The Cochrane Collaboration’sPrioritization Approaches

Lorne Becker: Co-Chair, Cochrane Collaboration Steering Group

US Cochrane Center Conference on Priority Setting for Systematic ReviewsJuly 10 2008, Baltimore, USA

Outline of presentation

Dangers & difficulties in prioritization Cochrane approaches to prioritization

– Individual Cochrane “entities”– Organization-wide

Dangers and difficulties

• Is prioritization compatible with the Cochrane way of doing things?

• What are the opportunity costs?• Whose priorities would we follow?

How Cochrane Review Topics are Chosen

Curiosity driven Investigator-initiated Peer-reviewed

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Cochrane Decision Making

Primarily bottom up– Authors’ interests– Scope of editorial group (CRG)

Minimally top down– Methods– Procedures– Updating

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10 Cochrane Principles

#2 - Building on the enthusiasm of individuals,

- by involving and supporting people of different skills and backgrounds.

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Opportunity Costs of Prioritization

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Could Prioritization Help Focus Collaboration Efforts?

Prioritization helps decide what not to do Cochrane aim is to build a comprehensive

database of reviews– What to do first

Whose priorities should we use?

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Who Are Our Stakeholders?

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Who Are Our Stakeholders?

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Who Are Our Stakeholders?

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Who Are Our Stakeholders?

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Priority setting

Be sure not to miss important perspectives or stakeholders

How would these Cochrane reviews have been prioritized?

Routine perineal shaving on admission in labor

Episiotomy for vaginal birth

Countries With Cochrane Contributors

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Diabetes Prevalence

www.WorldMapper.org

Tuberculosis Prevalence

www.WorldMapper.org

HIV Prevalence

www.WorldMapper.org

Women Smokers

www.WorldMapper.org

Location of Cochrane Review Groups

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Cochrane Authors (2007)

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Who Are Potential Readers?

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One Click Free Access

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Cochrane Prioritization Processes

Until 2006 No central prioritization process Each of the 52 editorial groups responsible

for setting its own priorities Variety of approaches

Skin Group

21 titles proposed for development Resources allow only 6Vote by Skin Group Members vote to rank

titles in order of priority. – Authors– Editors– Peer reviewers– Consumers

Skin Group – results of prioritisation

Sentinel node biopsy followed by elective node dissection for early malignant melanoma.

Maintenance treatment for chronic plaque type psoriasis. Topical corticosteroids for atopic eczema. Interventions for erosive lichen planus. Interventions for mycosis fungoides. Concomitant hyperthermia and radiation for recurrent or

metastatic malignant melanoma.

Renal Group

Examination of Trial Register by staff Identification of important studies Group studies into broad topical areas Split each topic into several manageable

reviews. Post list of priority topics on web site

Infectious Diseases Group

Interplay of 3 criteria1. Importance of the topic2. Number of trials (0, 1, 2+)3. Availability of experienced author

team

Importance – Cochrane ID Group

1 – Strategic ImportanceKnown interest from funders, policy makers or other

key stakeholders

2 – Potentially ImportantWHO Millennium Development Goals

Health in Developing Countries

3 – Minimal relevance to MDGs

Health Promotion & Public Health Group

Taskforce of advisors from global health organizations

– Identified “policy-urgent topics”

Literature review for existing SRs– List of potential review topics to fill the gaps

Prioritization of the list by the Advisor taskforce Dissemination throughout the Collaboration to

relevant editorial groups– Formation of a Health Promotion & Public Health editorial group

J Epidemiol Community Health 2005;59:193–197

Steering Group Perspective

A key recommendation of the 2006 Steering Group review

Half day session at 2006 mid year meetings £100,000 to fund prioritization projects

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Cochrane Prioritization Projects

Top down vs. Bottom up– Call for proposals from Cochrane entities

Opportunity Costs– £100,000 from central Cochrane funds

Whose Priorities?– Up to applicant entities to decide

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Collaboration between a Cochrane Review Group and a Cochrane Field

Condition:– Hip fracture rehabilitation

Cochrane Entities:– Bone, Joint and Muscle Trauma Review Group– Health Care of Older People Field

Whose Priorities?– Members of the CRG and the Field

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A patient-professional partnership approach

Condition:- Incontinence

Cochrane Entities:– Cochrane Incontinence Review Group

Collaborators:– The James Lind Alliance– a UK-based patient support charity

Whose Priorities?– 30 patient and professional advocacy groups

Using practice guidelines to determine review priorities

Condition:– Eye and Vision Disorders

Cochrane Entities:– US Cochrane Centre– Eyes and Vision Review Group

Whose Priorities?– International clinical experts

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Prioritisation of Cochrane reviews for consumers and the public

Condition:– Any with a current Cochrane Review

Cochrane Entities:– Cochrane Consumer Network

Whose Priorities?– Consumers in low and middle income countries

Identify Reviews most in need of updating

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Reducing the know-do gap in low and middle income countries

Condition:– Relevant to most disadvantaged in LMICs

Cochrane Entities: Health Equity Field Health Promotion & Public Health Field Developing Countries Network EPOC Review Group

Whose Priorities?– Experts on health of the disadvantaged in LMICs

Similar methodology to HPPH group38

Conclusion

Prioritization is seen as desirable

But there are potential questions & difficulties

The Collaboration is proceeding deliberately

And hoping to learn from our experiences

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