Skip to main content
Top
Published in: BMC Medical Research Methodology 1/2009

Open Access 01-12-2009 | Research article

Estimating required information size by quantifying diversity in random-effects model meta-analyses

Authors: Jørn Wetterslev, Kristian Thorlund, Jesper Brok, Christian Gluud

Published in: BMC Medical Research Methodology | Issue 1/2009

Login to get access

Abstract

Background

There is increasing awareness that meta-analyses require a sufficiently large information size to detect or reject an anticipated intervention effect. The required information size in a meta-analysis may be calculated from an anticipated a priori intervention effect or from an intervention effect suggested by trials with low-risk of bias.

Methods

Information size calculations need to consider the total model variance in a meta-analysis to control type I and type II errors. Here, we derive an adjusting factor for the required information size under any random-effects model meta-analysis.

Results

We devise a measure of diversity (D 2) in a meta-analysis, which is the relative variance reduction when the meta-analysis model is changed from a random-effects into a fixed-effect model. D 2 is the percentage that the between-trial variability constitutes of the sum of the between-trial variability and a sampling error estimate considering the required information size. D 2 is different from the intuitively obvious adjusting factor based on the common quantification of heterogeneity, the inconsistency (I 2), which may underestimate the required information size. Thus, D 2 and I 2 are compared and interpreted using several simulations and clinical examples. In addition we show mathematically that diversity is equal to or greater than inconsistency, that is D 2I 2, for all meta-analyses.

