International Journal of Technology Assessment in Health Care


Meta-analysis when only the median survival times are known: A comparison with individual patient data results

Stefan Michiels a1, Pascal Piedbois a2, Sarah Burdett a3, Nathalie Syz a1, Lesley Stewart a3 and Jean-Pierre Pignon a1
a1 Institut Gustave-Roussy
a2 Henri Mondor Hospital
a3 MRC Clinical Trials Unit


Background: The hazard ratio (HR) is the most appropriate measure for time to event outcomes such as survival. In systematic reviews, HRs can be calculated either from the raw trial data obtained as part of an individual patient data (IPD) meta-analysis or from the appropriate trial-level summary statistics. However, the information required for the latter are seldom reported in sufficient detail to allow reviewers to calculate HRs. In contrast, the median survival and survival rates at specific time points are frequently presented. We aimed to evaluate retrospectively the performance of meta-analyses using median survival times and survival rates by comparing them with meta-analyses using IPD to calculate HRs.

Methods: IPD from thirteen published meta-analyses (MAs) in cancers with high mortality rates were used. Median survival and survival rates were calculated from the IPD rather than taken from publications so that the same trials, patients, and extended follow-up are used in each analysis.

Results and Conclusions: We show that using median survival times or survival rates at a particular point in time are not reasonable surrogate measures for meta-analyses of survival outcomes and that, wherever possible, HRs should be calculated. Individual trial publications reporting on time to event outcomes, therefore, should provide more detailed statistical information, preferably logHRs and their variances, or their estimators.

Key Words: Meta-analysis; Summary data; Median survival time; Survival analysis; Time to event outcomes.