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Accounting for centre-effects in multicentre trials with a binary outcome - when, why, and how?

ABSTRACT: BACKGROUND: It is often desirable to account for centre-effects in the analysis of multicentre randomised trials, however it is unclear which analysis methods are best in trials with a binary outcome. METHODS: We compared the performance of four methods of analysis (fixed-effects models, random-effects models, generalised estimating equations (GEE), and Mantel-Haenszel) using a re-analysis of a previously reported randomised trial (MIST2) and a large simulation study. RESULTS: The re-analysis of MIST2 found that fixed-effects and Mantel-Haenszel led to many patients being dropped from the analysis due to over-stratification (up to 69% dropped for Mantel-Haenszel, and up to 33% dropped for fixed-effects). Conversely, random-effects and GEE included all patients in the analysis, however GEE did not reach convergence. Estimated treatment effects and p-values were highly variable across different analysis methods.The simulation study found that most methods of analysis performed well with a small number of centres. With a large number of centres, fixed-effects led to biased estimates and inflated type I error rates in many situations, and Mantel-Haenszel lost power compared to other analysis methods in some situations. Conversely, both random-effects and GEE gave nominal type I error rates and good power across all scenarios, and were usually as good as or better than either fixed-effects or Mantel-Haenszel. However, this was only true for GEEs with non-robust standard errors (SEs); using a robust 'sandwich' estimator led to inflated type I error rates across most scenarios. CONCLUSIONS: With a small number of centres, we recommend the use of fixed-effects, random-effects, or GEE with non-robust SEs. Random-effects and GEE with non-robust SEs should be used with a moderate or large number of centres.

SUBMITTER: Kahan BC

PROVIDER: S-EPMC3923100 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Accounting for centre-effects in multicentre trials with a binary outcome - when, why, and how?

Kahan Brennan C BC

BMC medical research methodology 20140210

<h4>Background</h4>It is often desirable to account for centre-effects in the analysis of multicentre randomised trials, however it is unclear which analysis methods are best in trials with a binary outcome.<h4>Methods</h4>We compared the performance of four methods of analysis (fixed-effects models, random-effects models, generalised estimating equations (GEE), and Mantel-Haenszel) using a re-analysis of a previously reported randomised trial (MIST2) and a large simulation study.<h4>Results</h4 ...[more]

PMID: 24512175

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Project description:MotivationAccurate power and sample size estimation is crucial to the design and analysis of genetic association studies. When analyzing a binary trait via logistic regression, important covariates such as age and sex are typically included in the model. However, their effects are rarely properly considered in power or sample size computation during study planning. Unlike when analyzing a continuous trait, the power of association testing between a binary trait and a genetic variant depends, explicitly, on covariate effects, even under the assumption of gene-environment independence. Earlier work recognizes this hidden factor but the implemented methods are not flexible. We thus propose and implement a generalized method for estimating power and sample size for (discovery or replication) association studies of binary traits that (i) accommodates different types of nongenetic covariates E, (ii) deals with different types of G-E relationships, and (iii) is computationally efficient.ResultsExtensive simulation studies show that the proposed method is accurate and computationally efficient for both prospective and retrospective sampling designs with various covariate structures. A proof-of-principle application focused on the understudied African sample in the UK Biobank data. Results show that, in contrast to studying the continuous blood pressure trait, when analyzing the binary hypertension trait ignoring covariate effects of age and sex leads to overestimated power and underestimated replication sample size.Availability and implementationThe simulated datasets can be found on the online web-page of this manuscript, and the UK Biobank application data can be accessed at https://www.ukbiobank.ac.uk. The R package SPCompute that implements the proposed method is available at CRAN. The genome-wide association studies are carried out using the software PLINK 2.0 [Purcell et al. (Plink: a tool set for whole-genome association and population-based linkage analyses. Am J Hum Genet 2007;81:559-75.)].

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Accounting for centre-effects in multicentre trials with a binary outcome - when, why, and how?

Publications

Accounting for centre-effects in multicentre trials with a binary outcome - when, why, and how?

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