Unconditional Exact Tests for Equivalence or Noninferiority for Paired Binary Endpoints

Problems of establishing equivalence or noninferiority between two medical diagnostic procedures involve comparisons of the response rates between correlated proportions. When the sample size is small, the asymptotic tests may not be reliable. This article proposes an unconditional exact test procedure to assess equivalence or noninferiority. Two statistics, a sample-based test statistic and a restricted maximum likelihood estimation (RMLE)-based test statistic, to define the rejection region of the exact test are considered. We show the p-value of the proposed unconditional exact tests can be attained at the boundary point of the null hypothesis. Assessment of equivalence is often based on a comparison of the confidence limits with the equivalence limits. We also derive the unconditional exact confidence intervals on the difference of the two proportion means for the two test statistics. A typical data set of comparing two diagnostic procedures is analyzed using the proposed unconditional exact and asymptotic methods. The p-value from the unconditional exact tests is generally larger than the p-value from the asymptotic tests. In other words, an exact confidence interval is generally wider than the confidence interval obtained from an asymptotic test.     

Exact unconditional inference for risk ratio in a correlated 2 x 2 table with structural zero

In this article, we consider small-sample statistical inference for rate ratio (RR) in a correlated 2 x 2 table with a structural zero in one of the off-diagonal cells. Existing Wald's test statistic and logarithmic transformation test statistic will be adopted for this purpose. Hypothesis testing and confidence interval construction based on large-sample theory will be reviewed first. We then propose reliable small-sample exact unconditional procedures for hypothesis testing and confidence interval construction. We present empirical results to evince the better confidence interval performance of our proposed exact unconditional procedures over the traditional large-sample procedures in small-sample designs. Unlike the findings given in Lui (1998, Biometrics 54, 706-711), our empirical studies show that the existing asymptotic procedures may not attain a prespecified confidence level even in moderate sample-size designs (e.g., n = 50). Our exact unconditional procedures on the other hand do not suffer from this problem. Hence, the asymptotic procedures should be applied with caution. We propose two approximate unconditional confidence interval construction methods that outperform the existing asymptotic ones in terms of coverage probability and expected interval width. Also, we empirically demonstrate that the approximate unconditional tests are more powerful than their associated exact unconditional tests. A real data set from a two-step tuberculosis testing study is used to illustrate the methodologies.     

Statistical analysis of noninferiority trials with a rate ratio in small-sample matched-pair designs

Testing of noninferiority has become increasingly important in modern medicine as a means of comparing a new test procedure to a currently available test procedure. Asymptotic methods have recently been developed for analyzing noninferiority trials using rate ratios under the matched-pair design. In small samples, however, the performance of these asymptotic methods may not be reliable, and they are not recommended. In this article, we investigate alternative methods that are desirable for assessing noninferiority trials, using the rate ratio measure under small-sample matched-pair designs. In particular, we propose an exact and an approximate exact unconditional test, along with the corresponding confidence intervals based on the score statistic. The exact unconditional method guarantees the type I error rate will not exceed the nominal level. It is recommended for when strict control of type I error (protection against any inflated risk of accepting inferior treatments) is required. However, the exact method tends to be overly conservative (thus, less powerful) and computationally demanding. Via empirical studies, we demonstrate that the approximate exact score method, which is computationally simple to implement, controls the type I error rate reasonably well and has high power for hypothesis testing. On balance, the approximate exact method offers a very good alternative for analyzing correlated binary data from matched-pair designs with small sample sizes. We illustrate these methods using two real examples taken from a crossover study of soft lenses and a Pneumocystis carinii pneumonia study. We contrast the methods with a hypothetical example.     

Unconditional versions of several tests commonly used in the analysis of contingency tables

By focusing on a confidence interval for a nuisance parameter, Berger and Boos (1994, Journal of the American Statistical Association 89, 1012-1016) proposed new unconditional tests. In particular, they showed that, for a 2 x 2 table, this procedure generally was more powerful than Fisher's exact test. This paper utilizes and extends their approach to obtain unconditional tests for combining several 2 x 2 tables and testing for trend and homogeneity in a 2 x K table. The unconditional procedures are compared to the conditional ones by reanalyzing some published biomedical data.     

An Exact Unconditional test for the Hardy-Weinberg Equilibrium

An exact test based on the unconditional distribution of a test statistic for the Hardy-Weinberg equilibrium is introduced. This test is usually more powerful and requires less extensive tabulations compared with the (ordinary) exact conditional test. Tables of critical values are given for N = 5(1)100 and α =·10, ·05, ·01. Sample sizes required to attain a given power with the unconditional and conditional exact tests are provided.     

