The Cochrane Library: a resource for Europe's...

The Cochrane Library:a resource for Europe's citizens?

Nick RoyleCEO

The Cochrane Collaboration™

SANCO NCA 5th July 2005, ©The Cochrane Collaboration

2

Goal:

� Providing reviews of clearly formulated questions about specific health care interventions

� Using systematic and explicit methods to identify, select, and critically appraise relevant research

� Collecting and analysing data from the studies that are included in the review

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Reviews used by:

� Physicians, consultants, medical staff� Health care service providers� Policy makers� Members of the public

“reliable source that summarises the best evidence on the effects of a particular healthcare intervention at a particular point in time”

Jadad AR, Cook DJ, Jones A, Klassen TP, Tugwell P, Moher M, Moher D. Methodology and reports of systematic reviews and meta-analyses: a comparison of Cochrane reviews with articles published in paper-based journals. JAMA 1998;280:278-280

Odds Ratio (Log Scale)

0.5 1.0 2.0

Favours Treatment Favours Control

P<.01

P<.001

P<.00001

Thrombolytic Therapy

Patients

12

65

149

3161,793

2,5442,6513,3113,9295,452

5,767

6,1256,3466,571

21,05922,05147,18547,53148,154

CumulativeRCTs

1

2

3

47

1011151722

23

2730334354656770

Year

1960

1965

1970

1980

1985

1990

30 years

70 trials

48,154 people

Lives wasted ?

€ wasted?

Antman et. al., JAMA 1992

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Cochrane – international

� 12,000 contributors� From more than 90 nations� Over 1,000 individuals from developing countries. � 51 Collaborative Review Groups (CRGs)� 9 Fields� 10 Methods Groups� Consumer Network� 12 regional Cochrane Centres and their branches

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Cochrane - European

� Europe 63

� Asia and Pacific 14

� Sub-Saharan Africa 1

� South America 1

� North/Central America 21 (incl. satellites)

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Funding model

� Policy – no commercial sponsorship

� Annual expenditure €14.46 million

� Mostly government funding (80%)

� Pays for facilitation service

� Most systematic reviews unfunded

� If funded – annual cost €119.022 million

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The Cochrane Database of Systematic Reviews

0

500

1000

1500

2000

2500

3000

3500

4000

4500

500019

95/1

1996

/1

1996

/3

1997

/2

1997

/4

1998

/2

1998

/4

1999

/2

1999

/4

2000

/2

2000

/4

2001

/2

2001

/4

2002

/2

2002

/4

2003

/2

2003

/4

2004

/2

2004

/4

2005

/2

Issue of CDSR

New Protocols

Existing ProtocolsUpdated Reviews

New ReviewsExisting Reviews

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Full-text: most accessed SRs

� Interventions for preventing falls in elderly people 520 May 05

� Glucosamine therapy for treating osteoarthritis 362

� Acupuncture for low-back pain 311

� St John's Wort for depression 249

� Interventions for preventing obesity in children 235

� Cognitive behaviour therapy for schizophrenia 225

� Support surfaces for pressure ulcer prevention 201

� Continuous support for women during childbirth 196

� Action plans for chronic obstructive pulmonary disease 186

� Cranberries for preventing urinary tract infections 185

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Abstracts: most accessed SRs

� Exercise for intermittent claudication 1100 hits Jun 05

� Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride 1070

� Glucosamine therapy for treating osteoarthritis 950

� Castor oil, bath and/or enema for cervical priming and inductionof labour 770

� Surgery for nonarteritic anterior ischemic optic neuropathy 760

� Mannitol for acute traumatic brain injury 750

� St John's Wort for depression 750

� Vitamin C for preventing and treating the common cold 730

� Massage for low-back pain 720

� Sexual intercourse for cervical ripening and induction of labour 710

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Cochrane Library databases

� Cochrane Database of Systematic Reviews (CDSR) – now ISI listed, impact factor soon� 2435 Systematic Reviews, 1606 protocols

