Original Research

Journal of General Internal Medicine

, Volume 27, Issue 1, pp 83-93

Open Access This content is freely available online to anyone, anywhere at any time.

Chapter 11: Challenges in and Principles for Conducting Systematic Reviews of Genetic Tests used as Predictive Indicators

  • Daniel E. JonasAffiliated withDepartment of Medicine, Cecil G. Sheps Center for Health Services Research, and Institute for Pharmacogenomics and Individualized Therapy, University of North Carolina Email author 
  • , Timothy J. WiltAffiliated withCenter for Chronic Disease Outcomes Research, Department of Veterans Affairs Health Care SystemDepartment of Medicine, University of Minnesota
  • , Brent C. TaylorAffiliated withCenter for Chronic Disease Outcomes Research, Department of Veterans Affairs Health Care SystemDepartment of Medicine, University of Minnesota
  • , Tania M. WilkinsAffiliated withCecil G. Sheps Center for Health Services Research, University of North Carolina
  • , David B. MatcharAffiliated withDuke-NUS Graduate Medical School Singapore, Health Services and Systems ResearchDepartment of Medicine, Duke University Medical Center

Abstract

In this paper, we discuss common challenges in and principles for conducting systematic reviews of genetic tests. The types of genetic tests discussed are those used to 1). determine risk or susceptibility in asymptomatic individuals; 2). reveal prognostic information to guide clinical management in those with a condition; or 3). predict response to treatments or environmental factors. This paper is not intended to provide comprehensive guidance on evaluating all genetic tests. Rather, it focuses on issues that have been of particular concern to analysts and stakeholders and on areas that are of particular relevance for the evaluation of studies of genetic tests. The key points include:
  • The general principles that apply in evaluating genetic tests are similar to those for other prognostic or predictive tests, but there are differences in how the principles need to be applied or the degree to which certain issues are relevant.

  • A clear definition of the clinical scenario and an analytic framework is important when evaluating any test, including genetic tests.

  • Organizing frameworks and analytic frameworks are useful constructs for approaching the evaluation of genetic tests.

  • In constructing an analytic framework for evaluating a genetic test, analysts should consider preanalytic, analytic, and postanalytic factors; such factors are useful when assessing analytic validity.

  • Predictive genetic tests are generally characterized by a delayed time between testing and clinically important events.

  • Finding published information on the analytic validity of some genetic tests may be difficult. Web sites (FDA or diagnostic companies) and gray literature may be important sources.

  • In situations where clinical factors associated with risk are well characterized, comparative effectiveness reviews should assess the added value of using genetic testing along with known factors compared with using the known factors alone.

  • For genome-wide association studies, reviewers should determine whether the association has been validated in multiple studies to minimize both potential confounding and publication bias. In addition, reviewers should note whether appropriate adjustments for multiple comparisons were used.

KEY WORDS

genetic test systematic review methods predictive tests prognostic tests risk