Most Powerful Permutation Invariant Tests for Relatedness Hypotheses Using Genotypic Data

The problem of inferring kinship structure among a sample of individuals using genetic markers is considered with the objective of developing hypothesis tests for genetic relatedness with nearly optimal properties. The class of tests considered are those that are constrained to be permutation invariant, which in this context defines tests whose properties do not depend on the labeling of the individuals. This is appropriate when all individuals are to be treated identically from a statistical point of view. The approach taken is to derive tests that are probably most powerful for a permutation invariant alternative hypothesis that is, in some sense, close to a null hypothesis of mutual independence. This is analagous to the locally most powerful test commonly used in parametric inference. Although the resulting test statistic is a U-statistic, normal approximation theory is found to be inapplicable because of high skewness. As an alternative it is found that a conditional procedure based on the most powerful test statistic can calculate accurate significance levels without much loss in power. Examples are given in which this type of test proves to be more powerful than a number of alternatives considered in the literature, including Queller and Goodknight's (1989) estimate of genetic relatedness, the average number of shared alleles (Blouin, 1996), and the number of feasible sibling triples (Almudevar and Field, 1999).     

Exact tests for the analysis of case-control studies of genetic markers

OBJECTIVES: The association of a candidate gene with disease can be evaluated by a case-control study in which the genotype distribution is compared for diseased cases and unaffected controls. Usually, the data are analyzed with Armitage's test using the asymptotic null distribution of the test statistic. Since this test does not generally guarantee a type I error rate less than or equal to the significance level alpha, tests based on exact null distributions have been investigated. METHODS: An algorithm to generate the exact null distribution for both Armitage's test statistic and a recently proposed modification of the Baumgartner-Weiss-Schindler statistic is presented. I have compared the tests in a simulation study. RESULTS: The asymptotic Armitage test is slightly anticonservative whereas the exact tests control the type I error rate. The exact Armitage test is very conservative, but the exact test based on the modification of the Baumgartner-Weiss-Schindler statistic has a type I error rate close to alpha. The exact Armitage test is the least powerful test; the difference in power between the other two tests is often small and the comparison does not show a clear winner. CONCLUSION: Simulation results indicate that an exact test based on the modification of the Baumgartner-Weiss-Schindler statistic is preferable for the analysis of case-control studies of genetic markers.     

A Comparison of the Three Conditional Exact Tests in Two‐way Contingency Tables Using the Unconditional Exact Power

The conditional exact tests of homogeneity of two binomial proportions are often used in small samples, because the exact tests guarantee to keep the size under the nominal level. The Fisher's exact test, the exact chi‐squared test and the exact likelihood ratio test are popular and can be implemented in software StatXact. In this paper we investigate which test is the best in small samples in terms of the unconditional exact power. In equal sample cases it is proved that the three tests produce the same unconditional exact power. A symmetry of the unconditional exact power is also found. In unequal sample cases the unconditional exact powers of the three tests are computed and compared. In most cases the Fisher's exact test turns out to be best, but we characterize some cases in which the exact likelihood ratio test has the highest unconditional exact power. (© 2004 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

Unconditional inferences on the difference of two proportions in cross-sectional studies

In order to analyse a 2 x 2 table it is usual to perform inferences (hypothesis test or interval of confidence) on the difference d = p2 - p1 between two independent proportions. To this end it has been customary to adopt the Fisher conditional method, but nowadays the unconditional method of Barnard is increasingly adopted. However, all the present unconditional inferences are based on a double-binomial model. This article performs these inferences - exact and asymptotic - under a multinomial model, which is the appropriate one when the data proceed from a cross-sectional survey. At http://www.ugr.es/-bioest/SG_ASO.EXE there is a program for performing the said unconditional tests that may be copied.     

The 2 x 2 matched-pairs trial: exact unconditional design and analysis

An exact unconditional method for the design and analysis of the 2 x 2 matched-pairs trial is presented. Unlike the exact conditional method, which is based on only the number of discordant pairs, the exact unconditional method uses the total number N of sampled pairs. This unconditional test, based on a simple Z statistic, yields sample sizes that are generally smaller than those produced by the exact conditional test for the cases tabulated herein, namely one-sided alpha = .01, .025, and .05 along with 80% and 90% power. Moreover, it is found to be uniformly more powerful than the latter for all the combinations of parameters considered in this paper, namely alpha = .01, .025, and .05, and N = 10(1)200. The method is illustrated by assessing various design options of an in vitro study of the effectiveness of antimicrobial agents. Some numerical examples of matching efficiency are also given.