gms | German Medical Science

62. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V. (GMDS)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie

17.09. - 21.09.2017, Oldenburg

Comparison of the multinomial generalized linear mixed model with three alternative generalized mixed models in the meta-analysis of diagnostic accuracy trials with non-evaluable index test results

Meeting Abstract

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  • Jenny Pham
  • Peter Schlattmann - Universitätsklinikum Jena, Jena, Deutschland

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. 62. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e.V. (GMDS). Oldenburg, 17.-21.09.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocAbstr. 200

doi: 10.3205/17gmds046, urn:nbn:de:0183-17gmds0465

Veröffentlicht: 29. August 2017

© 2017 Pham et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



For the meta-analysis of diagnostic test accuracy trials with a dichotomous understanding of the disease, one state-of-the-art model is the bivariate Generalized Linear Mixed Model (GLMM) which assumes the true positive and true negative counts to follow a binomial distribution drawn from the diseased and non-diseased population, respectively. Thus, the two outcomes sensitivity (=true positive rate) and specificity (=true negative rate) can be simultaneously modelled and the heterogeneity between studies as well as their correlation across studies be incorporated.

However, if the index test yields non-evaluable results, no standard procedure exists.

A novel idea is the modelling of unevaluable results as separate category, thereby extending the binomial distribution of the bivariate GLMM to the multinomial.

A simulation study was implemented to validate the performance of four competing GLMMs in terms of bias, mean squared error (MSE), coverage probability and convergence frequency: the multinomial, the excluding, the worst case and the extended trivariate GLMM. The excluding GLMM discarded the unevaluable results while the worst case model treated them as false results. The extended trivariate GLMM (TGLMM) modelled the unevaluable results as missing data with a missing at random structure and modelled the prevalence as third outcome which is adjusted for the non-evaluable results.

In the estimation of pooled sensitivity and specificity, the multinomial GLMM outperformed the remaining models in terms of bias, MSE and coverage probability. In the mean, the relative bias was about -0.5%, the MSE 0.002 and the coverage probability ~93%. All performance parameters improved considerably with a larger number of primary studies.

The worst case GLMM yielded estimates that came closest to the multinomial GLMM (mean relative bias ~ -2.0%, mean coverage probability ~ 90%) with an MSE nearly identical to the multinomial GLMM. Again, a larger number of primary studies improved the bias and the MSE. The coverage probability however decreased.

Estimates for sensitivity and specificity of the excluding GLMM and the extended TGLMM were markedly worse. The bias was theoretically derived and amounted to the odds of the non-evaluable results for the relative bias and to the product of the odds and the respective accuracy parameter for the absolute bias. Observed and theoretical bias were nearly identical. The MSE was also highly dependent on the true values. The coverage probability varied between 0% and 80%, with lower coverage probabilities in scenarios with larger number of studies. Regarding the convergence frequency, the worst case GLMM yielded the best results (mean: 99.9%± 0.4), followed by the excluding GLMM (mean: 99.0%± 2.2) and the multinomial GLMM (mean: 97.5% ± 3.5). The extended TGLMM failed to converge in > 50% of the cases.

The multinomial GLMM is an intuitive extension of the bivariate GLMM that models non-evaluable results as separate category. This approach satisfies the intention-to-diagnose principle and provides promising candidates for unbiased and efficient estimates of sensitivity and specificity, which consistently approach the true values with increasing number of primary studies.

Die Autoren geben an, dass kein Interessenkonflikt besteht.

Die Autoren geben an, dass kein Ethikvotum erforderlich ist.


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