An Exact Test for Meta-analysis with Binary Endpoints

Summary Objectives : We reintroduce an exact Mantel-Haenszel (MH) procedure for meta-analysis with binary endpoints which is expected to workespeciallywell i sparse data, e.g., in meta-analyses of safety or adverse events. Methods : The performance of the exact MH procedure in terms of empirical size and power is compared to the asymptotic MH and to the two standard procedures (fixed effects and random effects model) in a simulation study. We illustrate the methods with a metaanalysis of postoperative stroke occurrence after offpump or on-pump surgery in coronary artery bypass grafting. Results : We find that in almost all situations the asymptotic MH procedure outperforms its competitors; especially the standard methods yield poor results in terms of power and size. Conclusions : There is no need to use the reintroduced exact MH procedure; the asymptotic MH procedure will be sufficient in most practical situations. The standard methods (fixed effects and random effects model) should not be used in the sparse data situation.