Multivariate meta-analysis of individual participant data helped externally validate the performance and implementation of a prediction model. | Biowebspin
Journal of clinical epidemiology. 2015 12 26

Multivariate meta-analysis of individual participant data helped externally validate the performance and implementation of a prediction model.

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Citimpact
Snell KI, Hua H, Debray TP, Ensor J, Look MP, Moons KG, Riley RD. Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, Public Health Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Abstract
OBJECTIVES: Our aim was to improve meta-analysis methods for summarizing a prediction model's performance when individual participant data are available from multiple studies for external validation.

STUDY DESIGN AND SETTING: We suggest multivariate meta-analysis for jointly synthesizing calibration and discrimination performance, while accounting for their correlation. The approach estimates a prediction model's average performance, the heterogeneity in performance across populations, and the probability of "good" performance in new populations. This allows different implementation strategies (e.g., recalibration) to be compared. Application is made to a diagnostic model for deep vein thrombosis (DVT) and a prognostic model for breast cancer mortality.

RESULTS: In both examples, multivariate meta-analysis reveals that calibration performance is excellent on average but highly heterogeneous across populations unless the model's intercept (baseline hazard) is recalibrated. For the cancer model, the probability of "good" performance (defined by C statistic ≥0.7 and calibration slope between 0.9 and 1.1) in a new population was 0.67 with recalibration but 0.22 without recalibration. For the DVT model, even with recalibration, there was only a 0.03 probability of "good" performance.

CONCLUSION: Multivariate meta-analysis can be used to externally validate a prediction model's calibration and discrimination performance across multiple populations and to evaluate different implementation strategies. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

PMID: 26142114
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