Test equality and sample size calculation based on risk difference in a randomized clinical trial with noncompliance and missing outcomes

Abstract

In a randomized clinical trial (RCT), noncompliance with an assigned treatment can occur due to serious side effects, while missing outcomes on patients may happen due to patients' withdrawal or loss to follow up. To avoid the possible loss of power to detect a given risk difference (RD) of interest between two treatments, it is essentially important to incorporate the information on noncompliance and missing outcomes into sample size calculation. Under the compound exclusion restriction model proposed elsewhere, we first derive the maximum likelihood estimator (MLE) of the RD among compliers between two treatments for a RCT with noncompliance and missing outcomes and its asymptotic variance in closed form. Based on the MLE with tanh(-1)(x) transformation, we develop an asymptotic test procedure for testing equality of two treatment effects among compliers. We further derive a sample size calculation formula accounting for both noncompliance and missing outcomes for a desired power 1 - beta at a nominal alpha-level. To evaluate the performance of the test procedure and the accuracy of the sample size calculation formula, we employ Monte Carlo simulation to calculate the estimated Type I error and power of the proposed test procedure corresponding to the resulting sample size in a variety of situations. We find that both the test procedure and the sample size formula developed here can perform well. Finally, we include a discussion on the effects of various parameters, including the proportion of compliers, the probability of non-missing outcomes, and the ratio of sample size allocation, on the minimum required sample size.