Conclusion

We conclude that D 2 seems a better alternative than I 2 to consider model variation in any random-effects meta-analysis despite the choice of the between trial variance estimator that constitutes the model. Furthermore, D 2 can readily adjust the required information size in any random-effects model meta-analysis.
Appendix
Available only for authorised users
Literature
1.
go back to reference Guyatt GH, Mills EJ, Elbourne D: In the era of systematic reviews, does the size of an individual trial still matter?. PLoS Medicine. 2008, 5 (1): e4-10.1371/journal.pmed.0050004. doi:10.1371/jounal.pmed.0050004.CrossRefPubMedPubMedCentral Guyatt GH, Mills EJ, Elbourne D: In the era of systematic reviews, does the size of an individual trial still matter?. PLoS Medicine. 2008, 5 (1): e4-10.1371/journal.pmed.0050004. doi:10.1371/jounal.pmed.0050004.CrossRefPubMedPubMedCentral
2.
go back to reference Pogue J, Yusuf S: Cumulating evidence from randomized trials: utilizing sequential monitoring boundaries for cumulative meta-analysis. Controlled Clinical Trials. 1997, 18: 580-93. 10.1016/S0197-2456(97)00051-2.CrossRefPubMed Pogue J, Yusuf S: Cumulating evidence from randomized trials: utilizing sequential monitoring boundaries for cumulative meta-analysis. Controlled Clinical Trials. 1997, 18: 580-93. 10.1016/S0197-2456(97)00051-2.CrossRefPubMed
3.
go back to reference Pogue J, Yusuf S: Overcoming the limitations of current meta-analysis of randomised controlled trials. Lancet. 1998, 351 (9095): 47-52. 10.1016/S0140-6736(97)08461-4.CrossRefPubMed Pogue J, Yusuf S: Overcoming the limitations of current meta-analysis of randomised controlled trials. Lancet. 1998, 351 (9095): 47-52. 10.1016/S0140-6736(97)08461-4.CrossRefPubMed
4.
go back to reference Devereaux PJ, Beattie WS, Choi PT, Badner NH, Guyatt GH, Villar JC: How strong is the evidence for the use of perioperative beta-blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials. BMJ. 2005, 331 (7512): 313-21. 10.1136/bmj.38503.623646.8F.CrossRefPubMedPubMedCentral Devereaux PJ, Beattie WS, Choi PT, Badner NH, Guyatt GH, Villar JC: How strong is the evidence for the use of perioperative beta-blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials. BMJ. 2005, 331 (7512): 313-21. 10.1136/bmj.38503.623646.8F.CrossRefPubMedPubMedCentral
5.
go back to reference Wetterslev J, Thorlund K, Brok J, Gluud C: Trial sequential analysis may establish when firm evidence is reached in a meta-analysis. Journal of Clinical Epidemiology. 2008, 61 (1): 64-75. 10.1016/j.jclinepi.2007.03.013.CrossRefPubMed Wetterslev J, Thorlund K, Brok J, Gluud C: Trial sequential analysis may establish when firm evidence is reached in a meta-analysis. Journal of Clinical Epidemiology. 2008, 61 (1): 64-75. 10.1016/j.jclinepi.2007.03.013.CrossRefPubMed
6.
go back to reference Brok J, Thorlund K, Gluud C, Wetterslev J: Trial sequential analysis reveals insufficient information size and potentially false positive results in many meta-analyses. Journal of Clinical Epidemiology. 2008, 61 (8): 763-9. 10.1016/j.jclinepi.2007.10.007.CrossRefPubMed Brok J, Thorlund K, Gluud C, Wetterslev J: Trial sequential analysis reveals insufficient information size and potentially false positive results in many meta-analyses. Journal of Clinical Epidemiology. 2008, 61 (8): 763-9. 10.1016/j.jclinepi.2007.10.007.CrossRefPubMed
7.
go back to reference Thorlund K, Devereaux PJ, Wetterslev , Guyatt G, Ioannidis JPA, Thabane L, Gluud LL, Als-Nielsen B, Gluud C: Can trial sequential monitoring boundaries reduce spurious inferences from meta-analyses?. International Journal of Epidemiology. 2008, Doi:10.1093/iej/dyn179. Thorlund K, Devereaux PJ, Wetterslev , Guyatt G, Ioannidis JPA, Thabane L, Gluud LL, Als-Nielsen B, Gluud C: Can trial sequential monitoring boundaries reduce spurious inferences from meta-analyses?. International Journal of Epidemiology. 2008, Doi:10.1093/iej/dyn179.
8.
