Systematic Reviews, Meta-Analyses, and Cost-Effective Analyses on Breast MRI Screening of High-Risk Women

Abstract

During the last decades, the rules of evidence-based medicine have increasingly influenced clinical practice and progressively expanded their role from therapy to diagnostics. Secondary studies, that are finalized to summarize the evidence available in the published literature on a given topic, acquired a prominent role in the decision to recommend in favor or against a medical technology. These studies favored the adoption of breast MRI for screening high-risk women by governmental bodies and guidelines. Thus, in this chapter we: (1) describe systematic reviews and meta-analyses (SRandMAs) in the context of contemporary medicine and the practice of healthcare systems; (2) provide a brief history of SRs; (3) present an overview of the methods of SRs and of MAs, including the differentiation between study-level, also called aggregate-data MAs, and individual-patient (or -participant) data MAs, summarizing their advantages and limitations; (4) present the results of SRandMAs performed on breast MRI for screening high-risk women, looking not only at reinforced knowledge about the capability of MRI but also at new knowledge acquired through meta-analytic methods that the original individual primary studies were not able to provide; and (5) examine the contributions of cost-effective analyses to this topic.