Meta-Analysis

September 15, 2019


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Definition

Meta-analysis is a set of techniques used “to combine the results of a number of different reports into one report to create a single, more precise estimate of an effect” (Ferrer, 1998). The aims of the meta-analysis are “to increase statistical power; to deal with controversy when individual studies disagree; to improve estimates of the size of the effect, and to answer new questions not previously posed in component studies” (Hunter and Schmidt, 1990).
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A meta-analysis would be used for the following purposes:

To establish statistical significance with studies that have conflicting results

To develop a more correct estimate of effect magnitude

To provide a more complex analysis of harms, safety data, and benefits

To examine subgroups with individual numbers that are not statistically significant

Steps in a meta-analysis

A meta-analysis is usually preceded by a systematic review, as this allows identification and critical appraisal of all the relevant evidence (thereby limiting the risk of bias in summary estimates). The general steps are then as follows;
  1. Formulation of the research question, e.g. using the PICO model (Population, Intervention, Comparison, Outcome).
  2. Search of literature
  3. Selection of studies ('incorporation criteria')
  • Based on quality criteria, e.g. the requirement of randomization and blinding in a clinical trial
  • Selection of specific studies on a well-specified subject, e.g. the treatment of breast cancer.
  • Decide whether unpublished studies are included to avoid publication bias 
      4. Decide which dependent variables or summary measures are allowed. For instance, when                    considering a meta-analysis of published (aggregate) data: 
      5. Selection of a meta-analysis model e.g. fixed-effect or random-effects meta-analysis. 
      6. Examine sources of between-study heterogeneity, e.g. using subgroup analysis 
          or meta-regression. 
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