6 Introduction to Sample Size Determination

6.1 Defining the sample size

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definition

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).

6.2 ICH E9

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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.

6.3 Hypothesis tests and error rates

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Classical hypothesis testing use p-values to determine which of two competing hypotheses to draw from available data, H0 versus H1, say.

P-value: the probability p of obtaining a test result as extreme or more extreme than that observed assuming the null hypothesis H0 is true.

Choose the size of test is given by the value α.

If pα reject H0 and conclude data inconsistent with null. Often α=0.05 is used.

Methods based upon experimental data carry some risk of drawing a false conclusion

Truth
H0 true H1 true
Decision Fail to reject H0 - Type II error
made Reject H0 Type I error -

Unnumbered Figure: Link

  • type I error rate α

  • type II error rate β

  • critical value tcrit

  • power =1-β=P(rejectH0H1 true)

6.4 Power of a test

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Definition

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 α;

  • 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, Δ*, say.

6.5 Basic principle of power calculation

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Consider (approx ) normally distributed test statistic ZN(θ,1)

θ=0 under H0 and θ=θ under H1

Set power equal to target value: P(ZΦ-1(1-α)H1 true)=1-β

1-Φ(Φ-1(1-α)-θ)=1-β
θ=Φ-1(1-α)+Φ-1(1-β)

Note θ=θ(n), solve equation for n.

6.6 One-sample Gauss test

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Data

ZiN(Δ,σ2), i=1,,n iid with known variance σ2.

Hypotheses

H0:Δ=0 vs. H1:Δ>0.

Test statistic

Z=nZ¯σ with Z¯=1ni=1nZi.

Critical value

Φ-1(1-α).

Desired power: if Δ=Δ (smallest clinically relevant difference), probability for rejection of the null hypothesis at least 1-β.

Non-centrality parameter

θ=nΔσ.

Required sample size
n=(Φ-1(α)+Φ-1(β))2Δ2σ2

6.7 Two-sample Gauss test

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Data

XijN(μi,σ2), i=1,2, j=1,,ni with n1=rn and n2=(1-r)n iid. Denote Δ=μ1-μ2.

Hypotheses

H0:Δ=0 vs. H1:Δ=Δ*>0.

Test statistic

T=r(1-r)nX¯1-X¯2σ.

Variance

σ2 known.

Exercise day 3: non-centrality parameter? sample size?

6.8 Approximate sample size for two sample t-test

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Data and hypotheses as for 2-sample Gauss test, but unknown variance.
Test statistic:

T=r(1-r)nX¯1-X¯2S

with

S2=1n-2i=12j=1ni(Xij-X¯i)2

Non-centrality parameter
θ=r(1-r)nΔσ

approximate sample size

n=1r(1-r)(Φ-1(α)+Φ-1(β))2Δ2σ2

6.9 Exact sample size for two-sample t-test

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Under H0:Δ=0: Tt(n-2).

Under H1:Δ=Δ: Tt(n-2,θ) with θ=r(1-r)nΔσ.

Sample size: smallest n such that

1-Tn-2,θ(tn-2,1-α)1-β.

Equation cannot be solved for n explicitly.