The sample size is the number of subjects in a clinical trial.
Reasons for the need for adequate sample sizes
ethics
budget
time.
The trial should be sufficiently large to provide a reliable answer to
the research question.
Usually based upon the primary objective of the trial
(efficacy as opposed to safety/tolerability).
Guidelines
ICH E9: Statistical Principles for Clinical Trials (Section 3.5: Sample Size).
Outline of points mentioned in ICH E9 Section 3.5 ‘Sample Size’.
Sample size specification in study protocol/report
primary variable (endpoint used to measure efficacy)
test statistic/form of analysis
null hypothesis
alternative ’working’ hypothesis
Error rates (defined over-leaf)
type I error rate (5% two-sided test)
type II error rate (10 or 20%)
how to deal with withdrawals and protocol violations.
Additional specifications
details of sample size method (including estimates of variances, differences to be detected)
sensitivity analysis: assess impact of changes in parameter values
for confirmatory trials (phase III): “…assumptions should normally be based on published data or on the results of earlier trials”
multiplicity considerations (controlling error rates).
Analysis set (primary analysis)
ITT
per protocol.
Classical hypothesis testing use p-values to determine
which of two competing hypotheses to draw from available data,
versus , say.
P-value: the probability of obtaining a test result as extreme or more
extreme than that observed assuming the null hypothesis is
true.
Choose the size of test is given by the value .
If reject and conclude data inconsistent with null. Often is used.
Methods based upon experimental data carry some risk of drawing a false conclusion
Truth | |||
---|---|---|---|
true | true | ||
Decision | Fail to reject | - | Type II error |
made | Reject | Type I error | - |
Unnumbered Figure: Link
type I error rate
type II error rate
critical value
power
The power of a test ’probability of concluding that the alternative hypothesis is true given that it is in fact, true….’ (Senn, 1997)
Power depends upon:
statistical test being used;
the size of that test ;
the nature and variability of the observations made
the alternative hypothesis (e.g the size of difference).
Usually the alternate hypothesis is based upon a clinically relevant difference, , say.
Consider (approx ) normally distributed test statistic
under and under
Set power equal to target value:
Note , solve equation for .
, iid with known variance .
vs. .
with .
.
Desired power: if (smallest clinically relevant difference), probability for rejection of the null hypothesis at least .
.
, , with and iid. Denote .
vs. .
.
known.
Exercise day 3: non-centrality parameter? sample size?
Data and hypotheses as for 2-sample Gauss test, but unknown variance.
Test statistic:
with
Non-centrality parameter
approximate sample size
Under : .
Under : with .
Sample size: smallest such that
Equation cannot be solved for explicitly.