title: Meta-analytic estimation of measurement variability and assessment of its impact on decision-making: the case of perioperative haemoglobin concentration monitoring.
abstract: BACKGROUND
  As a part of a larger Health Technology Assessment (HTA), the measurement error of a device used to monitor the hemoglobin concentration of a patient undergoing surgery, as well as its decision consequences, were to be estimated from published data.
  
  
  METHODS
  A Bayesian hierarchical model of measurement error, allowing the meta-analytic estimation of both central and dispersion parameters (under the assumption of normality of measurement errors) is proposed and applied to published data; the resulting potential decision errors are deduced from this estimation. The same method is used to assess the impact of an initial calibration.
  
  
  RESULTS
  The posterior distributions are summarized as mean ± sd (credible interval). The fitted model exhibits a modest mean expected error (0.24 ± 0.73 (-1.23 1.59) g/dL) and a large variability (mean absolute expected error 1.18 ± 0.92 (0.05 3.36) g/dL). The initial calibration modifies the bias (-0.20 ± 0.87 (-1.99 1.49) g/dL), but the variability remains almost as large (mean absolute expected error 1.05 ± 0.87 (0.04 3.21) g/dL). This entails a potential decision error ("false positive" or "false negative") for about one patient out of seven.
  
  
  CONCLUSIONS
  The proposed hierarchical model allows the estimation of the variability from published aggregates, and allows the modeling of the consequences of this variability in terms of decision errors. For the device under assessment, these potential decision errors are clinically problematic.
authors.affiliation: Secrétariat Scientifique du CEDIT - Assistance Publique - Hôpitaux de Paris, 3, Avenue Victoria, Paris, F-75186, France. emmanuel.charpentier@aphp.fr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Charpentier
authors.affiliation: Secrétariat Scientifique du CEDIT - Assistance Publique - Hôpitaux de Paris, 3, Avenue Victoria, Paris, F-75186, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Looten
authors.affiliation: Secrétariat Scientifique du CEDIT - Assistance Publique - Hôpitaux de Paris, 3, Avenue Victoria, Paris, F-75186, France.
authors.forename: Björn
authors.initials: B
authors.lastname: Fahlgren
authors.affiliation: Secrétariat Scientifique du CEDIT - Assistance Publique - Hôpitaux de Paris, 3, Avenue Victoria, Paris, F-75186, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Barna
authors.affiliation: CEDIT - Assistance Publique - Hôpitaux de Paris, 3, Avenue Victoria, Paris, F-75186, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Guillevin
mesh_terms: D000465:Algorithms; D001499:Bayes Theorem; D002138:Calibration; D003657:Decision Making; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008962:Models, Theoretical; D059035:Perioperative Period; D015203:Reproducibility of Results; D013673:Technology Assessment, Biomedical / Q000379:methods*
chemical_list: D006454:Hemoglobins