IDEAS home Printed from
   My bibliography  Save this paper

A generalized meta-analysis model for binary diagnostic test performance


  • Ben Dwamena

    () (University of Michigan Radiology and VA Nuclear Medicine)


Methods for meta-analysis of diagnostic test accuracy studies must, in addition to unobserved heterogeneity, account for covariate heterogeneity, threshold effects, methodological quality and small study bias, whic constitute the major threats to the validity of meta-analytic results. These have traditionally been addressed independent of each other. Two recent methodological advances include (1) the bivariate random-effects model for joint synthesis of sensitivity and specificity, which accounts for unobsrved heterogeneity and threshold variation using random-effects and covariate and qualty effects as indepedent variables in a meta-regression; and (2) a linear regression test for funnel plot asymmetry in which the diagnostic odds ratio as effect size measure is regressed on effective sample size as a precision measure. I propose a generalized framework for diagnostic meta-analysis which integrates both developments based on a modification of the bivariate Dale's model in which two univariate random-effects logistic models for sensitivity and specificity are associated through a log-linear model of odds ratios with the effective sample size as an independent variable,. This unifies the estimation of summary test performance and assessment of the presence, extent and sources of variability. Taking advantage of the ability of gllamm to model a mixture of discrete and continous outcomes, I will discuss specification, estimation, diagnostics and prediction of the model, using a motivating dataset of 43 studies investigating FDG-PET for staging the axilla in patients with newly-diagnosed breast cancer.

Suggested Citation

  • Ben Dwamena, 2008. "A generalized meta-analysis model for binary diagnostic test performance," Fall North American Stata Users' Group Meetings 2008 8, Stata Users Group.
  • Handle: RePEc:boc:fsug08:8

    Download full text from publisher

    File URL:
    Download Restriction: no

    More about this item

    NEP fields

    This paper has been announced in the following NEP Reports:


    Access and download statistics


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:boc:fsug08:8. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Christopher F Baum). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.