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Objectives: Large secondary databases, such as those containing insurance claims data, are increasingly being used to compare the effects and costs of treatments in routine clinical practice. Despite their appeal, however, caution must be exercised when using these data. In this study, we aimed to identify and assess the methodological quality of studies that used claims data to compare the effectiveness, costs, or cost-effectiveness of systemic therapies for breast cancer.Methods: We searched Embase, the Cochrane Library, Medline, Web of Science, and Google Scholar for English-language publications and assessed the methodological quality using the Good Research for Comparative Effectiveness principles. This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under number CRD42018103992.Results: We identified 1251 articles, of which 106 met the inclusion criteria. Most studies were conducted in the United States (74%) and Taiwan (9%) and were based on claims data sets (35%) or claims data linked to cancer registries (58%). Furthermore, most included large samples (mean 17 130 patients) and elderly patients, and they covered various outcomes (eg, survival, adverse events, resource use, and costs). Key methodological shortcomings were the lack of information on relevant confounders, the risk of immortal time bias, and the lack of information on the validity of outcomes. Only a few studies performed sensitivity analyses.Conclusions: Many comparative studies of cost, effectiveness, and cost-effectiveness have been published in recent decades based on claims data, and the number of publications has increased over time. Despite the availability of guidelines to improve quality, methodological issues persist and are often inappropriately addressed or reported. [ABSTRACT FROM AUTHOR]

Objective: To assess the effects of α‐blockers compared to standard therapy or placebo for ureteric stones of ≤10 mm confirmed by imaging in adult patients presenting with symptoms of ureteric stone disease. Patients and Methods: We performed a systematic search in multiple databases and grey literature with no restrictions on the language of publication or publication status, up until November 2017. We included randomised controlled trials evaluating ureteric stone passage in adult patients that compared α‐blockers with standard therapy or placebo. Two review authors were independently responsible for study selection, data extraction, and risk‐of‐bias assessment. We performed a meta‐analysis using a random‐effect model. The quality of evidence was assessed on outcome basis according to Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results: We included 67 studies, with 10 509 participants overall. Of these, 15 studies with 5 787 participants used a placebo. Stone clearance: treatment with an α‐blocker may result in a large increase in stone clearance (risk ratio [RR] 1.45, 95% confidence interval [CI] 1.36–1.55; low‐quality evidence), corresponding to 278 more (95% CI: 223–340 more) stone clearances per 1 000 participants. For major adverse events, treatment with an α‐blocker may have little effect (RR 1.25, 95% CI: 0.80–1.96; low‐quality evidence), which corresponds to five more (95% CI four fewer to 19 more) major adverse events per 1 000 participants. Patients treated with α‐blockers may also experience shorter stone expulsion times (mean difference [MD] −3.40 days, 95% CI: −4.17 to −2.63; low‐quality evidence), use less diclofenac (MD −82.41 mg, 95% CI: −122.51 to −42.31; low‐quality evidence) and likely require fewer hospitalisations (RR 0.51, 95% CI: 0.34–0.77; moderate‐quality evidence). Meanwhile, the need for surgical intervention appears similar (RR 0.74, 95% CI: 0.53–1.02; low‐quality evidence). Based on a pre‐defined subgroup analysis (test for subgroup difference, P = 0.002), there may be a different effect of α‐blockers based on stone size with RRs of 1.06 (95% CI: 0.98–1.15; P = 0.16; I² = 62%) for stones of ≤5 mm vs 1.45 (95% CI: 1.22–1.72; P < 0.0001; I² = 59%) for stones of >5 mm. We did not find evidence for possible subgroup effects based on stone location or α‐blocker type. Conclusions: In patients with ureteric stones, α‐blockers likely increase stone clearance but probably also slightly increase the risk of major adverse events. Subgroup analyses suggest that α‐blockers may be less effective in smaller (≤5 mm) than larger stones (>5 mm). [ABSTRACT FROM AUTHOR]

Introduction and objectives: Heart transplantation (HT) is the treatment for patients with end‐stage heart disease. Despite contradictory reports, survival seems to be worse when donor/recipient sex is mismatched. This systematic review and meta‐analysis aims to synthesize the evidence on the effect of donor/recipient sex mismatch after HT. Methods: We searched PubMed and EMBASE until November 2017. Comparative cohort and registry studies were included. Published articles were systematically selected and, when possible, pooled in a meta‐analysis. The primary endpoint was one‐year mortality. Results: After retrieving 556 articles, ten studies (76 175 patients) were included in the quantitative meta‐analysis. Significant differences were found in one‐year survival between sex‐matched and mismatched recipients (odds ratio (OR) 1.30, 95% confidence interval (CI) 1.25‐1.35, P <.001). In female recipients, we found that sex mismatch was not a risk factor for one‐year mortality (OR = 0.93, 95% CI = 0.85‐1.00, P =.06). However, in male recipients, we found that it was a risk factor for one‐year mortality (OR = 1.38, 95% CI = 1.31‐1.44, P <.001). Conclusions: Sex mismatch increases one‐year mortality after HT in male recipients. Its influence in long‐term survival should be further explored with high‐quality studies. [ABSTRACT FROM AUTHOR]