TY - JOUR
T1 - Bivariate meta-analysis of predictive values of diagnostic tests can be an alternative to bivariate meta-analysis of sensitivity and specificity
AU - Leeflang, Mariska M.G.
AU - Deeks, Jonathan J.
AU - Rutjes, Anne W.S.
AU - Reitsma, Johannes B.
AU - Bossuyt, Patrick M.M.
N1 - Funding Information: The authors thank Dr M. Di Nisio, Dr J.C. van Rijn, and Dr N. Smidt for their contribution to the collection of data. The authors thank Professor Dr Aeilko Zwinderman for his contribution to the calculation of the area of the ellipse. M.M.G.L. is supported by The Netherlands Organization for Scientific Research (NWO); project 916.10.034. A.W.S.R. was supported by a research grant from the NWO (registration no. 945-10-012). J.J.D. is partially supported by the Medical Research Council Midland Hub for Trials Methodology Research , University of Birmingham (grant G0800808 ). No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the article.
PY - 2012/10
Y1 - 2012/10
N2 - Objective: Meta-analysis of predictive values is usually discouraged because these values are directly affected by disease prevalence, but sensitivity and specificity sometimes show substantial heterogeneity as well. We propose a bivariate random-effects logitnormal model for the meta-analysis of the positive predictive value (PPV) and negative predictive value (NPV) of diagnostic tests. Study Design and Setting: Twenty-three meta-analyses of diagnostic accuracy were reanalyzed. With separate models, we calculated summary estimates of the PPV and NPV and summary estimates of sensitivity and specificity. We compared these summary estimates, the goodness of fit of the two models, and the amount of heterogeneity of both approaches. Results: There were no substantial differences in the goodness of fit or amount of heterogeneity between both models. The median absolute difference between the projected PPV and NPV from the summary estimates of sensitivity and specificity and the summary estimates of PPV and NPV was 1% point (interquartile range, 0-2% points). Conclusion: A model for the meta-analysis of predictive values fitted the data from a range of systematic reviews equally well as meta-analysis of sensitivity and specificity. The choice for either model could be guided by considerations of the design used in the primary studies and sources of heterogeneity.
AB - Objective: Meta-analysis of predictive values is usually discouraged because these values are directly affected by disease prevalence, but sensitivity and specificity sometimes show substantial heterogeneity as well. We propose a bivariate random-effects logitnormal model for the meta-analysis of the positive predictive value (PPV) and negative predictive value (NPV) of diagnostic tests. Study Design and Setting: Twenty-three meta-analyses of diagnostic accuracy were reanalyzed. With separate models, we calculated summary estimates of the PPV and NPV and summary estimates of sensitivity and specificity. We compared these summary estimates, the goodness of fit of the two models, and the amount of heterogeneity of both approaches. Results: There were no substantial differences in the goodness of fit or amount of heterogeneity between both models. The median absolute difference between the projected PPV and NPV from the summary estimates of sensitivity and specificity and the summary estimates of PPV and NPV was 1% point (interquartile range, 0-2% points). Conclusion: A model for the meta-analysis of predictive values fitted the data from a range of systematic reviews equally well as meta-analysis of sensitivity and specificity. The choice for either model could be guided by considerations of the design used in the primary studies and sources of heterogeneity.
KW - Diagnostic test accuracy
KW - Meta-analyses
KW - Negative predictive value
KW - Positive predictive value
KW - Sensitivity and specificity
KW - Systematic reviews
UR - http://www.scopus.com/inward/record.url?scp=84865258544&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jclinepi.2012.03.006
DO - https://doi.org/10.1016/j.jclinepi.2012.03.006
M3 - Article
C2 - 22742916
SN - 0895-4356
VL - 65
SP - 1088
EP - 1097
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
IS - 10
ER -