Reporting and methods in systematic reviews of comparative accuracy

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1 Reporting and methods in systematic reviews of comparative accuracy Yemisi Takwoingi, Richard Riley and Jon Deeks Public Health, Epidemiology and Biostatistics

2 Which test is best?

3 Example

4 What is the evidence? Urea breath test 9 studies (565 patients) Rapid urease test 7 studies (432 patients) Histology 3 studies (337 patients) UBT, RUT, and histology separately metaanalyzed Test (studies) Sensitivity (95% CI) Specificity (95% CI) Histology (3) 93 (88, 97) 85 (73, 93) RUT (7) 79 (72, 84) 94 (90, 97) UBT (9) 77 (72, 82) 89 (85, 93)

5 Are comparative accuracy reviews fit-for-purpose?

6 Objectives To provide a descriptive survey of current practice To identify methodological shortcomings and highlight good practice

7

8 Data source Reviews identified in DARE from

9 Eligibility criteria Reviews identified in DARE from Included if published between 2007 and 2012, and: 1. Diagnostic accuracy of at least 2 tests assessed 2. Meta-analyses were performed

10 Methodological domains Study selection Study design Quality assessment Data synthesis

11

12 Test comparison designs Series of patients US CT Reference standard Compare test accuracy within patients

13 Test comparison designs Series of patients Series of patients US Randomize CT US CT Reference standard Reference standard Reference standard Compare test accuracy within patients Compare test accuracy between randomized groups Robust comparative studies

14

15 Test comparison designs Series of patients Series of patients Series of patients Series of patients US Randomize CT US CT US CT Reference standard Reference standard Reference standard Reference standard Reference standard Compare test accuracy within patients Compare test accuracy between randomized groups Compare test accuracy between studies Robust comparative studies Non-comparative studies

16

17 Methodological domains Study selection Study design Quality assessment Data synthesis

18

19 Availability of systematic reviews

20 General characteristics Characteristic Reviews % Type of comparison Direct Indirect Number of tests evaluated

21 General characteristics Clinical purpose of the tests Reviews % Diagnostic 86 Screening 6 Staging 5 Monitoring 2 Prognostic/prediction 1 Response to treatment 1

22 General characteristics Type of tests evaluated Reviews % Imaging 51 Laboratory 23 Clinical and physical examination 12 RDT or POCT 3 Self administered 2 Biopsy 1 Combinations of any of the above 9

23 General characteristics Clinical topic (according to ICD-10 Version: 2010) Reviews % Neoplasm 41 Circulatory system 16 Infectious and parasitic diseases 10 Digestive system 6 Musculoskeletal system and connective tissue 6 Injury, poisoning and certain other consequences of external causes Mental and behavioural disorders 4 Other ICD-10 codes 12 5

24 Methodological and reporting characteristics study selection Characteristic Reviews (%) Comparative studies identified 63 (58) Study selection flow diagram presented Flow diagram shows number of studies for each test 74 (69) 23 (31)

25 Methodological and reporting characteristics quality assessment Characteristic Reviews (%) Quality assessment performed 90 (83) Presented results per study Presented results across studies per test Presented per study and across studies per test 43 (48) 11 (12) 10 (11)

26 Methodological and reporting characteristics data synthesis Characteristic Reviews (%) Direct comparison done 33 (31) Meta-analytic strategy for test comparison Informal comparison Within meta-analysis Between meta-analyses Unclear Summary ROC plot None Separate SROC plot for each test Multiple tests presented on single SROC plot 47 (44) 32 (30) 19 (18) 10 (9) 40 (37) 38 (35) 30 (28)

27 Methodological and reporting characteristics data synthesis Characteristic Reviews (%) Direct comparison done 33 (31) Meta-analytic strategy for test comparison Informal comparison Within meta-analysis Between meta-analyses Unclear Summary ROC plot None Separate SROC plot for each test Multiple tests presented on single SROC plot 47 (44) 32 (30) 19 (18) 10 (9) 40 (37) 38 (35) 30 (28)

28 GOOD PRACTICE

29 Examples of good practice study selection Debrey et al 2008

30 Examples of good practice quality assessment Cooper et al 2011

31 Examples of good practice quality assessment (a) PET, 26 studies (b) MRI, 9 studies Cooper et al 2011

32 Examples of good practice quality assessment (a) PET, 26 studies (b) MRI, 9 studies * * Cooper et al 2011

33 Examples of good practice data synthesis Comparative accuracy of renal duplex sonographic parameters in the diagnosis of renal artery stenosis: paired and unpaired analysis Williams et al 2007

34 Summary and conclusions Suboptimal reporting of: Study design (comparative versus non-comparative) Methodological quality assessment Inappropriate meta-analytic strategy Need for better understanding of strategies and methods for comparing tests in a meta-analysis Specific guidance for reporting of systematic reviews of comparative accuracy is needed

35 Whatever your view... Apples and oranges Fruit salads tower of statistical power (Gelber RD, Goldhirsch A. Ann Oncol 1991) Thank you

36 References Takwoingi Y, Leeflang MM, Deeks JJ. Empirical evidence of the importance of comparative studies of diagnostic test accuracy. Ann Intern Med 2013;158: Macaskill P, Gatsonis C, Deeks JJ, Harbord RM, Takwoingi Y (2010). Chapter 10: Analysing and Presenting Results. In: Deeks JJ, Bossuyt PM, Gatsonis C (editors), Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version 1.0. The Cochrane Collaboration. Available from: srdta.cochrane.org/ Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339: b2535.

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