A note on one-sided tests with multiple endpoints

Testing problems with multivariate one-sided alternative hypotheses are common in clinical trials with multiple endpoints. In the case of comparing two treatments, treatment 1 is often preferred if it is superior for at least one of the endpoints and not biologically inferior for the remaining endpoints. Bloch et al. (2001, Biometrics57, 1039-1047) propose an intersection-union test (IUT) for this testing problem, but their test does not utilize the appropriate multivariate one-sided test. In this note we modify their test by an alternative IUT that does utilize the appropriate one-sided test. Empirical and graphical evidence show that the proposed test is more appropriate for this testing problem.     

Power and sample size estimation for the clustered wilcoxon test

The Wilcoxon rank sum test is widely used for two-group comparisons of nonnormal data. An assumption of this test is independence of sampling units both within and between groups, which will be violated in the clustered data setting such as in ophthalmological clinical trials, where the unit of randomization is the subject, but the unit of analysis is the individual eye. For this purpose, we have proposed the clustered Wilcoxon test to account for clustering among multiple subunits within the same cluster (Rosner, Glynn, and Lee, 2003, Biometrics 59, 1089-1098; 2006, Biometrics 62, 1251-1259). However, power estimation is needed to plan studies that use this analytic approach. We have recently published methods for estimating power and sample size for the ordinary Wilcoxon rank sum test (Rosner and Glynn, 2009, Biometrics 65, 188-197). In this article we present extensions of this approach to estimate power for the clustered Wilcoxon test. Simulation studies show a good agreement between estimated and empirical power. These methods are illustrated with examples from randomized trials in ophthalmology. Enhanced power is achieved with use of the subunit as the unit of analysis instead of the cluster using the ordinary Wilcoxon rank sum test.     

On the use of historical control data for trend test in carcinogenicity studies

Historical control data are often available in carcinogenicity studies and are included for testing dose effects in current studies. A new method is developed for incorporating the historical control information into a dose effect test. The method generalizes the test procedures proposed by Tarone (1982, Biometrics 38, 215-220) and Ibrahim and Ryan (1996, Biometrics 52, 1478-1485) by taking into account the variation resulting from parameter estimation based on historical data. Two examples are discussed for illustrating the proposed method.     

Efficiency of balanced treatment allocation for survival analysis

We assess the efficiency of balanced treatment allocation methods in clinical trials for comparing treatments with respect to survival. We compare optimal designs for each of three standard survival analysis techniques (maximum partial likelihood estimation, log-rank test, exponential regression) with balanced designs, over a range of hypothetical trials. Although balanced designs are not optimal, we find them to be very efficient. In view of the high efficiency demonstrated in this and in a previous paper (Begg and Kalish, 1984, Biometrics 40, 409-420), and practical difficulties in implementing an optimal design, we recommend the use of balanced allocation methods in practice.     

Analysis of two-period crossover design in a multicenter clinical trial

A technique is discussed for analyzing a two-period crossover design for a multicenter trial using identical study protocols. The technique is a modification of the analysis originally proposed by Grizzle (1965, Biometrics 21, 467-480; 1974, Biometrics 30, 727) for analyzing a two-period crossover design when study is not a factor. A mixed model using the first baseline as a covariate is analyzed to increase the power of the test of significance of the treatment-by-period interaction. The baseline values are also used in a preliminary test.     

On the First-Order Rao—Scott Correction of the Umesh—Loughin—Scherer Statistic

Decady and Thomas (2000, Biometrics 56, 893-896) propose a first-order corrected Umesh-Loughin-Scherer statistic to test for association in an r x c contingency table with multiple column responses. Agresti and Liu (1999, Biometrics 55, 936-943) point out that such statistics are not invariant to the arbitrary designation of a zero or one to a positive response. This paper shows that, in addition, the proposed testing procedure does not hold the correct size when there are strong pairwise associations between responses.     

On constrained balance randomization for clinical trials

A method is proposed for calculating the probabilities of assignment of a patient to treatments; it involves minimizing a quadratic criterion subject to a balance constraint. The optimal probabilities are very easy to compute. Numerical illustration is given and comparisons are drawn with the entropy-based methods of Klotz (1978, Biometrics 34, 283-287).     

Analysis of ordered categorical data: two score-independent approaches

SUMMARY: A trend test is often employed to analyze ordered categorical data, in which a set of increasing scores is assigned a priori. There is a drawback in this approach, because how to choose a set of scores is not clear. There have been debates on which scores should be used (e.g., Graubard and Korn, 1987, Biometrics 43, 471-476; Ivanova and Berger, 2001, Biometrics 57, 567-570; Senn, 2007, Biometrics 63, 296-298). Conflicting conclusions are often obtained with different sets of scores. Two approaches, which have been applied to genetic case-control studies, are appealing for ordered categorical data, because they take into account the natural order in the data, are score independent, and not contingent on asymptotic theory. These two approaches are applied to a prospective study for detecting association between maternal drinking and congenital malformations.     

