Exact Inference for Random Effects Meta-Analyses with Small, Sparse Data

Meta-analysis aggregates information across related studies to provide more reliable statistical inference and has been a vital tool for assessing the safety and efficacy of many high profile pharmaceutical products. A key challenge in conducting a meta-analysis is that the number of related studies is typically small. Applying classical methods that are asymptotic in the number of studies can compromise the validity of inference, particularly when heterogeneity across studies is present. Moreover, serious adverse events are often rare and can result in one or more studies with no events in at least one study arm. Practitioners often apply arbitrary continuity corrections or remove zero-event studies to stabilize or define effect estimates in such settings, which can further invalidate subsequent inference. To address these significant practical issues, we introduce an exact inference method for comparing event rates in two treatment arms under a random effects framework, which we coin "XRRmeta". In contrast to existing methods, the coverage of the confidence interval from XRRmeta is guaranteed to be at or above the nominal level (up to Monte Carlo error) when the event rates, number of studies, and/or the within-study sample sizes are small. Extensive numerical studies indicate that XRRmeta does not yield overly conservative inference and we apply our proposed method to two real-data examples using our open source R package.