A re-evaluation of the 'quantile approximation method' for random effects meta-analysis

The quantile approximation method has recently been proposed as a simple method for deriving confidence intervals for the treatment effect in a random effects meta-analysis. Although easily implemented, the quantiles used to construct intervals are derived front a single simulation study. Here it is shown that altering the study parameters, and in particular introducing changes to the distribution of the within-study variances, can have a dramatic impact on the resulting quantiles. This is further illustrated analytically by examining the scenario where all trials are assumed to be the same size. A more Cautious approach is therefore suggested, where the conventional standard normal quantile is used in the primary analysis, but where the use of alternative quantiles is also considered in a sensitivity analysis. Copyright (C) 2008 John Wiley & Sons, Ltd.