title: The Moses-Littenberg meta-analytical method generates systematic differences in test accuracy compared to hierarchical meta-analytical models.
abstract: To compare meta-analyses of diagnostic test accuracy using the Moses-Littenberg summary receiver operating characteristic (SROC) approach with those of the hierarchical SROC (HSROC) model.
  
  
  
  Twenty-six data sets from existing test accuracy systematic reviews were reanalyzed with the Moses-Littenberg model, using equal weighting ("E-ML") and weighting by the inverse variance of the log DOR ("W-ML"), and with the HSROC model. The diagnostic odds ratios (DORs) were estimated and covariates added to both models to estimate relative DORs (RDORs) between subgroups. Models were compared by calculating the ratio of DORs, the ratio of RDORs, and P-values for detecting asymmetry and effects of covariates on DOR.
  
  
  
  Compared to the HSROC model, the Moses-Littenberg model DOR estimates were a median of 22% ("E-ML") and 47% ("W-ML") lower at Q*, and 7% and 42% lower at the central point in the data. Instances of the ML models giving estimates higher than the HSROC model also occurred. Investigations of heterogeneity also differed; the Moses-Littenberg models on average estimating smaller differences in RDOR.
  
  
  
  Moses-Littenberg meta-analyses can generate lower estimates of test accuracy, and smaller differences in accuracy, compared to mathematically superior hierarchical models. This has implications for the usefulness of meta-analyses using this approach. We recommend meta-analysis of diagnostic test accuracy studies to be conducted using available hierarchical model-based approaches.
authors.affiliation: Biostatistics, Evidence Synthesis and Test Evaluation Research Group, Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Dinnes
authors.affiliation: Biostatistics, Evidence Synthesis and Test Evaluation Research Group, Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Mallett
authors.affiliation: Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford/Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Hopewell
authors.affiliation: Department of Public Health Sciences and Medical Statistics, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Roderick
authors.affiliation: Biostatistics, Evidence Synthesis and Test Evaluation Research Group, Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. Electronic address: j.deeks@bham.ac.uk.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Deeks
mesh_terms: D003955:Diagnostic Tests, Routine / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D015201:Meta-Analysis as Topic; D016017:Odds Ratio; D012372:ROC Curve; D015203:Reproducibility of Results
keywords: Diagnostic odds ratio; Diagnostic test accuracy; Hierarchical models; Meta-analysis; Summary ROC curves; Systematic review