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Summarizing evidence for policy: some limitations of rapid and systematic reviews

Date and Location

Session: 

P3.017

Date

Sunday 22 September 2013 - 10:30 - 12:00

Location

Presenting author and contact person

Presenting author

Hela Makni

Contact person

Hela Makni
Abstract text
Background: The increasing demand for evidence-informed policymaking may translate into pressures on scientific advisory bodies to produce rigorous and timely assessments. Several constraints may force health agencies to opt for rapid reviews, the quality of which depends on previous evaluations and the applicability of results to the local context. Objectives: To share some observations on the conformity of systematic reviews and health technology assessment (HTA) or evidence-based (EB) reports to standard quality guidelines and on the pros and cons of rapid reviews to inform policy decisions. Methods: The observations derive from a rapid review of reviews on cystic fibrosis (CF) newborn screening (NBS), diagnosis and treatment. This review included a formal systematic review on the impact of CF NBS, for which the methods applied in systematic reviews, HTA or EB reports published between 1995 - 09/2011 were critically analyzed. Feedback on the quality of this assessment was obtained through formal peer review, a deliberative forum and a web-based consultation process. Results: Five reports on the impact of CF NBS were identified. Their methodological quality was acceptable but not optimal. Considerable heterogeneity was noted between reports with respect to data selection, description and appraisal. Authors’ conclusions were less concordant for clinical outcomes for which evidence was less conclusive. Their scope sometimes went beyond the quality of the reviewed evidence and was predominantly based on the benefits of NBS. Conclusions: A thorough review of reviews was less time-consuming than a systematic review but did not prove sufficient to derive final conclusions on CF NBS benefits at the population level or to gauge the balance between the benefits and risks in the local context. The focus of reviews on the benefits of CF NBS to the detriment of other aspects, including test performance, limited the scope of evidence readily available to support decision-making.
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