Meta-analysis of diagnostic test accuracy presents many challenges. Even in the simplest case, when the data are summarized by a 2 x 2 table from each study, a statistically rigorous analysis requires hierarchical (multilevel) models that respect the binomial data structure, such as hierarchical logistic regression. We present a Stata package, metandi, to facilitate the fitting of such models in Stata. The commands display the results in two alternative parameterizations and produce a customizable plot. metandi requires either Stata 10 or above (which has the new command xtmelogit), or Stata 8.2 or above with gllamm installed.
AlexanderssonA.2004. Graphing confidence ellipses: An update of ellip for Stata 8. Stata Journal4: 242–256.
2.
ArendsL. R., HamzaT. H., van HouwelingenJ. C., Heijenbrok-KalM. H., HuninkM. G. M., and StijnenT.2008. Bivariate random effects meta-analysis of ROC curves. Medical Decision Making28: 621–638.
3.
BradburnM. J., DeeksJ. J., and AltmanD. G.1998. sbe24: metan-an alternative meta-analysis command. Stata Technical Bulletin44: 4–15. Reprinted in Stata Technical Bulletin Reprints, vol. 8, pp. 86–100. College Station, TX: Stata Press.
4.
ChewV.1966. Confidence, prediction, and tolerance regions for the multivariate normal distribution. Journal of the American Statistical Association61: 605–617.
5.
ChuH., and ColeS. R.2006. Bivariate meta-analysis of sensitivity and specificity with sparse data: A generalized linear mixed model approach. Journal of Clinical Epidemiology59: 1331–1332.
CoxC.1998. Delta method. In Encyclopedia of Biostatistics, ed. ArmitageP., and ColtonT., 1125–1127. New York: Wiley.
8.
CoxD. R., and SnellE. J.1989. Analysis of Binary Data. 2nd ed. London: Chapman & Hall.
9.
DeeksJ. J.2001a. Systematic reviews of evaluations of diagnostic and screening tests. In Systematic Reviews in Health Care: Meta-Analysis in Context, 2nd edition, ed. EggerM., Davey SmithG., and AltmanD. G., 248–282. London: BMJ Books.
10.
DeeksJ. J.2001b. Systematic reviews in health care: Systematic reviews of evaluations of diagnostic and screening tests. British Medical Journal323: 157–162.
11.
DevilléW. L., BuntinxF., BouterL. M., MontoriV. M., de VetH. C. W., van der WindtD. A. W. M., and BezemerP. D.2002. Conducting systematic reviews of diagnostic studies: Didactic guidelines. BMC Medical Research Methodology2: 9.
12.
DouglasJ. B.1993. Confidence regions for parameter pairs. American Statistician47: 43–45.
13.
GatsonisC., and PaliwalP.2006. Meta-analysis of diagnostic and screening test accuracy evaluations: Methodologic primer. American Journal of Roentgenology187: 271–281.
14.
GluudC., and GluudL. L.2005. Evidence based diagnostics. British Medical Journal330: 724–726.
15.
HarbordR. M., DeeksJ. J., EggerM., WhitingP., and SterneJ. A. C.2007. A unification of models for meta-analysis of diagnostic accuracy studies. Biostatistics8: 239–251.
16.
LijmerJ. G., BossuytP. M. M., and HeisterkampS. H.2002. Exploring sources of heterogeneity in systematic reviews of diagnostic tests. Statistics in Medicine21: 1525–1537.
17.
MacaskillP.2004. Empirical Bayes estimates generated in a hierarchical summary roc analysis agreed closely with those of a full Bayesian analysis. Journal of Clinical Epidemiology57: 925–932.
18.
MallettS., DeeksJ. J., HalliganS., HopewellS., CorneliusV., and AltmanD. G.2006. Systematic reviews of diagnostic tests in cancer: Review of methods and reporting. British Medical Journal333: 413–416.
19.
MosesL. E., ShapiroD., and LittenbergB.1993. Combining independent studies of a diagnostic test into a summary ROC curve: Data-analytic approaches and some additional considerations. Statistics in Medicine12: 1293–1316.
20.
Nordic Cochrane Centre. 2007. Review Manager (RevMan): Version 5.Software program. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration.
21.
Rabe-HeskethS., SkrondalA., and PicklesA.2004. gllamm manual. Working Paper 160, Division of Biostatistics, University of California–Berkeley. Downloadable from http://www.bepress.com/ucbbiostat/paper160/.
22.
Rabe-HeskethS.2005. Maximum likelihood estimation of limited and discrete dependent variable models with nested random effects. Journal of Econometrics128: 301–323.
23.
ReitsmaJ. B., GlasA. S., RutjesA. W. S., ScholtenR. J. P. M., BossuytP. M., and ZwindermanA. H.2005. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. Journal of Clinical Epidemiology58: 982–990.
24.
RileyR. D., AbramsK. R., SuttonA. J., LambertP. C., and ThompsonJ. R.2007. Bivariate random-effects meta-analysis and the estimation of between-study correlation. BMC Medical Research Methodology7: 3.
25.
RutterC. M., and GatsonisC. A.2001. A hierarchical regression approach to metaanalysis of diagnostic test accuracy evaluations. Statistics in Medicine20: 2865–2884.
26.
ScheidlerJ., HricakH., YuK. K., SubakL., and SegalM. R.1997. Radiological evaluation of lymph node metastases in patients with cervical cancer: A meta-analysis. Journal of the American Medical Association278: 1096–1101.
27.
SkrondalA., and Rabe-HeskethS.2004. Generalized Latent Variable Modeling: Multilevel, Longitudinal, and Structural Equation Models.Boca Raton, fl: Chapman & Hall/CRC.
TatsioniA., ZarinD. A., AronsonN., SamsonD. J., FlammC. R., SchmidC., and LauJ.2005. Challenges in systematic reviews of diagnostic technologies. Annals of Internal Medicine142: 1048–1055.
30.
WalterS. D.2002. Properties of the summary receiver operating characteric (SROC) curve for diagnostic test data. Statistics in Medicine21: 1237–1256.
31.
ZwindermanA. H., and BossuytP. M.2008. We should not pool diagnostic likelihood ratios in systematic reviews. Statistics in Medicine27: 687–697.
