Meta-analysis and the synthesis of evidence

Use of meta-analytical (quantitative overview) techniques is now commonplace in a large range of medical-research contexts, with a rapid rise in its frequency of use being particularly apparent in the last decade. Many methods of meta-analysis have been proposed and used, from crude 'vote-counting' of studies showing significant or nonsignificant results, through methods for combination of effect-size estimates based on fixed- or random-effects models, to general, linear, mixed models and Bayesian methods. The history of meta-analysis and the advantages and disadvantages of various approaches to it are briefly reviewed in this paper, with reference to its application in health-services research and related fields. Broader approaches to the synthesis of evidence in these contexts using conventional multilevel modelling and hierarchical Bayesian models to address the combination of evidence from disparate types of study are then outlined.