Quality assessment of clinical practice guidelines on the treatment of hepatocellular carcinoma or metastatic liver cancer.

Yingqiang Wang,Haiqing Wang,Qianqian Luo,Shaolin Deng,Xianglian Li,Shiyou Wei,Youping Li,Christian Gluud

doi:10.1371/journal.pone.0103939

Abstract

ObjectivesTo assess the quality of the currently available clinical practice guidelines (CPGs) for hepatocellular carcinoma, and provide a reference for clinicians in selecting the best available clinical protocols.MethodsThe databases of PubMed, MEDLINE, Web of Science, Chinese Biomedical Literature database (CBM), China National Knowledge Infrastructure (CNKI), WanFang, and relevant CPGs websites were systematically searched through March 2014. CPGs quality was appraised using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument, and data analysis was performed using SPSS 13.0 software.ResultsA total of 20 evidence-based and 20 expert consensus-based guidelines were included. The mean percentage of the domain scores were: scope and purpose 83% (95% confidence interval (CI), 81% to 86%), clarity of presentation 79% (95% CI, 73% to 86%), stakeholder involvement 39% (95% CI, 30% to 49%), editorial independence 58% (95% CI, 52% to 64%), rigor of development 39% (95% CI, 31% to 46%), and applicability 16% (95% CI, 10% to 23%). Evidence-based guidelines were superior to those established by consensus for the domains of rigor of development (p<0.001), clarity of presentation (p = 0.01) and applicability (p = 0.021).ConclusionsThe overall methodological quality of CPGs for hepatocellular carcinoma and metastatic liver cancer is moderate, with poor applicability and potential conflict of interest issues. The evidence-based guidelines has become mainstream for high quality CPGs development; however, there is still need to further increase the transparency and quality of evidence rating, as well as the recommendation process, and to address potential conflict of interest.

Highlights

Hepatocellular carcinoma (HCC) is the seventh most common cancer worldwide [1], and the third most common cause of death from cancer with an overall mortality-to-incidence ratio of 0.93[2]
It is estimated that the number of disability-adjusted life years (DALYs) lost and medical costs due to HCC will gradually increase as the incidence of HCC rises in younger people
Guideline sources and search strategy The electronic databases of PubMed, MEDLINE, Web of Science, Chinese Biomedical Literature database (CBM), China National Knowledge Infrastructure (CNKI), and WanFang were systematically searched through March 2014

Summary

Introduction

Hepatocellular carcinoma (HCC) is the seventh most common cancer worldwide [1], and the third most common cause of death from cancer with an overall mortality-to-incidence ratio of 0.93[2]. Most of the burden is in developing countries, where almost 85% of cases occur [1,2]. The annual cost of HCC in the United States is $454.9 million, with an average cost per patient of $32,907. Healthcare costs and lost productivity account for 89.2% and 10.8% of the total, respectively [3]. A survey showed that the cost for patients with HCC is approximately 6 to 8 fold higher than for those without this cancer, with the mean per-patient-per-month (PPPM) cost of $7,863 for cases and $1,243 for controls [4]. It is estimated that the number of disability-adjusted life years (DALYs) lost and medical costs due to HCC will gradually increase as the incidence of HCC rises in younger people

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