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Meta-Analysis for Medical Decisions

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  • Charles F. Manski

Abstract

Statisticians have proposed meta-analysis to combine the findings of multiple studies of health risks or treatment response. The standard practice is to compute a weighted-average of the estimates. Yet it is not clear how to interpret a weighted average of estimates reported in disparate studies. Meta-analyses often answer this question through the lens of a random-effects model, which interprets a weighted average of estimates as an estimate of a mean parameter across a hypothetical population of studies. The relevance to medical decision making is obscure. Decision-centered research should aim to inform risk assessment and treatment for populations of patients, not populations of studies. This paper lays out principles for decision-centered meta-analysis. One first specifies a prediction of interest and next examines what each available study credibly reveals. Such analysis typically yields a set-valued prediction rather than a point prediction. Thus, one uses each study to conclude that a probability of disease, or mean treatment response, lies within a range of possibilities. Finally, one combines the available studies by computing the intersection of the set-valued predictions that they yield. To demonstrate decision-centered meta-analysis, the paper considers assessment of the effect of anti-hypertensive drugs on blood pressure.

Suggested Citation

  • Charles F. Manski, 2019. "Meta-Analysis for Medical Decisions," NBER Working Papers 25504, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:25504
    Note: EH TWP
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    References listed on IDEAS

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    1. Manski, Charles F, 1990. "Nonparametric Bounds on Treatment Effects," American Economic Review, American Economic Association, vol. 80(2), pages 319-323, May.
    2. T. D. Stanley & Stephen B. Jarrell, 2005. "Meta‐Regression Analysis: A Quantitative Method of Literature Surveys," Journal of Economic Surveys, Wiley Blackwell, vol. 19(3), pages 299-308, July.
    3. Kreider, Brent & Pepper, John V., 2007. "Disability and Employment: Reevaluating the Evidence in Light of Reporting Errors," Journal of the American Statistical Association, American Statistical Association, vol. 102, pages 432-441, June.
    4. Toru Kitagawa & Aleksey Tetenov, 2018. "Who Should Be Treated? Empirical Welfare Maximization Methods for Treatment Choice," Econometrica, Econometric Society, vol. 86(2), pages 591-616, March.
    5. Charles F. Manski, 2004. "Statistical Treatment Rules for Heterogeneous Populations," Econometrica, Econometric Society, vol. 72(4), pages 1221-1246, July.
    6. Manski, Charles F., 2016. "Interpreting Point Predictions: Some Logical Issues," Foundations and Trends(R) in Accounting, now publishers, vol. 10(2-4), pages 238-261, August.
    7. Charles F. Manski & John V. Pepper, 2000. "Monotone Instrumental Variables, with an Application to the Returns to Schooling," Econometrica, Econometric Society, vol. 68(4), pages 997-1012, July.
    8. Charles F. Manski, 2018. "Reasonable patient care under uncertainty," Health Economics, John Wiley & Sons, Ltd., vol. 27(10), pages 1397-1421, October.
    9. Stoye, Jörg, 2009. "Minimax regret treatment choice with finite samples," Journal of Econometrics, Elsevier, vol. 151(1), pages 70-81, July.
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    11. Clemen, Robert T., 1989. "Combining forecasts: A review and annotated bibliography," International Journal of Forecasting, Elsevier, vol. 5(4), pages 559-583.
    12. Jeff Dominitz & Charles F. Manski, 2017. "More Data or Better Data? A Statistical Decision Problem," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 84(4), pages 1583-1605.
    13. Charles F. Manski, 2004. "Social Learning from Private Experiences: The Dynamics of the Selection Problem," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 71(2), pages 443-458.
    14. David J. Spiegelhalter & Laurence S. Freedman & Mahesh K. B. Parmar, 1994. "Bayesian Approaches to Randomized Trials," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 157(3), pages 357-387, May.
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    Full references (including those not matched with items on IDEAS)

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    More about this item

    JEL classification:

    • C18 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Methodolical Issues: General
    • I1 - Health, Education, and Welfare - - Health

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