Transferability and applicability

To consider how transferable the results are from systematic reviews, three questions need to be addressed:16

• What are the beneficial and harmful effects of the intervention?

• Are there variations in the relative treatment effect?

• How does the treatment effect vary with baseline risk level?

Applicability addresses whether a particular treatment that showed an overall benefit in a study or systematic review can be expected to convey the same benefit to an individual patient.16 Two questions to consider when addressing how applicable the results are to individual patients are:16

• What are the predicted absolute risk reductions for individual patients?

• Do the expected benefits outweigh the harms?

When this framework was applied to systematic reviews of ondansetron for the prevention and/or treatment of PONV,17 the transferability issues were well described. However, the applicability questions were poorly addressed. None of the systematic reviews reported patient preferences associated with risk-benefit ratio because there was a lack of data in the primary randomised controlled trials included in the systematic reviews.17 More effort is required in reporting the results of meta-analysis in a way that will help anaesthetists apply the results to their daily practice. If applicability issues are addressed, we believe that this will greatly help anaesthetists to individualise treatment.

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