Bivariate network meta-analysis of diagnostic test accuracy studies synthesising multiple tests and multiple thresholds

Owen RK1, Cooper NJ1, Quinn T2, Sutton AJ1
1University of Leicester, 2University of Glasgow

Background: Network meta-analyses have extensively been used to compare the effectiveness of multiple interventions for healthcare policy and decision making. However, methods for evaluating the performance of multiple diagnostic tests are less established. In a decision-making context, we are often interested in comparing the performance of multiple diagnostic tests, at varying levels of test thresholds, in one simultaneous analysis.

Objectives: To develop a network meta-analysis framework in which diagnostic test accuracy data from multiple tests and thresholds can be synthesised and ranked in a single coherent analysis.

Methods: Motivated by an example of cognitive impairment diagnosis following stroke, we synthesised data from 13 studies assessing the efficiency of two diagnostic tests: Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), at two test thresholds: MMSE