Meta-analysis Summative Exam

Jessa Frances V. Francisco

ADZU-SOM
Level 5

1. The data below includes nine studies where patients were randomized to be treated for
cardiac arrest based on either old guidelines or new guidelines. Outcome was survival (being
alive) and we focused on the odds ratio as the effect size. Do both fixed-effects model and
random-effects model. Interpret completely the results.

Fixed-Effect Model

Random-Effect Model

Interpretation: Same outcome result for both fixed effect and random effect models.
 Trend
There is an increase in survival outcome among patients treated using the new guidelines
compared to the old guideline.
Pooled Results
The random effects model revealed OR 1.39 and CI of 1.10-1.75 and Z value of 2.80 and P value
of 0.005. While the fixed effect model revealed an OR of 1.31 and CI of 1.17-1.46 and Z value
4.61 and P value of 0.00001. This means an increased in the survival outcome on patient treated
using the new treatment guidelines compared to the old guidelines.
Variance
Chi square result of 24.04, P value of 0.002, Tau square 0.07 and I square 67% means that
variance for both models showed moderate heterogeneity.

2. Data on eight randomized controlled trials of the effectiveness of the calcium channel blocker
amlodipine as compared to placebo in improving work capacity in patients with angina. Effect
size was the difference in mean. Do both fixed-effects model and random-effects model. Which
model is the most appropriate to use? On the basis of the best model, interpret the results
completely.
Fixed-Effect Model

Random-effects Model
Interpretation: Both fixed and random effect model revealed the same outcome.

Trend
Mean difference of the fixed-effects and the random-effects model is 0.16. This means an
increase in the work capacity of patients treated with amlodipine compared to placebo only.

Pooled results
There is an increase in the work capacity of patients treated with amlodipine based on results of
mean difference of 0.16, CI of 0.10, 0.23 in the fixed-effects model and the same mean
difference of 0.16 for the random effect with CI of 0.07,0.25 in the random effect model
compared to the placebo. For the fixed effect model, Z value is 5.01 and P value of 0.00001
while random effect model has Z value of 3.54 and P value of 0.0004.

Variance
Variance for both fixed effect and random effect model revealed a Chi square result of 12.33 Df
of 7 and I square 43% which means that it has moderate heterogeneity. The fixed effect model is
more suitable to used considering its P value of <0.00001.