Pro: Meta-analysis: the case for

Abstract

With ever-accumulating medical evidence for treatment benefits and harms, it is vital that clinicians are able to access and use up-to-date, best evidence in specific clinical scenarios involving individual patients - the primary goal of evidence-based medicine. In this article, we propose that meta-analysis, when properly conducted and reported in the context of a rigorous systematic review, is an indispensable tool for synthesis and interpretation of clinical evidence for the purpose of informing clinical decision-making by clinicians, patients and health care policy makers. Meta-analysis provides many benefits, including enhanced precision and statistical power, greater transparency, identification of bias, exploration of heterogeneity of effects, enhanced generalizability, efficient integration of clinical knowledge, identification of evidence gaps, better informed future trial design and avoidance of unnecessary research duplication and potential patient harm. The overall standard, clinical value and reach of meta-analysis has been further enhanced by the development of standards for registration, conduct and reporting, as well as advanced meta-analytic techniques, such as network meta-analysis. Of course, meta-analysis can at times be limited by poor quality studies, trial heterogeneity, publication bias and non-rigorous review and analysis, although through appraisal these issues are often able to be identified and explored, such that valuable clinical information can still be obtained. Consequently, meta-analysis is now the most highly cited form of research and is considered by many leading organizations to represent the highest level of clinical evidence. However, to maximize their considerable value, it is essential that all clinicians have the skills to critically appraise, carefully interpret and judiciously apply meta-analyses in their practice.