Network meta-analysis of diagnostic test accuracy studies identifies and ranks the optimal diagnostic tests and thresholds for healthcare policy and decision making

Owen, R. K., Cooper, N. J., Quinn, T. J. , Lees, R. and Sutton, A. J. (2018) Network meta-analysis of diagnostic test accuracy studies identifies and ranks the optimal diagnostic tests and thresholds for healthcare policy and decision making. Journal of Clinical Epidemiology, 99, pp. 64-74. (doi: 10.1016/j.jclinepi.2018.03.005) (PMID:29548843)

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Abstract

Objective: Network meta-analyses have extensively been used to compare the effectiveness of multiple interventions for healthcare policy and decision-making. However, methods for evaluating the performance of multiple diagnostic tests are less established. In a decision-making context, we are often interested in comparing and ranking the performance of multiple diagnostic tests, at varying levels of test thresholds, in one simultaneous analysis. Study design and setting: Motivated by an example of cognitive impairment diagnosis following stroke, we synthesized data from 13 studies assessing the efficiency of two diagnostic tests: Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), at two test thresholds: MMSE <25/30 and <27/30, and MoCA <22/30 and <26/30. Using Markov Chain Monte Carlo (MCMC) methods, we fitted a bivariate network meta-analysis model incorporating constraints on increasing test threshold, and accounting for the correlations between multiple test accuracy measures from the same study. Results: We developed and successfully fitted a model comparing multiple tests/threshold combinations while imposing threshold constraints. Using this model, we found that MoCA at threshold <26/30 appeared to have the best true positive rate, whilst MMSE at threshold <25/30 appeared to have the best true negative rate. Conclusion: The combined analysis of multiple tests at multiple thresholds allowed for more rigorous comparisons between competing diagnostics tests for decision making.

Item Type:Articles
Keywords:Network meta-analysis, diagnostic test accuracy, meta-analysis, multiple tests, multiple thresholds.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Quinn, Professor Terry
Authors: Owen, R. K., Cooper, N. J., Quinn, T. J., Lees, R., and Sutton, A. J.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Journal of Clinical Epidemiology
Publisher:Elsevier
ISSN:0895-4356
ISSN (Online):1878-5921
Published Online:13 March 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in Journal of Clinical Epidemiology 99:64-74
Publisher Policy:Reproduced under a Creative Commons License

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