1. How to Conduct a Meta-Analysis Arindam Basu MD MPH About the Author Required Browsing

2. Objectives Following the course, you will be able to : Define Meta-analysis Select Studies for a Meta-analysis Identify different types of Models Calculate Summary Effects Interpret Results of a Meta-analysis

3. What is Meta-analysis? Synthesis of previous studies Providing a Summary estimate Steps –Identify studies –Define Eligibility Criteria –Abstract Data –Do Statistical Analysis

4. Identify Studies: Overview Steps: –Search Your Personal Files First –Search Electronic DatabasesSearch Electronic Databases –Review Reference Lists of Articles –Contact Experts and Researchers –Retrieve New Articles Evaluate Quality of the Studies Set Up Eligibility Criteria

5. Searching Electronic Databases First, Define a Search Strategy Limitations of Databases –incomplete and imperfect queries –language problems –problems with fugitive literatureproblems with fugitive literature Publication Bias is important –What is publication bias –How to deal with publication bias

6. Evaluating Study Quality Define Study Quality Criteria Early Set Up A Good Scoring System Develop A Form for Assessment Calculate Quality for each Study Use this for Sensitivity Analysis –stratify studies according to quality

7. Defining Eligibility of Studies Select Eligible Studies Based On: Study Designs Years of Publication Language Choice among multiple articles Sample-size or follow-up issues Similarity of Exposure and/or Rx Completeness of information

8. Abstract Data - Review! Steps: Identify Relevant Articles Sort out Eligible Articles Set up a Form for Abstraction Enter the Eligible Studies Use this as your database Statistical Analysis is next...

9. Statistical Analysis - Overview Select An Estimate of Effect Choose An Effects Measure Select An Effects Model For Each Model: –Calculate Summary Effect Size –Calculate Confidence Intervals –Calculate Q-statistic for Homogeneity Perform Sensitivity Analysis

10. Selecting Estimate of Effect Choose Only One Estimate For RCTS, choose the one with –Once randomized always randomized For nonrandomized trials, choose: –estimate adjusted only for age –that, and for a known confounder –the “most adjusted” estimate –estimate presented in the abstract

11. Choosing An Effect Measure RCTs or Cohort Studies –Rate Difference between Treatment and Control Groups –Ratio of Disease Rates Case Control Studies –Odds’ Ratio –Rate Ratio

12. Selecting An Effects Model Available Types: –Fixed Effects Model –Random Effects Model Difference Between the Two Special Cases: –When Outcomes are not binary Methods to be Used for them

13. Fixed Effects Model Methods: –Mantel Haenszel Method –Peto’s Method –General Variance Based Methods For Rate Difference For Rate Ratios When only RR and 95 CI given Tests of Homogeneity –Calculation of Q Statistic

14. Mantel Haenszel Method Download Spreasheet Calculator Strength of Mantel Haenszel –Very powerful –Widely Used Limitation –Cannot Control For Confounding!

15. Peto’s Method Similar to Mantel Haenszel Download Calculator Simpler Computation No Control for Confounding Good for RCTs Requires 2 X 2 Table

16. Variance-Based Methods Download Calculators For: –Rate DifferenceRate Difference –For only Relative Risk and 95% CIFor only Relative Risk and 95% CI Strengths and Limitations –Good For Rate Differences –Computationally Intensive

17. Tests of Homogeneity Establish Null Hypothesis that Effect Sizes Are Equal in All of the Studies [FAIL TO REJECT NULL] Tested By Using Q-statistic Q-statistic is distributed as chi- square distribution with degree of freedom = n-1 where n = number of studies

18. Random Effects Model Download The Calculator! Strengths and Limitations: –Can Generalize the Conclusions –Computationally Intensive

19. Continuous Outcomes Measurement Scale: Continuous Outcome Measured in Same Scale –Download Spreadsheet Calculator!Download Spreadsheet Calculator! Essentially Extension of ANOVA Useful For Integrating Social Science Research Data

20. Sensitivity and Publication Bias Conduct Sensitivity Analysis –Stratify studies by their quality rating –Compare Fixed and Random Effects Deal With Publication Bias –Construct A Funnel PlotConstruct A Funnel Plot

21. Conclusion Presentation of Meta-analysis or Literature Synthesis Download The Graph Maker More Resources...