CRD Summary: The authors concluded that epoetin α treatment of anaemia in various conditions had a statistically and clinically significant impact on health-related quality of life, particularly fatigue. In light of the possibility of error and bias in the review process, and the unclear quality of the included studies, the authors’ conclusions should be treated with caution.

CRD Commentary: Inclusion criteria were well-defined for intervention and participants, and broadly defined for study designs and outcomes. Two databases were searched, but studies were restricted to English language, which may have introduced language bias. A search for unpublished material did not appear to have been carried out, so publication bias may have been introduced. There was insufficient information about the review process to rule out the possibility of reviewer error and bias. A validity assessment did not appear to have been carried out. The authors did note limitations in the available evidence, in terms of small sample size and the possibility of measurement bias. Given the clinical heterogeneity between included studies, the decision to combine the studies in a narrative synthesis was appropriate. In light of the possibility of error and bias in the review process, and the unclear quality of the included studies, the authors’ conclusions should be treated with caution.