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Meta-analysis of diagnostic test accuracy across all possible cut-offs and selection of the optimal cut-off

Thursday 13 June 2019, 12.15PM to - 1.15pm

Speaker(s): Dr Hayley Jones, University of Bristol

Abstract: The optimum threshold or cut-off at which to operate a diagnostic test is usually a key question for clinical practice. Standard methods for meta-analysis of test accuracy don’t facilitate answering this question, since they (i) don’t provide summary estimates of accuracy across the full range of thresholds, and (ii) can only synthesise a single pair of sensitivity and specificity from each study, despite studies often reporting data at more than one threshold.

Several models have recently been proposed for a unified meta-analysis of all available data, via assumptions about the underlying distributional form of test results. I will describe a multinomial random effects model, fitted in WinBUGS, which synthesises test accuracy data across studies reporting at different and varying numbers of cut-offs. The model allows for a flexible range of underlying distributions of test results, through estimation of a Box-Cox transformation parameter. I will present examples including meta-analysis of the accuracy of B-type natriuretic peptide in the diagnosis of acute heart failure, for which I will also show how we can estimate the threshold to maximise the expected net benefit in an economic decision model.

In a recent collaboration with researchers at McGill University and with Gerta Rücker (University of Freiburg), we compared results from three alternative models fitted to data from 45 studies reporting on accuracy of PHQ-9 in diagnosing major depression. Each model was fitted to two alternative versions of the data: (i) that available from the study publications, (ii) the full individual participant data (IPD). I will present results from this study, in particular showing that our model fitted to the ‘published’ dataset well approximated the IPD.

Location: The Professor Alan Maynard Auditorium A/RC/014

Who to contact

For more information on these seminars, contact:
Alfredo Palacios
Shainur Premji

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so that we can ensure we have sufficient space

Economic evaluation seminar dates

  • Tuesday 28 November 2023
  • Thursday 14 December 2023