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Designing efficient randomized trials: power and sample size calculation when using semiparametric efficient estimators

  • Alejandro Schuler ORCID logo EMAIL logo
Published/Copyright: August 6, 2021

Abstract

Trials enroll a large number of subjects in order to attain power, making them expensive and time-consuming. Sample size calculations are often performed with the assumption of an unadjusted analysis, even if the trial analysis plan specifies a more efficient estimator (e.g. ANCOVA). This leads to conservative estimates of required sample sizes and an opportunity for savings. Here we show that a relatively simple formula can be used to estimate the power of any two-arm, single-timepoint trial analyzed with a semiparametric efficient estimator, regardless of the domain of the outcome or kind of treatment effect (e.g. odds ratio, mean difference). Since an efficient estimator attains the minimum possible asymptotic variance, this allows for the design of trials that are as small as possible while still attaining design power and control of type I error. The required sample size calculation is parsimonious and requires the analyst to provide only a small number of population parameters. We verify in simulation that the large-sample properties of trials designed this way attain their nominal values. Lastly, we demonstrate how to use this formula in the “design” (and subsequent reanalysis) of a real randomized trial and show that fewer subjects are required to attain the same design power when a semiparametric efficient estimator is accounted for at the design stage.


Corresponding author: Alejandro Schuler, Unlearn.AI, Inc., San Francisco, CA, USA, E-mail:

Article Note: For the Critical Path for Alzheimer’s Disease, data used in the preparation of this article were obtained from the Critical Path Institute’s Critical Path for Alzheimer’s Disease (CPAD) consortium. As such, the investigators within CPAD contributed to the design and implementation of the CPAD database and/or provided data, but did not participate in the analysis of the data or the writing of this report.

The Alzheimer’s Disease Neuroimaging Initiative, data used in preparation of this article were obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database (adni.loni.usc.edu). As such, the investigators within the ADNI contributed to the design and implementation of ADNI and/or provided data but did not participate in analysis or writing of this report. A complete listing of ADNI investigators can be found at http://adni.loni.usc.edu/wp-content/uploads/how_to_apply/ADNI_Acknowledgement_List.pdf.

And the Alzheimer’s Disease Cooperative Study, data used in preparation of this manuscript/publication/article were obtained from the University of California, San Diego Alzheimer’s Disease Cooperative Study. Consequently, the ADCS Core Directors contributed to the design and implementation of the ADCS and/or provided data but did not participate in analysis or writing of this report.


Acknowledgments

The author thanks Xinkun Nie, Charles Fisher, and David Miller for helpful conversations.

  1. Author contribution: The author has accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: Data collection and sharing for this project was funded in part by the Alzheimer’s Disease Neuroimaging Initiative (ADNI) (National Institutes of Health Grant U01 AG024904) and DOD ADNI (Department of Defense award number W81XWH-12-2-0012). ADNI is funded by the National Institute on Aging, the National Institute of Biomedical Imaging and Bioengineering, and through generous contributions from the following: AbbVie, Alzheimer’s Association; Alzheimer’s Drug Discovery Foundation; Araclon Biotech; BioClinica, Inc.; Biogen; Bristol-Myers Squibb Company; CereSpir, Inc.; Cogstate; Eisai Inc.; Elan Pharmaceuticals, Inc.; Eli Lilly and Company; EuroImmun; F. Hoffmann-La Roche Ltd and its affiliated company Genentech, Inc.; Fujirebio; GE Healthcare; IXICO Ltd.; Janssen Alzheimer Immunotherapy Research & Development, LLC.; Johnson & Johnson Pharmaceutical Research & Development LLC.; Lumosity; Lundbeck; Merck & Co., Inc.; Meso Scale Diagnostics, LLC.; NeuroRx Research; Neurotrack Technologies; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Piramal Imaging; Servier; Takeda Pharmaceutical Company; and Transition Therapeutics. The Canadian Institutes of Health Research is providing funds to support ADNI clinical sites in Canada. Private sector contributions are facilitated by the Foundation for the National Institutes of Health (www.fnih.org). The grantee organization is the Northern California Institute for Research and Education, and the study is coordinated by the Alzheimer’s Therapeutic Research Institute at the University of Southern California. ADNI data are disseminated by the Laboratory for Neuro Imaging at the University of Southern California. Data collection and sharing for this project was funded in part by the University of California, San Diego Alzheimer’s Disease Cooperative Study (ADCS) (National Institute on Aging Grant Number U19AG010483).

