Inference for the treatment effect in longitudinal cluster randomized trials when treatment effect heterogeneity is ignored

2021 ◽  
pp. 096228022110417
Author(s):  
Rhys Bowden ◽  
Andrew B Forbes ◽  
Jessica Kasza
Keyword(s):  
Treatment Effect ◽  
Randomized Trials ◽  
Error Rates ◽  
Type I ◽  
Cluster Randomized Trials ◽  
Stepped Wedge ◽  
Treatment Effect Heterogeneity ◽  
Cluster Randomized ◽  
Effect Heterogeneity ◽  
The Impact

In cluster-randomized trials, sometimes the effect of the intervention being studied differs between clusters, commonly referred to as treatment effect heterogeneity. In the analysis of stepped wedge and cluster-randomized crossover trials, it is possible to include terms in outcome regression models to allow for such treatment effect heterogeneity yet this is not frequently considered. Outside of some simulation studies of specific cases where the outcome is binary, the impact of failing to include terms for treatment effect heterogeneity on the variance of the treatment effect estimator is unknown. We analytically examine the impact of failing to include terms for treatment effect heterogeneity on the variance of the treatment effect estimator, when outcomes are continuous. Using analysis of variance and feasible generalized least squares we provide expressions for this variance. For both the cluster-randomized crossover design and the stepped wedge design, our analytic derivations indicate that failing to include treatment effect heterogeneity results in the estimates for variance of the treatment effect that are too small, leading to inflation of type I error rates. We therefore recommend assessing the sensitivity of sample size calculations and conclusions drawn from the analysis of cluster randomized trials to the inclusion of treatment effect heterogeneity.

scholarly journals Sample size requirements for detecting treatment effect heterogeneity in cluster randomized trials

2020 ◽  
Vol 39 (28) ◽  
pp. 4218-4237
Author(s):  
Siyun Yang ◽  
Fan Li ◽  
Monique A. Starks ◽  
Adrian F. Hernandez ◽  
Robert J. Mentz ◽  
...  
Keyword(s):  
Sample Size ◽  
Treatment Effect ◽  
Randomized Trials ◽  
Cluster Randomized Trials ◽  
Treatment Effect Heterogeneity ◽  
Cluster Randomized ◽  
Effect Heterogeneity

scholarly journals Statistical approaches to computing sample size in cluster randomized trials: a simulation study

2020 ◽  
Author(s):  
Ashutosh Ranjan ◽  
Guangzi Song ◽  
Christopher S Coffey ◽  
Leslie A McClure
Keyword(s):  
Sample Size ◽  
Cluster Size ◽  
Randomized Trials ◽  
Sample Size Calculation ◽  
Minimum Variance ◽  
Type I ◽  
Cluster Randomized Trials ◽  
Planning Stage ◽  
Cluster Randomized ◽  
The Impact

Abstract Background: Cluster randomized trials, which randomize groups of individuals to an intervention, are common in health services research when one wants to evaluate improvement in a subject's outcome by intervening at an organizational level. For many such trials, sample size calculation is performed under the assumption of equal cluster size. For a variety of reasons, many trials that set out to recruit clusters of the same size end up with unequal clusters. This leads to a misalignment between the method used for sample size calculation and the data analysis, which may affect trial power. Various weighted analysis methods for analyzing cluster means have been suggested to overcome the problem introduced by unbalanced clusters; however, the performance of such methods has not been evaluated extensively. Methods: We examine the use of the general linear model for analysis of clustered randomized trials that assume equal cluster sizes during the planning stage, but for which the realized cluster sizes are unequal. We demonstrate the performance of three approaches using different weights for analyzing the cluster means: (1) the standard analysis of cluster means, (2) weighting by cluster size, and (3) minimum variance weights. Several distributions are used to generate cluster sizes to assess a range of patterns of imbalance. The variability in cluster size is measured by the coefficient of variation (CV). We assess the impact of using each of the three methods of analysis with respect to type I error and power of the study and how each are impacted by the variability in cluster size via simulations. Results: Analyses that assumes equal clusters provide a reasonable approximation when cluster sizes vary minimally (CV < 0.30). For analyses weighted by cluster size type I errors were inflated, and that worsened as the variation in cluster size increases, despite reasonable power. However, minimum variance weighted analyses best maintain target power and level of significance under scenarios considered. Conclusion: Unweighted analyses work well as an approximate method when variation in cluster size is minimal. However, using minimum variance weights performs much better across the full range of variation in cluster size and is recommended.

xtgeebcv: A command for bias-corrected sandwich variance estimation for GEE analyses of cluster randomized trials

2020 ◽  
Vol 20 (2) ◽  
pp. 363-381 ◽  
Author(s):  
John A. Gallis ◽  
Fan Li ◽  
Elizabeth L. Turner
Keyword(s):  
Randomized Trials ◽  
Variance Estimation ◽  
Public Health Education ◽  
Standard Errors ◽  
Future Research ◽  
Type I ◽  
Cluster Randomized Trials ◽  
Finite Sample ◽  
Individual Level ◽  
Cluster Randomized

Cluster randomized trials, where clusters (for example, schools or clinics) are randomized to comparison arms but measurements are taken on individuals, are commonly used to evaluate interventions in public health, education, and the social sciences. Analysis is often conducted on individual-level outcomes, and such analysis methods must consider that outcomes for members of the same cluster tend to be more similar than outcomes for members of other clusters. A popular individual-level analysis technique is generalized estimating equations (GEE). However, it is common to randomize a small number of clusters (for example, 30 or fewer), and in this case, the GEE standard errors obtained from the sandwich variance estimator will be biased, leading to inflated type I errors. Some bias-corrected standard errors have been proposed and studied to account for this finite-sample bias, but none has yet been implemented in Stata. In this article, we describe several popular bias corrections to the robust sandwich variance. We then introduce our newly created command, xtgeebcv, which will allow Stata users to easily apply finite-sample corrections to standard errors obtained from GEE models. We then provide examples to demonstrate the use of xtgeebcv. Finally, we discuss suggestions about which finite-sample corrections to use in which situations and consider areas of future research that may improve xtgeebcv.

scholarly journals Impact of unequal cluster sizes for GEE analyses of stepped wedge cluster randomized trials with binary outcomes

2021 ◽  
Author(s):  
Zibo Tian ◽  
John S. Preisser ◽  
Denise Esserman ◽  
Elizabeth L. Turner ◽  
Paul J. Rathouz ◽  
...  
Keyword(s):  
Randomized Trials ◽  
Binary Outcomes ◽  
Cluster Randomized Trials ◽  
Stepped Wedge ◽  
Cluster Randomized ◽  
Unequal Cluster
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