Meta‐CART: A tool to identify interactions between moderators in meta‐analysis

In the framework of meta‐analysis, moderator analysis is usually performed only univariately. When several study characteristics are available that may account for treatment effect, standard meta‐regression has difficulties in identifying interactions between them. To overcome this problem, meta‐CART has been proposed: an approach that applies classification and regression trees (CART) to identify interactions, and then subgroup meta‐analysis to test the significance of moderator effects. The previous version of meta‐CART has its shortcomings: when applying CART, the sample sizes of studies are not taken into account, and the effect sizes are dichotomized around the median value. Therefore, this article proposes new meta‐CART extensions, weighting study effect sizes by their accuracy, and using a regression tree to avoid dichotomization. In addition, new pruning rules are proposed. The performance of all versions of meta‐CART was evaluated via a Monte Carlo simulation study. The simulation results revealed that meta‐regression trees with random‐effects weights and a 0.5‐standard‐error pruning rule perform best. The required sample size for meta‐CART to achieve satisfactory performance depends on the number of study characteristics, the magnitude of the interactions, and the residual heterogeneity.