The online version of this article (doi:10.1186/1471-2288-14-128) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
All the authors contributed substantively to the study and approved the manuscript submitted for review. XM and HC conceived of the idea of the study, XM was responsible for data analysis. FS, XM and HC all contributed in drafting and revising the manuscript. All authors read and approved the final manuscript.
A recent paper proposed an intent-to-diagnose approach to handle non-evaluable index test results and discussed several alternative approaches, with an application to the meta-analysis of coronary CT angiography diagnostic accuracy studies. However, no simulation studies have been conducted to test the performance of the methods.
We propose an extended trivariate generalized linear mixed model (TGLMM) to handle non-evaluable index test results. The performance of the intent-to-diagnose approach, the alternative approaches and the extended TGLMM approach is examined by extensive simulation studies. The meta-analysis of coronary CT angiography diagnostic accuracy studies is re-evaluated by the extended TGLMM.
Simulation studies showed that the intent-to-diagnose approach under-estimate sensitivity and specificity. Under the missing at random (MAR) assumption, the TGLMM gives nearly unbiased estimates of test accuracy indices and disease prevalence. After applying the TGLMM approach to re-evaluate the coronary CT angiography meta-analysis, overall median sensitivity is 0.98 (0.967, 0.993), specificity is 0.875 (0.827, 0.923) and disease prevalence is 0.478 (0.379, 0.577).
Under MAR assumption, the intent-to-diagnose approach under-estimate both sensitivity and specificity, while the extended TGLMM gives nearly unbiased estimates of sensitivity, specificity and prevalence. We recommend the extended TGLMM to handle non-evaluable index test subjects.
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- A trivariate meta-analysis of diagnostic studies accounting for prevalence and non-evaluable subjects: re-evaluation of the meta-analysis of coronary CT angiography studies
Muhammad Fareed K Suri
- BioMed Central
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