  3. Conflict of interest statement: The author declares no conflicts of interest regarding this article.

Appendix A. Mathematical results

A.1 Details of the cross-fit AIPW estimator in randomized trials

Here we discuss the AIPW estimator and its semiparametric efficiency in the context of randomized trials. While the conclusions of this paper apply to any semiparametric efficient estimator, it may help the reader to understand semiparametric efficiency in the context of a single estimator. The details provided here are all available elsewhere in the literature or follow immediately from known results [14, 20, 27, 32]. We reframe them here to provide a quick reference and starting point for further reading.

Preliminaries. A scalar parameter of a distribution is a functional that ingests the distribution and returns a number. For example, consider the distribution of a scalar random variable Y defined by the PDF f y . The mean of Y (which is a parameter) is the functional ∫yf y (y)dy. An estimator of a (scalar) parameter is a function that takes data sampled from the distribution in question and returns a number which is meant to approximate the parameter. For example, an estimate of the mean of Y is 1 n i y i when y i are assumed to be draws from the distribution of Y. An estimator is consistent if it recovers the true value of the parameter as the sample size grows. It is usually possible to construct many different consistent estimators of the same parameter, so we are interested in finding the one that has the smallest possible sampling variance. We call this the efficient estimator.

It becomes much easier to find the efficient estimator if we restrict our attention to the class of regular and asymptotically linear (RAL) estimators, and we actually don’t lose anything by doing so. It is not important to understand the precise mathematical definition of regularity, but heuristically, a regular estimator does not have anomalously bad performance for certain special values of the parameter. Thus restricting ourselves to regular estimators is a good and sensible thing to do. Effectively all estimators which can be used in practice are regular. Moreover, among regular estimators of some parameter, a result called the Hájek–Le Cam convolution theorem guarantees that the estimator with the smallest asymptotic variance is asymptotically linear, so we lose nothing by further restricting ourselves to asymptotically linear estimators once we’ve excluded irregular estimators [14].

The definition of asymptotic linearity for an estimator ψ ̂ of a parameter ψ is that there exists an influence function ϕ such that n ( ψ ̂ ψ ) = E ̂ ϕ + o p ( 1 ) . In other words, the estimator ψ ̂ behaves like an IID average of some random variable ϕ in large samples. Asymptotic linearity immediately implies n ( ψ ̂ ψ ) N ( 0 , V ϕ ) by the central limit theorem. Therefore the asymptotic variance of any asymptotically linear estimator is given by the variance of its influence function.

Finding the most efficient RAL estimator thus boils down to finding the influence function with the smallest variance, which we call the efficient influence function (EIF). The EIF defines a lower bound on the achievable sampling variance when estimating a parameter. It so happens that it is often possible to characterize the space of all influence functions of RAL estimators of a given parameter in a generic generative model, which makes it possible to derive the EIF. Obtaining an efficient estimator is therefore a matter of deriving the EIF for the class of RAL estimators of a parameter and then constructing an estimator that has that influence function.

Application. In the semiparametric statistical model P(Y, W, X) = P(Y|X)P(W|X)P(X) (with P(Y|X), P(W|X), and P(X) free to be any distributions that satisfy mild regularity conditions), it turns out that the efficient influence function of the class of RAL estimators for the parameter μ w = E Y | W = w is ϕ w = W w π w ( X ) ( Y μ w ( X ) ) + ( μ w ( X ) μ w ) . Proving this is not simple (see Tsiatis [14]), but after the fact has been established all our subsequent theory requires only algebra and elementary tools from large-sample theory.

As might be expected, the EIF for the two-dimensional parameter μ = [ μ 0 , μ 1 ] is ϕ μ = [ ϕ 0 , ϕ 1 ] . Influence functions obey a “chain rule” such that if the EIF of ψ is ϕ, the EIF of g(ψ) is ∇g ψ. For us, that means that the EIF of τ = r(μ0μ1) is ϕ = r0′(μ0μ1)ϕ0 + r1′(μ0μ1)ϕ1.

In a two arm randomized trial with treatment fractions π w , one estimator of μ w that has the efficient influence function is μ ̂ w * = E ̂ W w π w ( Y μ w ( X ) ) + μ w ( X ) . The fact is easily verified by showing n ( μ ̂ w μ w ) = E ̂ ϕ w + o p ( 1 ) with an application of the central limit theorem. An application of the delta method shows that τ ̂ * = r ( μ ̂ 0 * , μ ̂ 1 * ) attains the asymptotic variance ν 2 = V ϕ and is therefore efficient. We’ll call this the “oracle estimator”.

