Table 5Strengths and Limitations of Systematic Reviews and Meta-Analyses using AMSTAR

StrengthsLimitations
Health Technology Assessment
Thurgar,2 2016, UK
Appraisal of the systematic review included in the health technology assessment:
  • The objective was clearly stated.
  • The inclusion criteria were stated.
  • The exclusion criteria were stated
  • Multiple databases (Medline, Embase, and Cochrane databases, Web of Science and NHS Economic evaluation databases) were searched from inception (or January 2000 for Web of science) to September 2014. Also, trial registries and reference lists of retrieved articles were searched.
  • Study selection was described
  • Flow chart of study selection was provided
  • List of included studies was provided
  • List of excluded studies was provided
  • Article selection was done in duplicate
  • Data extraction was done in duplicate
  • Quality assessment was done in duplicate. Quality was assessed according to the recommendations of the Centre for Reviews and Dissemination and the Cochrane Handbook of Systematic reviews of Interventions and study quality was recorded using the Cochrane risk of bias tool. No study was judged to have an overall low risk of bias, with the largest number of studies having overall unclear risk of bias mainly due to limited reporting in the publications.
  • Characteristics of the studies were provided
  • Meta-analysis and mixed treatment comparison analysis were conducted
  • Low number of studies included in each meta-analysis precluded the assessment of publication bias
  • The authors mentioned that there were no conflicts of interest
  • There appear to be no major limitations
Systematic Review
Bertolotti,12 2017, France
  • The objective was clearly stated.
  • The inclusion criteria were stated.
  • The exclusion criteria were stated
  • Twelve databases were searched from inception to October 2016, but the databases searched were not specified. Reference lists of reviews were also searched.
  • Study selection was described
  • Flow chart of study selection was provided
  • List of included studies was provided
  • Article selection was done independently by two reviewers
  • Data extraction was done independently by two reviewers
  • Quality assessment was done independently by two reviewers using the Cochrane risk of bias tool. Also the quality of evidence was graded using the GRADE approach when there were ≥ 2 RCTs. Majority (all but one RCT) of the studies were considered to have high risk of bias
  • Characteristics of the studies were provided but details were lacking
  • Meta-analysis was conducted
  • The authors mentioned that there were no conflicts of interest
  • List of excluded studies was not provided
  • Unclear if publication bias was explored. However considering the few included studies, investigation of publication bias using Funnel plots would not be feasible
Grillo-Ardila,5 2014, Cochrane Collaboration
  • The objective was clearly stated.
  • The inclusion criteria were stated.
  • The exclusion criteria were stated
  • Multiple databases were searched until April 2014 (Medline [from 1946], Embase [from 1947], LILACS [from 1982], Cochrane Sexually Transmitted Infections Group Specialized Register, Cochrane Central register of Controlled Trials [from 1991]. In addition trial registries, relevant websites and reference list of relevant publications were searched
  • Study selection was described
  • Flow chart of study selection was provided
  • List of included studies was provided
  • List of excluded studies was provided
  • Article selection was done independently by three reviewers
  • Data extraction was done independently by three reviewers
  • Quality assessment was done independently by three reviewers using the Cochrane risk of bias tool. Also the quality of evidence was graded using the GRADE approach. No study was judged to have an overall low risk of bias, with most studies having overall unclear risk of bias or high risk of bias.
  • Characteristics of the individual studies were provided.
  • Meta-analyses were conducted
  • Publication bias was intended to be explored using Funnel plot and other tests but as there were fewer than 10 studies for each outcome, exploration of publication bias was not feasible
  • The authors mentioned that there were no conflicts of interest
  • There appears to be no major limitations
Werner,13 2017, Germany
  • The objective was clearly stated.
  • The inclusion criteria were stated.
  • The exclusion criteria were stated
  • Multiple databases from inception of database until March 2016 (Medline, Embase) and Cochrane Central register of Controlled Trials were searched.
  • Study selection was described
  • Flow chart of study selection was provided
  • List of included studies was provided
  • List of excluded studies was provided
  • Article selection was done independently by two reviewers
  • Data extraction was done independently by two reviewers
  • Quality assessment was done using the Cochrane risk of bias tool. Also the quality of evidence was graded using the GRADE approach. Majority of the studies had overall unclear risk of bias or high risk of bias.
  • Characteristics of the individual studies were provided.
  • Meta-analyses were conducted
  • Conflicts of interest were reported; the authors had industry association and the study was funded by a research grant from industry
  • Unclear if publication bias was explored. However considering the few included studies, investigation of publication bias using Funnel plots would not be feasible

From: Imiquimod for the Treatment of Genital Warts: A Review of Clinical Effectiveness and Cost-Effectiveness

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Imiquimod for the Treatment of Genital Warts: A Review of Clinical Effectiveness and Cost-Effectiveness [Internet].
Banerjee S, Kaunelis D.
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