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2018 ; 9
(1
): 41-50
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gab.com Text
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Detecting small-study effects and funnel plot asymmetry in meta-analysis of
survival data: A comparison of new and existing tests
#MMPMID28975717
Debray TPA
; Moons KGM
; Riley RD
Res Synth Methods
2018[Mar]; 9
(1
): 41-50
PMID28975717
show ga
Small-study effects are a common threat in systematic reviews and may indicate
publication bias. Their existence is often verified by visual inspection of the
funnel plot. Formal tests to assess the presence of funnel plot asymmetry
typically estimate the association between the reported effect size and their
standard error, the total sample size, or the inverse of the total sample size.
In this paper, we demonstrate that the application of these tests may be less
appropriate in meta-analysis of survival data, where censoring influences
statistical significance of the hazard ratio. We subsequently propose 2 new tests
that are based on the total number of observed events and adopt a multiplicative
variance component. We compare the performance of the various funnel plot
asymmetry tests in an extensive simulation study where we varied the true hazard
ratio (0.5 to 1), the number of published trials (N=10 to 100), the degree of
censoring within trials (0% to 90%), and the mechanism leading to participant
dropout (noninformative versus informative). Results demonstrate that previous
well-known tests for detecting funnel plot asymmetry suffer from low power or
excessive type-I error rates in meta-analysis of survival data, particularly when
trials are affected by participant dropout. Because our novel test (adopting
estimates of the asymptotic precision as study weights) yields reasonable power
and maintains appropriate type-I error rates, we recommend its use to evaluate
funnel plot asymmetry in meta-analysis of survival data. The use of funnel plot
asymmetry tests should, however, be avoided when there are few trials available
for any meta-analysis.