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Sample size calculation in clinical trial using R.

ABSTRACT: Since the era of evidence-based medicine, it has become a matter of course to use statistics to create objective evidence in clinical research. As an extension of this, it has become essential in clinical research to calculate the correct sample size to demonstrate a clinically significant difference before starting the study. Also, because sample size calculation methods vary from study design to study design, there is no formula for sample size calculation that applies to all designs. It is very important for us to understand this. In this review, each sample size calculation method suitable for various study designs was introduced using the R program (R Foundation for Statistical Computing). In order for clinical researchers to directly utilize it according to future research, we presented practice codes, output results, and interpretation of results for each situation.

SUBMITTER: Park S

PROVIDER: S-EPMC10020745 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Sample size calculation in clinical trial using R.

Park Suyeon S Kim Yeong-Haw YH Bang Hae In HI Park Youngho Y

Journal of minimally invasive surgery 20230301 1

Since the era of evidence-based medicine, it has become a matter of course to use statistics to create objective evidence in clinical research. As an extension of this, it has become essential in clinical research to calculate the correct sample size to demonstrate a clinically significant difference before starting the study. Also, because sample size calculation methods vary from study design to study design, there is no formula for sample size calculation that applies to all designs. It is ve ...[more]

PMID: 36936043

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Project description:BackgroundMulti-centre randomized controlled clinical trials play an important role in modern evidence-based medicine. Advantages of collecting data from more than one site are numerous, including accelerated recruitment and increased generalisability of results. Mixed models can be applied to account for potential clustering in the data, in particular when many small centres contribute patients to the study. Previously proposed methods on sample size calculation for mixed models only considered balanced treatment allocations which is an unlikely outcome in practice if block randomisation with reasonable choices of block length is used.MethodsWe propose a sample size determination procedure for multi-centre trials comparing two treatment groups for a continuous outcome, modelling centre differences using random effects and allowing for arbitrary sample sizes. It is assumed that block randomisation with fixed block length is used at each study site for subject allocation. Simulations are used to assess operation characteristics such as power of the sample size approach. The proposed method is illustrated by an example in disease management systems.ResultsA sample size formula as well as a lower and upper boundary for the required overall sample size are given. We demonstrate the superiority of the new sample size formula over the conventional approach of ignoring the multi-centre structure and show the influence of parameters such as block length or centre heterogeneity. The application of the procedure on the example data shows that large blocks require larger sample sizes, if centre heterogeneity is present.ConclusionUnbalanced treatment allocation can result in substantial power loss when centre heterogeneity is present but not considered at the planning stage. When only few patients by centre will be recruited, one has to weigh the risk of imbalance between treatment groups due to large blocks and the risk of unblinding due to small blocks. The proposed approach should be considered when planning multi-centre trials.

Project description:BackgroundObservational burden of illness studies are used in pharmacoepidemiology to address a variety of objectives, including contextualizing the current treatment setting, identifying important treatment gaps, and providing estimates to parameterize economic models. Methodologies such as retrospective chart review may be utilized in settings for which existing datasets are not available or do not include sufficient clinical detail. While specifying the number of charts to be extracted and/or determining whether the number that can feasibly extracted will be clinically meaningful is an important study design consideration, there is a lack of rigorous methods available for sample size calculation in this setting. The objective of this study was to develop recommended sample size calculations for use in such studies.MethodsCalculations for identifying the optimal feasible sample size calculations were derived, for studies characterizing treatment patterns and medical costs, based on the ability to comprehensively observe treatments and maximize precision of resulting 95% confidence intervals. For cost outcomes, if the standard deviation is not known, the coefficient of variation cv can be used as an alternative. A case study of a chart review of advanced melanoma (MELODY) was used to characterize plausible values for cv in a real-world example.ResultsAcross sample sizes, any treatment given with greater than 1% frequency has a high likelihood of being observed. For a sample of size 200, and a treatment given to 5% of the population, the precision of a 95% confidence interval (CI) is expected to be ±0.03. For cost outcomes, for the median cv value observed in the MELODY study (0.72), a sample size of approximately 200 would be required to generate a 95% CI precise to within ±10% of the mean.ConclusionThis study presents a formal guidance on sample size calculations for retrospective burden of illness studies. The approach presented here is methodologically rigorous and designed for practical application in real-world retrospective chart review studies.

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Sample size calculation in clinical trial using R.

Publications

Sample size calculation in clinical trial using R.

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