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16.9.1  Meta-analysis of rare events

For rare outcomes, meta-analysis may be the only way to obtain reliable evidence of the effects of healthcare interventions. Individual studies are usually underpowered to detect differences in rare outcomes, but a meta-analysis of many studies may have adequate power to investigate whether interventions do impact on the incidence of the rare event.  However, many methods of meta-analysis are based on large sample approximations, and are unsuitable when events are rare.  Thus authors must take care when selecting a method of meta-analysis.


There is no single risk at which events are classified as ‘rare’. Certainly risks of 1 in 1000 constitute rare events, and many would classify risks of 1 in 100 the same way. However, the performance of methods when risks are as high as 1 in 10 may also be affected by the issues discussed in this section.  What is typical is that a high proportion of the studies in the meta-analysis observe no events in one or more study arm.