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Biostatistics Advance Access first published online on May 11, 2006
This version published online on March 5, 2007
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.

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

Roger M. Harbord*

Medical Research Council Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK roger.harbord{at}bristol.ac.uk

Jonathan J. Deeks

Centre for Statistics in Medicine, Oxford, UK

Matthias Egger

Department of Social and Preventive Medicine, University of Berne, Switzerland

Penny Whiting and Jonathan A. C. Sterne

Medical Research Council Health Services Research Collaboration, Department of Social Medicine, University of Bristol, UK

* To whom correspondence should be addressed.

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 (ROC) model (Rutter and Gatsonis, 2001) and bivariate random-effects meta-analysis (van Houwelingen and others, 1993), (van Houwelingen and others, 2002), (Reitsma and others, 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 curves, summary points, confidence regions, and prediction regions.

Keywords: Bivariate normal distribution; Diagnostic tests; Hierarchial models; HSROC model; Meta-analysis; ROC analysis; Sensitivity and specificity

Received January 31, 2006; revised March 17, 2006; revised April 10, 2006; accepted for publication May 10, 2006.


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