go back to reference Brok J, Thorlund K, Wetterslev J, Gluud C: Apparently conclusive meta-analyses may be inconclusive-Trial sequential analysis adjustment of random error risk due to repetitive testing of accumulating data in apparently conclusive neonatal meta-analyses. International Journal of Epidemiology. 2008, Doi:10.1093/iej/dyn188. Brok J, Thorlund K, Wetterslev J, Gluud C: Apparently conclusive meta-analyses may be inconclusive-Trial sequential analysis adjustment of random error risk due to repetitive testing of accumulating data in apparently conclusive neonatal meta-analyses. International Journal of Epidemiology. 2008, Doi:10.1093/iej/dyn188.
9.
go back to reference Altman DG, Deeks JJ: Meta-analysis, Simpson's paradox, and the number needed to treat. BMC Medical Research Methodology. 2002, 2: 3-10.1186/1471-2288-2-3.CrossRefPubMedPubMedCentral Altman DG, Deeks JJ: Meta-analysis, Simpson's paradox, and the number needed to treat. BMC Medical Research Methodology. 2002, 2: 3-10.1186/1471-2288-2-3.CrossRefPubMedPubMedCentral
10.
go back to reference Higgins JP, Thompson SG: Quantifying heterogeneity in a meta-analysis. Statistics in Medicine. 2002, 21: 1539-1558. 10.1002/sim.1186.CrossRefPubMed Higgins JP, Thompson SG: Quantifying heterogeneity in a meta-analysis. Statistics in Medicine. 2002, 21: 1539-1558. 10.1002/sim.1186.CrossRefPubMed
11.
go back to reference Feinstein AR: Clinical Epidemiology: the Architecture of Clinical Research. 1985, Philadelphia: W.B. Saunders, 166- Feinstein AR: Clinical Epidemiology: the Architecture of Clinical Research. 1985, Philadelphia: W.B. Saunders, 166-
12.
go back to reference Chow S-C, Shao J, Wang H: Sample Size Calculation in Clinical Research. Edited by: Shein-Chung Chow. 2003, CRC, Taylor & Francis Group, Chapter 8.8.1: 204-206. Chow S-C, Shao J, Wang H: Sample Size Calculation in Clinical Research. Edited by: Shein-Chung Chow. 2003, CRC, Taylor & Francis Group, Chapter 8.8.1: 204-206.
14.
go back to reference Takouche B, Cadarso-Suaréz C, Spiegelman D: Evaluation of old and new tests of heterogeneity in epidemiologic meta-analysis. American Journal of Epidemiology. 1999, 150: 206-215.CrossRef Takouche B, Cadarso-Suaréz C, Spiegelman D: Evaluation of old and new tests of heterogeneity in epidemiologic meta-analysis. American Journal of Epidemiology. 1999, 150: 206-215.CrossRef
15.
go back to reference DerSimonian R, Laird NM: Meta-analysis in clinical trials. Controlled Clinical Trials. 1986, 7: 177-188. 10.1016/0197-2456(86)90046-2.CrossRefPubMed DerSimonian R, Laird NM: Meta-analysis in clinical trials. Controlled Clinical Trials. 1986, 7: 177-188. 10.1016/0197-2456(86)90046-2.CrossRefPubMed
16.
go back to reference Afshari A, Wetterslev J, Brok J, Møller AM: Antithrombin III in critically ill patients. A systematic review with meta-analysis and trial sequential analysis. BMJ. 2007, 335 (7632): 1219-20. 10.1136/bmj.39398.682500.25.CrossRef Afshari A, Wetterslev J, Brok J, Møller AM: Antithrombin III in critically ill patients. A systematic review with meta-analysis and trial sequential analysis. BMJ. 2007, 335 (7632): 1219-20. 10.1136/bmj.39398.682500.25.CrossRef
17.
go back to reference Al-Inany HG, Abou-Settea AM, Aboulghar M: Gonadotrophin-releasing hormone antagonists for assisted conception. Cochrane Database of Systematic Reviews. 2006, 3: CD001750-PubMed Al-Inany HG, Abou-Settea AM, Aboulghar M: Gonadotrophin-releasing hormone antagonists for assisted conception. Cochrane Database of Systematic Reviews. 2006, 3: CD001750-PubMed
18.
go back to reference Soll RF: Prophylactic natural surfactant extract for preventing morbidity and mortality in preterm infants. The Cochrane Database of Systematic Reviews. 1997, 4: CD000511-10.1002/14651858. C. Soll RF: Prophylactic natural surfactant extract for preventing morbidity and mortality in preterm infants. The Cochrane Database of Systematic Reviews. 1997, 4: CD000511-10.1002/14651858. C.
19.
go back to reference Wetterslev J, Juul AB: Benefits and harms of perioperative beta-blockade. Best Practice and Research of Clinical Anesthesiology. 2006, 20: 285-302. 10.1016/j.bpa.2005.10.006.CrossRef Wetterslev J, Juul AB: Benefits and harms of perioperative beta-blockade. Best Practice and Research of Clinical Anesthesiology. 2006, 20: 285-302. 10.1016/j.bpa.2005.10.006.CrossRef
20.
go back to reference Bury RG, Tudehope D: Enteral antibiotics for preventing necrotizing enterocolitis in low birthweight or preterm infants. The Cochrane Database of Systematic Reviews. 2000, 2: CD000405-DOI: 10.1002/14651858.CD000405.PubMed Bury RG, Tudehope D: Enteral antibiotics for preventing necrotizing enterocolitis in low birthweight or preterm infants. The Cochrane Database of Systematic Reviews. 2000, 2: CD000405-DOI: 10.1002/14651858.CD000405.PubMed