Inference in spline-based models for multiple time-to-event data, with applications to a breast cancer prevention trial

As part of the National Surgical Adjuvant Breast and Bowel Project, a controlled clinical trial known as the Breast Cancer Prevention Trial (BCPT) was conducted to assess the effectiveness of tamoxifen as a preventive agent for breast cancer. In addition to the incidence of breast cancer, data were collected on several other, possibly adverse, outcomes, such as invasive endometrial cancer, ischemic heart disease, transient ischemic attack, deep vein thrombosis and/or pulmonary embolism. In this article, we present results from an illustrative analysis of the BCPT data, based on a new modeling technique, to assess the effectiveness of the drug tamoxifen as a preventive agent for breast cancer. We extended the flexible model of Gray (1994, Spline-based test in survival analysis, Biometrics 50, 640-652) to allow inference on multiple time-to-event outcomes in the style of the marginal modeling setup of Wei, Lin, and Weissfeld (1989, Regression analysis of multivariate incomplete failure time data by modeling marginal distributions, Journal of the American Statistical Association 84, 1065-1073). This proposed model makes inference possible for multiple time-to-event data while allowing for greater flexibility in modeling the effects of prognostic factors with nonlinear exposure-response relationships. Results from simulation studies on the small-sample properties of the asymptotic tests will also be presented.     

Sample size determination for case-control studies and the comparison of stratified and unstratified analyses.

Woolson, Bean, and Rojas (1986, Biometrics 42, 927-932) present a simple approximation of sample size for Cochran's (1954, Biometrics 10, 417-451) test for detecting association between exposure and disease. It is useful in the design of case-control studies. We derive a sample size formula for Cochran's statistic with continuity correction which guarantees that the actual Type I error rate of the test does not exceed the nominal level. The corrected sample size is necessarily larger than the uncorrected one given by Woolson et al. and the relative difference between the two sample sizes is considerable. Allocation of equal number of cases and controls within each stratum is asymptotically optimal when the costs per case and control are the same. When any effect of stratification is absent, Cochran's stratified test, although valid, is less efficient than the unstratified one except for the important case of a balanced design.     

Estimators and tests in the analysis of multiple nonindependent 2 x 2 tables with partially missing observations

We present methods for the analysis of a K-variate binary measure for two independent groups where some observations may be incomplete, as in the case of K repeated measures in a comparative trial. For the K 2 X 2 tables, let theta = (theta 1,..., theta K) be a vector of association parameters where theta k is a measure of association that is a continuous function of the probabilities pi ik in each group (i = 1, 2; k = 1,..., K), such as the log odds ratio or log relative risk. The asymptotic distribution of the estimates theta = (theta 1,..., theta K) is derived. Under the assumption that theta k = theta for all k, we describe the maximally efficient linear estimator theta of the common parameter theta. Tests of contrasts on the theta are presented which provide a test of homogeneity Ha: theta k = theta l for all k not equal to l. We then present maximally efficient tests of aggregate association Hb: theta = theta 0, where theta 0 is a given value. It is shown that the test of aggregate association Hb is asymptotically independent of the preliminary test of homogeneity Ha. These methods generalize the efficient estimators of Gart (1962, Biometrics 18, 601-610), and the Cochran (1954, Biometrics 10, 417-451), Mantel-Haenszel (1959, Journal of the National Cancer Institute 22, 719-748), and Radhakrishna (1965, Biometrics 21, 86-98) tests to nonindependent tables. The methods are illustrated with an analysis of repeated morphologic evaluations of liver biopsies obtained in the National Cooperative Gallstone Study.     

Sample size determination for testing whether an identified treatment is best

Laska and Meisner (1989, Biometrics 45, 1139-1151) dealt with the problem of testing whether an identified treatment belonging to a set of k + 1 treatments is better than each of the other k treatments. They calculated sample size tables for k = 2 when using multiple t-tests or Wilcoxon-Mann-Whitney tests, both under normality assumptions. In this paper, we provide sample size formulas as well as tables for sample size determination for k > or = 2 when t-tests under normality or Wilcoxon-Mann-Whitney tests under general distribution assumptions are used.     

Testing for a treatment effect in the presence of nonresponders

Good (1979, Biometrics 35, 483-489) introduced a new randomization test for the two-sample problem where a proportion 1 - p of the treatment group does not respond to the treatment, and suggested that the Wilcoxon test is not effective for this situation. We show to the contrary that the Wilcoxon test is quite useful when p greater than or equal to .6 and point out an error in his definition of a one-tailed randomization test.     