� Cochrane Central Register of Controlled Trials (CENTRAL), principally reports of randomised controlled trials (some others), the source data for Cochrane Systematic Reviews� 454,449 records

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CLIB databases (2)

� Database of Abstracts of Reviews of Effects (DARE), records of structured abstracts of quality-assured non-Cochrane systematic reviews published in the scientific literature� 5340 records

� Health Technology Assessment database (HTA), records of international information on healthcare technology assessments� 4620 records

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CLIB databases (3)

� NHS Economic Evaluation Database (NHS EED), structured abstracts of articles describing economic evaluations of health care interventions from around the world� 15,884 records

� Cochrane Database of Methodology Reviews (CDMR), full-text systematic reviews of methodological studies� 20 records

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CLIB databases (4)

� Cochrane Methodology Register (CMR), a bibliography of publications that report on methods used in the conduct of controlled trials.� 7059 records

� Future additions?� GIN guidelines register?� EBM Logbook?

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Uptake of Cochrane Reviews

� Clinical Guidelines� Best Practice Information Sheets, Australia� EBM Guidelines, Finland� National Co-ordinating Centre for Health Technology Assessment,

England� National Institute of Clinical Excellence, England� New Zealand Guidelines Group (NZGG)� Nursing Best Practice Guidelines, Canada� SBU Reports, Sweden� Scottish Intercollegiate Guidelines Network (SIGN, Scotland)� Therapeutics Initiative, Canada

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Uptake of Cochrane Reviews (2)

� Electronic Databases� Clinical Information Service, Australia

� La Cochrane Library Plus, Spain� National electronic Library for Health, England

� Northern Ontario Virtual Library, Canada

� Treatobacco.net, EU/WHO� UpToDate, USA

� Videns-og Forskningscenter for Alternativ Behandling (ViFAB), Denmark

� The WHO Reproductive Health Library, WHO

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Uptake of Cochrane Reviews (3)

� Indexes� Enhanced Reference List of Neurological Reviews,

Italy� Evidence from Systematic Reviews of Research

Relevant to Implementing the 'Wider Public Health' Agenda, England

� Policy Liaison Project web site, Australia� PubMed, USA

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Uptake of Cochrane Reviews (4)

� Journals (regular Cochrane publication)� American Family Physician, USA� Australian Dental Journal, Australia� Evidence-Based Medicine, England� Huisarts en Wetenschap, Holland� The Journal of the Philippine Dermatological Society,

Phillipines� Läkartidningen, Sweden� New Zealand Family Physician� Paediatrics and Child Health, Canada� Spine, USA� Ugeskrift for Læger, Denmark

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Uptake of Cochrane Reviews (5)

� Summaries and news bulletins� The Arthritis Society/La Société d’arthrite, Canada� Effective Health Care, England� Evidence Notes, Scotland� Global Health Council, USA� Health Evidence Bulletins, Wales� HTA Newsletter, Austria� Impakti, Finland� Informed Health Online, Australia� MDLinx, USA� New Zealand Evidence-based Healthcare Bulletin� Revisoni Scelte dal Database Cochrane, Italy� RyggInfo (BackInfo), Norway

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WHO Ministerial Summit:

Called on Governments to:

‘Promote access to reliable, relevant, and up-to-date evidence on the effects of interventions, based on systematic reviews of the totality of available research findings’

Mexico City, Nov 2004, ratified by WHO Assembly May 2005

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Access for Europe’s citizens

� Current national subscriptions (EU/EEA):� Denmark� England� Finland� Island of Ireland� Norway� Scotland� Spain (Spanish version) � Sweden� Wales

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Why?

� Equity

� Competition

� Informed practitioners – and consumers

� Quality – ‘CLIB is the Jewel in the crown’

� Improved healthcare

� Lowest cost treatment - do it right first time

� EU ‘value added’

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Thanks!

Nick Roylenroyle@cochrane.orgwww.cochrane.org

This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.