The binomial distribution of meta-analysis was preferred to model within-study variability

Objective: When studies report proportions such as sensitivity or specificity, it is customary to meta-analyze them using the DerSimonian and Laird random effects model. This method approximates the within-study variability of the proportion by a normal distribution, which may lead to bias for several reasons. Alternatively an exact likelihood approach based on the binomial within-study distribution can be used. This method can easily be performed in standard statistical packages. We investigate the performance of the standard method and the alternative approach. Study Design and Setting: We compare the two approaches through a simulation study, in terms of bias, mean-squared error, and coverage probabilities. We varied the size of the overall sensitivity or specificity, the between-studies variance, the within-study sample sizes, and the number of studies. The methods are illustrated using a published meta-analysis data set. Results: The exact likelihood approach performs always better than the approximate approach and gives unbiased estimates. The coverage probability, in particular for the profile likelihood, is also reasonably acceptable. In contrast, the approximate approach gives huge bias with very poor coverage probability in many cases. Conclusion: The exact likelihood approach is the method of preference and should be used whenever feasible. (C) 2008 Elsevier Inc. All rights reserved.