A Bayesian decision approach for sample size determination in phase II trials

Stallard (1998, Biometrics 54, 279-294) recently used Bayesian decision theory for sample-size determination in phase II trials. His design maximizes the expected financial gains in the development of a new treatment. However, it results in a very high probability (0.65) of recommending an ineffective treatment for phase III testing. On the other hand, the expected gain using his design is more than 10 times that of a design that tightly controls the false positive error (Thall and Simon, 1994, Biometrics 50, 337-349). Stallard's design maximizes the expected gain per phase II trial, but it does not maximize the rate of gain or total gain for a fixed length of time because the rate of gain depends on the proportion of treatments forwarding to the phase III study. We suggest maximizing the rate of gain, and the resulting optimal one-stage design becomes twice as efficient as Stallard's one-stage design. Furthermore, the new design has a probability of only 0.12 of passing an ineffective treatment to phase III study.     

The variance for the disequilibrium coefficient in the individual Hardy-Weinberg test

It is of interest to detect the deviation from Hardy-Weinberg proportion (HWP) for a particular heterozygote. Hernández and Weir (1989, Biometrics 45, 53-70) suggested a disequilibrium coefficient approach and proposed a 1-d.f. chi2 test. This note derives the appropriate variance under the null hypothesis for performing this individual HWP test. Examples of applying the test to human genetic disease data are presented.     

Modelling ties in the sign test

If ties occur in the sign test, the procedure recommended by Coakley and Heise (1996, Biometrics 52, 1242-1251) is the asymptotic uniformly most powerful nonrandomised test due to Putter (1955, Annals of Mathematical Statistics 26, 368-386). It may be shown that this is a consequence of how the probability of a tie is modelled. Other models with different optimal procedures can be constructed.     

Statistical methods in ophthalmology: an adjusted chi-square approach

Ophthalmologic studies often compare several groups of subjects for the presence or absence of some ocular finding, where each subject may contribute two eyes to the analysis, the values from the two eyes being highly correlated. Rosner (1982, Biometrics 38, 105-114) and Dallal (1988, Biometrics 44, 253-257) proposed procedures for testing whether the proportion of affected eyes is the same among the different groups, while accounting for the intrasubject correlation. In this paper we propose an alternative approach, based on a simple adjustment of the standard Pearson chi-square test for the equality of proportions. The suggested approach utilizes information on subjects who supply only one eye to the analysis, and readily generalizes to studies in which more than two units of analysis are provided by each subject.     

The ML estimation and testing of generalized ABO-like data with no observed double recessives

The general method of the discrepancy or heterogeneity chi-square is applied to ABO-like data in which there are no observed double blanks in either the disease or the control group. When the recessive gene frequency is assumed zero, this method leads to an approximate chi-square test identical to that suggested by Smouse and Williams (1982, Biometrics 38, 757-768). When this assumption is relaxed, there arise two cases which are determined by whether the maximum likelihood estimate of this frequency is zero or not. It is shown that the value of the simple score statistic of Gart and Nam (1984, Biometrics 40, 887-894) discriminates between the two cases. The various omnibus test statistics for comparing groups are shown to differ little in several practical examples. However, under the more general assumption the appropriate degrees of freedom is one more than the number previously suggested.     

A note on Shirley's nonparametric test for comparing several dose levels with a zero-dose control

Shirley (1977, Biometrics 33, 386-389) proposed a nonparametric version of Williams' test for determining the lowest dose level at which there is evidence of a toxic effect. A modification of Shirley's procedure is now proposed, which improves its power.     

Some goodness-of-fit methods for the Poisson plus added zeros distribution

Methods for making inferences about the Poisson plus added zeros distribution and the truncated Poisson distribution are presented and illustrated with bacteriological data. Some of the methods are designed for testing the compatibility of the zero frequency with the Poisson distribution, whereas others are given for testing the goodness of fit for the truncated Poisson. In particular, a modified form of the Fisher index of dispersion is presented which is suitable for the truncated case. It is shown that the use of the usual expression of the index of dispersion for testing the adequacy of the truncated Poisson is not correct and leads to accepting inadequate fits more frequently than expected on the basis of test of significance. Furthermore, three test statistics are presented for testing the compatability of the zero frequency with the Poisson distribution. The results of the simulation show that two test statistics, one due to Cochran (W. G. Cochran, Biometrics 10:417-451, 1954) and the other to Rao and Chakravarti (C. R. Rao and I. M. Chakravarti, Biometrics 12:264-282, 1956), are preferable to those from the likelihood ratio test.