Use of Meta-Analysis to Evaluate Medical Questions of Interest: An Application to Studies of Secondary Prevention of Acu
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D N Infomiion ~ Journal. Vol. 33, pp. 1161-1171, 1999 F’rinted in the USA. All rights reserved.
USE OF META-ANALYSIS TO EVALUATE MEDICAL QUESTIONS OF INTEREST AN APPLICATION TO STUDIES OF SECONDARY PREVENTION OF ACUTE MYOCARDIAL INFARCTION YA-TING CHEN,PHD Associate Research Scientist, Department of Internal Medicine
ROBERTW. MAKUCH,PHD Professor and Head, Biostatistics, Department of Epidemiology and Public Health Yale University School of Medicine, New Haven, Connecticut
The popularity of meta-analysis in medical research can be attributed to the methodologic appeal of systematically identifying. reviewing, and combining individual studies, and explicitly reporting criteria used in their review. Meta-analysis also increases the chance of detecting effects of moderate size, which nevertheless have important public health implications, through minimization of biases and small random errors. The purpose of this report is to describe how a meta-analysis is performed, including protocol development, literature search strategy, considerations of study homogeneity, and combinability of studies. Methodologic issues concerning the conduct of meta-analysis are also discussed. A meta-analysis performed to evaluate the eficacy of verapamil usage in preventing secondary nonfatal myocardial infarctions among patients recovering from an acute myocardial infarction is presented to illustrate the issues. Key Words: Meta-analysis; Statistical methods; Medical intervention
META-ANALYSIS, OR A quantitative overview, is a systematic review that employs statistical methods to combine and summarize data from several studies. Meta-analysis has become a widely used technique in clinical and epidemiologic research, as well as in education and other areas (1). The increasing popularity of meta-analysis techniques
Presented at the DIA 32nd Annual Meeting, June 9-13, 1996. San Diego, California. Reprint address: Robert W. Makuch, PhD, Department of Epidemiology and Public Health, Yale University School of Medicine, LEPH 203, 60 College Street, P.O. Box 208034, New Haven, CT 06520-8034.
in medical studies, particularly in the past decade (2), can be attributed to several important features of this approach. 1. Meta-analysis is a systematic and quantitative strategy that encourages unbiased collection and review of individual studies, and explicit reporting of criteria used in the review, 2. In meta-analysis, several studies are combined to increase statistical power for detection of treatment effects that are moderate in size yet have important health implications, and 3. Meta-analysis minimizes biases and small
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random errors that otherwise may mask the detection of a true moderate effect size.
mize potential biases, a proper meta-analysis of RCTs often includes the following steps:
This overview strategy has been used successfully in combining data from randomized clinical trials (RCTs), where RCTs are widely a
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