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Biostatistics Advance Access published online on May 11, 2006
Biostatistics, doi:10.1093/biostatistics/kxl004
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© The Author 2006. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org
Received January 31, 2006
Revised April 10, 2006
Accepted May 10, 2006

Article

A unification of models for meta-analysis of diagnostic accuracy studies

Roger M. Harbord 1 *, Jonathan J. Deeks 2, Matthias Egger 3, Penny Whiting 4, and Jonathan A.C. Sterne 4

1 MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK
2 Centre for Statistics in Medicine, Oxford, UK
3 Department of Social and Preventive Medicine, University of Berne, Switzerland
4 MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, UK

* To whom correspondence should be addressed.
Roger M. Harbord, E-mail: roger.harbord{at}bristol.ac.uk


  Abstract

Studies of diagnostic accuracy require more sophisticated methods for their meta-analysis than studies of therapeutic interventions. A number of different, and apparently divergent, methods for meta-analysis of diagnostic studies have been proposed, including two alternative approaches that are statistically rigorous and allow for between-study variability: the hierarchical summary receiver operating characteristic (HSROC) model (Rutter and Gatsonis, 2001) and bivariate random-effects meta-analysis (van Houwelingen et al., 1993, 2002; Reitsma et al., 2005) We show that these two models are very closely related, and define the circumstances in which they are identical. We discuss the different forms of summary model output suggested by the two approaches, including summary ROC (SROC) curves, summary points, confidence regions and prediction regions.

Keywords: diagnostic tests; sensitivity and specificity; ROC analysis; meta-analysis; hierarchical models; bivariate normal distribution; HSROC model.
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