Exploring heterogeneity in meta-analysis: is the L'Abbé plot useful?

By using a published meta-analysis as an example, this paper discusses the use of L'Abbe plot for investigating the potential sources of heterogeneity in meta-analysis. As compared with other graphic procedures, the L'Abbe plot is useful to identify not only the studies having different results from other studies, but also the study arms that are responsible for such differences. This may be important for determining the focus of heterogeneity investigations. Results of stochastic simulation indicate that, purely because of random variation, studies with event rates of around 50% are more likely to be identified as outliers in a L'Abbe plot. This paper also demonstrates that different methods may identify different trials as "outliers" in meta-analysis.