Evidence-Based Medicine

Question 1

How much of Australian GDP is dedicated to healthcare related expenses?

Answer 1

10% of the Australian GDP

Question 2

What are some of the key challenges in healthcare?

Answer 2

1. Expense and affordability- Increasing ageing population and expensive technology
2. Goals
   
   • safety, quality and efficacy
   • patient-centred healthcare
   • value-based healthcare

Question 3

How is evidence collected and implemented in real time in healthcare?

Answer 3

Efficacy: Clinical trial -> Systematic review -> regulatory approval
Efficiency: Epidemiology, registries and systematic review -> Comparative effectiveness research –> Clinical guidelines -> Clinical practice
Cost-effectiveness: Cost and utility data –> Health technology assessment–> Health policy

Question 4

Allocative efficiency

Answer 4

• Efficient distribution of available resources

- Considers opportunity costs

Question 5

Technical efficency

Answer 5

• efficient management of one condition

- considers cost effectiveness

Question 6

Cost-benefit analysis vs cost-effectiveness analysis vs cost-utility analysis

Answer 6

Net costs vs net costs/net change in years of life vs net costs/net change in QALYs

Question 7

Value

Answer 7

Health outcomes that matter to patients/costs of delivering the outcomes

Question 8

Why are systematic reviews considered gold-standard and decrease the burden on the healthcare system?

Answer 8

1. Efficient way to access the body of research on a
   specific topic
   
   • Reduces time for searching for individual clinical
     trials
   • Critical appraisal of the method of clinical trials
   • Interpretations of results
   • Identify gaps in literature/research
2. Since the systematic review considers all clinical trials
   critically, it is a reliable basis for decision making
   
   • Healthcare
   • Policy
   • Future research

Question 9

Types of systematic review

Answer 9

1. Intervention
2. Diagnostic test accuracy (DTA)
3. Prognostic
4. Methodological
5. Qualitative

Question 10

What are the steps involved in a systematic review?

Answer 10

1. Define the question/objective clearly [Use PICOT]
2. Plan eligibility criteria
3. Plan method
4. Publish protocol
5. Search for studies
6. Apply eligibility criteria
7. Collect data
8. Assess studies for risk of bias (ROB)
9. Analyse and present results
10. Interpret results and draw conclusions
11. Improve and update review

Question 11

Risk of Bias

Answer 11

Selection 
Performance
Detection
Attrition 
Reporting

Sexy Pooja Demolished Andy Ruthlessly

Question 12

What are the predefined eligibility criteria?

Answer 12

• Study design
• Description of population
• Description of intervention and comparator