assesment of potential intervention

7/31/2019 Assesment of Potential Intervention

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Ridwan Amiruddin


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Assessing Evidence From Intervention StudiesAssesment evidence arising from individual studies

The evidence base for evaluating the option is often

weak Evaluating the quality of evidence originating from

research studies.


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Cecklist for Apprising randomized controlled trials

for use evidence

based health care Are the results of the trial valid

Did the trial addres a clearly focussed issue, in terms ofpopulation studied

Was the assigmnet of patents to treatment concealed Were the group similat antara the start of the trial

What were the results How large was the treatment effect How precise was the estimate of the treatment effect

How applicable were the research findings How wide were the confidence interval What were the excluison dan inclusion criteria Could the quality of service provided in the trial be

reproduced locally


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Checklist for appraising review articles for

use in evidence based health care

Are the results of the review valid? Did the review address a focused issue?

Did the authors look for the appropriate sort of papers?

Were the important, relevant studies included?

Did the review's authors do enough to assess the quality of the

included studies? If the results of the review have been combined, was it reasonable to do so?

What are the results? What is the overall result of the review?

How precise are the results?

Will the results help locally? Can the results be applied to the local population?

Were all important outcomes considered?

Are the benefits worth the harms and costs?


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Additional criteria for assessing a

meta-analysisWas the searching technique limited to an electronic

search of MEDLINE? (Undesirable)

Are the results of the trials all or mostly pointing in thesame direction? (Desirable)

Are the trials in the meta--analysis all small trials?(Very undesirl able)


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Proposed criteria for determining whether an

intervention should be included in a health policy Efficacy: Is the intervention known to work under optimal

conditions? Efectiveness: Is the intervention known to work under

normal conditions? Applicability: Is the intervention likely to be effective in the

target population for the proposed policy? Efficiency. Could the money be spent more productively on

other interventions? Feasibility: Can the intervention be implemented, given

the sociopolitical context? Potential "rage: Can the intervention reach the whole

target population?


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propose the following list for use in development of clinical

guidelines - meta-analyses involving analysis of individual data1. Supportive evidence from well-conducted RCTs that included 100 patients or

more, such as multicenter trial or meta-analysis with quality ratings

2. Supportive evidence from well-conducted RCTs or meta-analysis with quality ratings, with fewer than 100 patients

3. Supportive evidence from well-conducted cohort studies, suchas prospective or retrospective studies, or meta-analysisthereof

4. Supportive evidence from a well-conducted case-control study5. Supportive evidence from poorly controlled or uncontrolled

studies (e.g., significantly flawed RCTs, observational studieswith high potential for bias, or case series or reports)

6. Conflicting evidence with weight of evidence supporting therecommendation

7. Expert opinion.


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When should a new technology be adopted

1. Compelling: the new technology is equally or more effectiveand less costly than the current technology.

2. Strong: the new technology is more effective and costs lessthan $20,000/QALY gained, or the new technology is less

effective but saves more than $100,000/QALY lost through itsadoption.

3. Moderate: the new technology is more effective and costs$20,000 $100,000/QALY gained, or the new technology is lesseffective and saves $20,000-$100,000/QALY lost.

4. Weak: the new technology is more effective but costs morethan $ 100,000 /QALY gained, or the new technology is lesseffective and saves less than $20,000/QALY lost.

5. Compelling evidence for rejection: the new technology isless or equally effective, but is more costly than the technologycurrently in use.


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method for grading health care

recommendations1. How strong is the evidence? Evaluation is based on:

Quality of evidence (RCT vs observational studies)Presence or absence of important heterogeneity

2. How big an impact of treatment warrants its use?Evaluation is based on the threshold number needed totreat (TNNT), which is calculated from

1. Cost of treating the condition and the adverse effects of thetherapy

2. Values (economic burden) of the target outcomes andadverse events

3. How much does the treatment work? The decision isbased onRelationship of observed NNT to threshold TNNT

assesment of potential intervention

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