Selection of the effect size for sample size determination for a continuous response in a superiority clinical trial using a hybrid classical and Bayesian procedure

Abstract

When designing studies that have a continuous outcome as the primary endpoint, the hypothesized effect size ([Formula: see text]), that is, the hypothesized difference in means ([Formula: see text]) relative to the assumed variability of the endpoint ([Formula: see text]), plays an important role in sample size and power calculations. Point estimates for [Formula: see text] and [Formula: see text] are often calculated using historical data. However, the uncertainty in these estimates is rarely addressed. This article presents a hybrid classical and Bayesian procedure that formally integrates prior information on the distributions of [Formula: see text] and [Formula: see text] into the study's power calculation. Conditional expected power, which averages the traditional power curve using the prior distributions of [Formula: see text] and [Formula: see text] as the averaging weight, is used, and the value of [Formula: see text] is found that equates the prespecified frequentist power ([Formula: see text]) and the conditional expected power of the trial. This hypothesized effect size is then used in traditional sample size calculations when determining sample size for the study. The value of [Formula: see text] found using this method may be expressed as a function of the prior means of [Formula: see text] and [Formula: see text], [Formula: see text], and their prior standard deviations, [Formula: see text]. We show that the "naïve" estimate of the effect size, that is, the ratio of prior means, should be down-weighted to account for the variability in the parameters. An example is presented for designing a placebo-controlled clinical trial testing the antidepressant effect of alprazolam as monotherapy for major depression. Through this method, we are able to formally integrate prior information on the uncertainty and variability of both the treatment effect and the common standard deviation into the design of the study while maintaining a frequentist framework for the final analysis. Solving for the effect size which the study has a high probability of correctly detecting based on the available prior information on the difference [Formula: see text] and the standard deviation [Formula: see text] provides a valuable, substantiated estimate that can form the basis for discussion about the study's feasibility during the design phase.