The Cochrane Collaboration’s Prioritization Approaches Lorne Becker: Co-Chair, Cochrane Collaboration Steering Group US Cochrane Center Conference on Priority Setting for Systematic Reviews July , 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 4

Cochrane Decision Making Primarily bottom up – Authors’ interests – Scope of editorial group (CRG) Minimally top down – Methods – Procedures – Updating 5

10 Cochrane Principles #2 - Building on the enthusiasm of individuals, - by involving and supporting people of different skills and backgrounds. 6

Opportunity Costs of Prioritization 7

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? 9

Who Are Our Stakeholders? 10

Who Are Our Stakeholders? 11

Who Are Our Stakeholders? 12

Who Are Our Stakeholders? 13

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 16

Diabetes Prevalence

Tuberculosis Prevalence

HIV Prevalence

Women Smokers

Location of Cochrane Review Groups 21

Cochrane Authors (2007) 22

Who Are Potential Readers? 23

One Click Free Access 24

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 6 Vote 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 criteria 1. Importance of the topic 2. Number of trials (0, 1, 2+) 3. Availability of experienced author team

Importance – Cochrane ID Group 1 – Strategic Importance Known interest from funders, policy makers or other key stakeholders 2 – Potentially Important WHO 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 32

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 33

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 34

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 36

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 37

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 group 38

Conclusion Prioritization is seen as desirable But there are potential questions & difficulties The Collaboration is proceeding deliberately And hoping to learn from our experiences 39