21.
go back to reference Li J, Zhang M, Egger M: Intravenous magnesium for acute myocardial infarction. Cochrane Database of Systematic Reviews. 2007, 2: CD002755-PubMed Li J, Zhang M, Egger M: Intravenous magnesium for acute myocardial infarction. Cochrane Database of Systematic Reviews. 2007, 2: CD002755-PubMed
22.
go back to reference Meyhoff CS, Wetterslev J, Jorgensen LN, Henneberg SW, Simonsen I, Pulawska T, Walker LR, Skovgaard N, Heltø K, Gocht-Jensen P, Carlsson PS, Rask H, Karim S, Carlsen CG, Jensen FS, Rasmussen LS, the PROXI Trial Group: Perioperative oxygen fraction - effect on surgical site infection and pulmonary complications after abdominal surgery: a randomized clinical trial. Rationale and design of the PROXI-Trial. Trials. 2008, 9 (1): 58-10.1186/1745-6215-9-58.CrossRefPubMedPubMedCentral Meyhoff CS, Wetterslev J, Jorgensen LN, Henneberg SW, Simonsen I, Pulawska T, Walker LR, Skovgaard N, Heltø K, Gocht-Jensen P, Carlsson PS, Rask H, Karim S, Carlsen CG, Jensen FS, Rasmussen LS, the PROXI Trial Group: Perioperative oxygen fraction - effect on surgical site infection and pulmonary complications after abdominal surgery: a randomized clinical trial. Rationale and design of the PROXI-Trial. Trials. 2008, 9 (1): 58-10.1186/1745-6215-9-58.CrossRefPubMedPubMedCentral
23.
go back to reference Gluud LL: Bias in clinical intervention research. American Journal of Epidemiology. 2006, 163: 493-501. 10.1093/aje/kwj069.CrossRefPubMed Gluud LL: Bias in clinical intervention research. American Journal of Epidemiology. 2006, 163: 493-501. 10.1093/aje/kwj069.CrossRefPubMed
24.
go back to reference Chan AW, Hrobjartsson A, Haahr MT, Gøtzsche PC, Altman DG: Empirical evidence for selective reporting of outcomes in randomized trials: comparison of protocols to published articles. Journal of American Medical Association. 2004, 291 (20): 2457-2465. 10.1001/jama.291.20.2457.CrossRef Chan AW, Hrobjartsson A, Haahr MT, Gøtzsche PC, Altman DG: Empirical evidence for selective reporting of outcomes in randomized trials: comparison of protocols to published articles. Journal of American Medical Association. 2004, 291 (20): 2457-2465. 10.1001/jama.291.20.2457.CrossRef
25.
go back to reference Chan AW, Altman DG: Identifying outcome reporting bias in randomised trials on PubMed: review of publications and survey of authors. BMJ. 2005, 330 (7494): 753-10.1136/bmj.38356.424606.8F.CrossRefPubMedPubMedCentral Chan AW, Altman DG: Identifying outcome reporting bias in randomised trials on PubMed: review of publications and survey of authors. BMJ. 2005, 330 (7494): 753-10.1136/bmj.38356.424606.8F.CrossRefPubMedPubMedCentral
26.
go back to reference Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, Gluud C, Martin RM, Wood AJ, Sterne JA: Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. BMJ. 2008, 336 (7644): 601-5. 10.1136/bmj.39465.451748.AD.CrossRefPubMedPubMedCentral Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, Gluud C, Martin RM, Wood AJ, Sterne JA: Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. BMJ. 2008, 336 (7644): 601-5. 10.1136/bmj.39465.451748.AD.CrossRefPubMedPubMedCentral
27.
go back to reference Montori VM, Devereaux PJ, Adhikari NK, Burns KE, Eggert CH, Briel M, Guyatt G: Randomized trials stopped early for benefit: a systematic review. Journal of American Medical Association. 2005, 294 (17): 2203-2209. 10.1001/jama.294.17.2203.CrossRef Montori VM, Devereaux PJ, Adhikari NK, Burns KE, Eggert CH, Briel M, Guyatt G: Randomized trials stopped early for benefit: a systematic review. Journal of American Medical Association. 2005, 294 (17): 2203-2209. 10.1001/jama.294.17.2203.CrossRef
28.
go back to reference Flather MD, Farkouh ME, Pogue JM, Yusuf S: Strengths and limitations of meta-analysis: larger studies may be more reliable. Controlled Clinical Trials. 1997, 18 (6): 568-579. 10.1016/S0197-2456(97)00024-X.CrossRefPubMed Flather MD, Farkouh ME, Pogue JM, Yusuf S: Strengths and limitations of meta-analysis: larger studies may be more reliable. Controlled Clinical Trials. 1997, 18 (6): 568-579. 10.1016/S0197-2456(97)00024-X.CrossRefPubMed
