S. Government Printing Office, 1982.Google Scholar
29.Orwin, R. G.A fail-safe N for effect size in meta-analysis. Journal of Educational Statistics, 1983, 8, 157–159.Google Scholar
30.Pillemer, D. B., & Light, R. J.Synthesizing outcomes: How to use research evidence from many studies. Harvard Educational Review, 1980, 50, 176–195.CrossRefGoogle Scholar
31.Posavac, E. J.Evaluations of patient education programs: A meta-analysis. Evaluation and the Health Professions, 1980, 3, 47–62.Google Scholar
32.Rosenthal, R.Combining results of independent studies. Psychological Bulletin, 1978, 85, 185–193.Google Scholar
33.Rosenthal, R.Meta-analytic procedures for social research. Beverly Hills, CA: Sage, 1984.Google Scholar
34.Sacks, H. S., Berrier, J., Reitman, D., Ancona-Berk, V. A., & Chalmers, T. C.Meta-analyses of randomized controlled trails. New England Journal of Medicine, 1987, 316, 450–455.Google Scholar
35.Sacks, H., Chalmers, T. C., & Smith, H.Randomized versus historical controls for clinical trials. American Journal of Medicine, 1982, 72, 233–240.CrossRefGoogle ScholarPubMed
36.Smith, M. L., & Glass, G. V.Meta-analysis of psychotherapy outcome studies. American Psychologist, 1977, 32, 752–756.Google Scholar
37.Wagner, J. L. Toward a research agenda on medical technology. In Medical Technology, Washington, DC: U.S. Government Printing Office (PHS—79 3254), 1979.Google Scholar
38.Weinstein, M. C., & Stason, W. B.Cost-effectiveness of coronary artery bypass surgery. Circulation, 1982, 66–111, 56–66.Google Scholar
39.Wortman, P. M. Randomized clinical trials. In Wortman, P. M. (ed.), Methods for evaluating health services. Beverly Hills, CA: Sage, 1981.Google Scholar
40.Wortman, P. M.Evaluation research: A methodological perspective. Annual Review of Psychology, 1983, 34, 223–260.CrossRefGoogle Scholar
41.Wortman, P. M., & Yeaton, W. H. Synthesis of results in controlled trials of coronary artery bypass graft surgery. In Light, R. J. (ed.), Evaluation studies review annual, vol. 8. Beverly Hills, CA: Sage, 1983.Google Scholar
42.Wortman, P. M., & Yeaton, W. H.Cumulating quality of life results in controlled trials of coronary artery bypass graft surgery. Controlled Clinical Trials, 1985, 6, 289–305.CrossRefGoogle ScholarPubMed
43.Yeaton, W. H., & Sechrest, L. Estimating effect size. In Wortman, P. M. (ed.), Methods for evaluating health services. Beverly Hills, CA: Sage, 1981.Google Scholar
44.Yeaton, W. H., & Wortman, P. M.Evaluation issues in medical research synthesis. New Directions for Program Evaluation, 1984, 24, 43–56.CrossRefGoogle Scholar
45.Yeaton, W. H., & Wortman, P. M.Medical technology assessment: The evaluation of coronary artery bypass surgery using data synthesis techniques. International Journal of Technology Assessment in Health Care, 1985, 1, 125–146.Google Scholar
46.Yeaton, W. H., Wortman, P. M., & Langberg, N.Differential attrition: Estimating the effect of crossovers on the evaluation of a medical technology. Evaluation Review, 1983, 7, 831–840.CrossRefGoogle Scholar
47.Yusuf, S., Collins, R., Peto, R., Furberg, C., Stampfer, M. J., Goldhaber, S. Z., & Hennekens, C. H.Intravenous and intracoronary fibrinolytic therapy in acute myocardial infarction: Overview of results on mortality, reinfarction, and side effects from 33 randomized controlled trials. European Heart Journal, 1985, 6, 556–585.CrossRefGoogle ScholarPubMed
48.Yusuf, S., Peto, R., Lewis, J. A., & Sleight, P.Beta-blockade during and after myocardial infarction. Progress in Cardiovascular Disease, 1985, 27, 335–371.CrossRefGoogle ScholarPubMed