An extended trivariate vine copula mixed model for meta-analysis of diagnostic studies in the presence of non-evaluable outcomes

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A recent paper proposed an extended trivariate generalized linear mixed model (TGLMM) for synthesis of diagnostic test accuracy studies in the presence of non-evaluable index test results. Inspired by the aforementioned model we propose an extended trivariate vine copula mixed model that includes the TGLMM as special case, but can also operate on the original scale of sensitivity, specificity, and disease prevalence. The performance of the proposed vine copula mixed model is examined by extensive simulation studies in comparison with the TGLMM. Simulation studies showed that the TGLMM leads to biased meta-analytic estimates of sensitivity, specificity, and prevalence when the univariate random effects are misspecified. The vine copula mixed model gives nearly unbiased estimates of test accuracy indices and disease prevalence. Our general methodology is illustrated by meta-analysing coronary CT angiography studies.
Original languageEnglish
Article number20190107
Number of pages14
Journal International Journal of Biostatistics
Issue number2
Early online date10 Aug 2020
Publication statusPublished - Nov 2020


  • diagnostic tests
  • multivariate meta-analysis
  • prevalence
  • sensitivity
  • specificity
  • summary receiver operating characteristic curves

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