29.
go back to reference Fedorov V, Jones B: The design of multicentre trials. Statistical Methods in Medical Research. 2005, 14: 205-248. 10.1191/0962280205sm399oa.CrossRefPubMed Fedorov V, Jones B: The design of multicentre trials. Statistical Methods in Medical Research. 2005, 14: 205-248. 10.1191/0962280205sm399oa.CrossRefPubMed
30.
go back to reference Bangalore S, Wetterslev J, Pranesh S, Sawhney S, Gluud C, Messerli FH: Perioperative beta blockers in patients having non-cardiac surgery: a meta-analysis. Lancet. 2008, 372 (9654): 1962-76. 10.1016/S0140-6736(08)61560-3.CrossRefPubMed Bangalore S, Wetterslev J, Pranesh S, Sawhney S, Gluud C, Messerli FH: Perioperative beta blockers in patients having non-cardiac surgery: a meta-analysis. Lancet. 2008, 372 (9654): 1962-76. 10.1016/S0140-6736(08)61560-3.CrossRefPubMed
31.
go back to reference Jennison C, Turnbull BW: Group sequential methods with application to clinical trials. 2000, Chapman & Hall/CRC, Chapter III: 49- Jennison C, Turnbull BW: Group sequential methods with application to clinical trials. 2000, Chapman & Hall/CRC, Chapter III: 49-
32.
go back to reference Sidik K, Jonkman JN: A comparison of heterogeneity variance estimators in combining results of studies. Statistics in Medicine. 2007, 30;26 (9): 1964-81. 10.1002/sim.2688.CrossRef Sidik K, Jonkman JN: A comparison of heterogeneity variance estimators in combining results of studies. Statistics in Medicine. 2007, 30;26 (9): 1964-81. 10.1002/sim.2688.CrossRef
33.
go back to reference Rücker G, Schwarzer , Carpenter JR, Schumacher M: Undue reliance on I 2 in assessing heterogeneity may mislead. BMC Medical Research Methodology. 2008, 8: 79-10.1186/1471-2288-8-79. doi:10.1186/1471-2288-8-79.CrossRefPubMedPubMedCentral Rücker G, Schwarzer , Carpenter JR, Schumacher M: Undue reliance on I 2 in assessing heterogeneity may mislead. BMC Medical Research Methodology. 2008, 8: 79-10.1186/1471-2288-8-79. doi:10.1186/1471-2288-8-79.CrossRefPubMedPubMedCentral
34.
go back to reference Higgins JP: Commentary: Heterogeneity in meta-analysis should be expected and appropriately quantified. International Journal of Epidemiology. 2008, 37: 1158-1160. 10.1093/ije/dyn204.CrossRefPubMed Higgins JP: Commentary: Heterogeneity in meta-analysis should be expected and appropriately quantified. International Journal of Epidemiology. 2008, 37: 1158-1160. 10.1093/ije/dyn204.CrossRefPubMed
35.
go back to reference Rücker G, Schwarzer G, Carpenter JR, Schumacher M: Are large trials less reliable than small trials? Letter to the editor. Journal of Clinical Epidemiology. 2009, 62: 886-889. 10.1016/j.jclinepi.2009.03.007.CrossRefPubMed Rücker G, Schwarzer G, Carpenter JR, Schumacher M: Are large trials less reliable than small trials? Letter to the editor. Journal of Clinical Epidemiology. 2009, 62: 886-889. 10.1016/j.jclinepi.2009.03.007.CrossRefPubMed
36.
go back to reference Ioannidis JP, Trikalinos TA, Zintzaras E: Extreme between-study homoge-neity in meta-analyses could offer useful insights. Journal of Clinical Epidemiology. 2006, 59 (10): 1023-32. 10.1016/j.jclinepi.2006.02.013.CrossRefPubMed Ioannidis JP, Trikalinos TA, Zintzaras E: Extreme between-study homoge-neity in meta-analyses could offer useful insights. Journal of Clinical Epidemiology. 2006, 59 (10): 1023-32. 10.1016/j.jclinepi.2006.02.013.CrossRefPubMed
37.
go back to reference Ioannidis JP, Patsopoulos NA, Evangelou E: Uncertainty in heterogeneity estimates in meta-analyses. BMJ. 2007, 335 (7626): 914-6. 10.1136/bmj.39343.408449.80.CrossRefPubMedPubMedCentral Ioannidis JP, Patsopoulos NA, Evangelou E: Uncertainty in heterogeneity estimates in meta-analyses. BMJ. 2007, 335 (7626): 914-6. 10.1136/bmj.39343.408449.80.CrossRefPubMedPubMedCentral
Metadata
Title
Estimating required information size by quantifying diversity in random-effects model meta-analyses
Authors
Jørn Wetterslev
Kristian Thorlund
Jesper Brok
Christian Gluud
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Medical Research Methodology / Issue 1/2009
Electronic ISSN: 1471-2288
DOI
https://doi.org/10.1186/1471-2288-9-86

Other articles of this Issue 1/2009

BMC Medical Research Methodology 1/2009 Go to the issue