A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints

RM Harbord, M Egger, JAC Sterne

Research output: Contribution to journalArticle (Academic Journal)peer-review

1116 Citations (Scopus)

Abstract

Publication bias and related bias in meta-analysis is often examined by visually checking for asymmetry in funnel plots of treatment effect against its standard error. Formal statistical tests of funnel plot asymmetry have been proposed, but when applied to binary outcome data these can give false-positive rates that are higher than the nominal level in some situations (large treatment effects, or few events per trial, or all trials of similar sizes). We develop a modified linear regression test for funnel plot asymmetry based on the efficient score and its variance, Fisher's information. The performance of this test is compared to the other proposed tests in simulation analyses based on the characteristics of published controlled trials. When there is little or no between-trial heterogeneity, this modified test has a false-positive rate close to the nominal level while maintaining similar power to the original linear regression test (Egger test). When the degree of between-trial heterogeneity is large, none of the tests that have been proposed has uniformly good properties.
Translated title of the contributionA modified test for small-study effects in meta-analyses of controlled trials with binary endpoints
Original languageEnglish
Pages (from-to)3443 - 3457
Number of pages15
JournalStatistics in Medicine
Volume25 (20)
DOIs
Publication statusPublished - Oct 2006

Bibliographical note

Publisher: Wiley

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