Practical guide to the meta-analysis of rare events.

Efthimiou, Orestis (2018). Practical guide to the meta-analysis of rare events. Evidence-Based Mental Health, 21(2), pp. 72-76. BMJ Publishing Group 10.1136/eb-2018-102911

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OBJECTIVE

Meta-analysing studies with low event rates is challenging as some of the standard methods for meta-analysis are not well suited to handle rare outcomes. This is more evident when some studies have zero events in one or both treatment groups. In this article, we discuss why rare events require special attention in meta-analysis, we present an overview of some approaches suitable for meta-analysing rare events and we provide practical recommendations for their use.

METHODS

We go through several models suggested in the literature for performing a rare events meta-analysis, highlighting their respective advantages and limitations. We illustrate these models using a published example from mental health. We provide the software code needed to perform all analyses in the appendix.

RESULTS

Different methods may give different results, and using a suboptimal approach may lead to erroneous conclusions. When data are very sparse, the choice between the available methods may have a large impact on the results. Methods that use the so-called continuity correction (eg, adding 0.5 to the number of events and non-events in studies with zero events in one treatment group) may lead to biased estimates.

CONCLUSIONS

Researchers should define the primary analysis a priori, in order to avoid selective reporting. A sensitivity analysis using a range of methods should be used to assess the robustness of results. Suboptimal methods such as using a continuity correction should be avoided.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Efthimiou, Orestis

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1362-0347

Publisher:

BMJ Publishing Group

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

24 Apr 2018 09:21

Last Modified:

19 Dec 2019 05:21

Publisher DOI:

10.1136/eb-2018-102911

PubMed ID:

29650528

BORIS DOI:

10.7892/boris.114821

URI:

https://boris.unibe.ch/id/eprint/114821

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