Unfortunately, the oracle estimator τ ̂ * is infeasible in practice because the conditional means μ w (X) are not known. However, it turns out that estimates can be substituted without sacrificing the optimality properties. Let μ ̂ w ( k ) = E ̂ W w π w ( Y μ ̂ w ( k ) ( X ) ) + μ ̂ w ( k ) ( X ) k ( i ) = k . This is the marginal mean estimated from the kth fold of data using the conditional mean function estimated from the rest of the data. Let μ ̂ w * ( k ) be the oracle equivalent that uses the true conditional mean μ w (X). Clearly, μ ̂ w = n ( k ) n μ ̂ w ( k ) where n(k) is the number of observations in fold k (and similarly for μ ̂ w ). If we can show that n ( μ ̂ w ( k ) μ ̂ w * ( k ) ) p 0 , then Slutsky’s theorem and the delta method imply that τ ̂ has the same asymptotic properties as τ ̂ * , i.e. n ( τ ̂ τ ) N ( 0 , ν 2 ) . In other words, since the oracle estimator is efficient with a known asymptotic variance, the feasible estimator is also efficient and has the same asymptotic variance. It turns out that if we assume that E μ ̂ w ( k ) ( X ) μ w ( X ) 2 0 (a very weak condition), then it is possible to show n ( μ ̂ w ( k ) μ ̂ w * ( k ) ) p 0 as desired.

We begin by deriving an expression for the difference between the oracle and feasible estimators:

(10) μ ̂ w ( k ) μ ̂ w * ( k ) = E ̂ W w π w ( Y μ ̂ w ( k ) ( X ) ) + μ ̂ w ( k ) ( X ) W w π w ( Y μ w ( X ) ) + μ w ( X ) k ( i ) = k = E ̂ 1 W w π w μ ̂ w ( k ) ( X ) μ w ( X ) k ( i ) = k = 1 n ( k ) i I k n ( k ) 1 W w , i π w μ ̂ w ( k ) ( X i ) μ w ( X i )

where in the last line all we’ve done is expand the E ̂ notation and introduce I k = { i : k ( i ) = k } . Notice that if we condition on the dataset I ( k ) , the estimated function μ ̂ w ( k ) ( ) becomes fixed because it does not depend on the data in fold k. Therefore E μ ̂ w ( k ) μ ̂ w * ( k ) I ( k ) = 0 because of the conditional independence between 1 W w , i π w and μ ̂ w ( k ) ( X i ) μ w ( X i ) in fold k and the fact that E 1 W w , i π w = 0 . This, in turn, implies that E μ ̂ w ( k ) μ ̂ w * ( k ) 2 I ( k ) = V μ ̂ w ( k ) μ ̂ w * ( k ) I ( k ) , which we will use shortly. Moreover, the terms within the sum of Eq. (10) are all IID conditional on I ( k ) so we can pass the variance through the sum (and gain a 1/n(k) in the process):

(11) V μ ̂ w ( k ) μ ̂ w * ( k ) I ( k ) = 1 ( n ( k ) ) 2 i I k n ( k ) V 1 W w , i π w μ ̂ w ( k ) ( X i ) μ w ( X i ) I ( k ) = 1 n ( k ) 1 π w π w E μ ̂ w ( k ) ( X i ) μ w ( X i ) 2 I ( k )

Our plan is to show n ( μ ̂ w ( k ) μ ̂ w * ( k ) ) L 2 0 , which implies n ( μ ̂ w ( k ) μ ̂ w * ( k ) ) p 0 because L2 convergence implies convergence in probability. By the definition of L2 convergence, that means we must show E n μ ̂ w ( k ) μ ̂ w * ( k ) 2 0 , which we can do by using what we’ve derived above:

(12) E n μ ̂ w ( k ) μ ̂ w * ( k ) 2 = n E E μ ̂ w ( k ) μ ̂ w * ( k ) 2 I ( k ) = n E V μ ̂ w ( k ) μ ̂ w * ( k ) I ( k ) = n n ( k ) 1 π w π w E E μ ̂ w ( k ) ( X i ) μ w ( X i ) 2 I ( k ) = n n ( k ) 1 π w π w E μ ̂ w ( k ) ( X i ) μ w ( X i ) 2

This must converge to 0 because n and n(k) grow in proportion to each other and the expectation E μ ̂ w ( k ) ( X i ) μ w ( X i ) 2 converges to 0 by our mean-square consistency assumption (Eq. (3)).

By the arguments above, this is enough to establish the asymptotic normality of our estimator with the efficient asymptotic variance: n ( τ ̂ τ ) N ( 0 , ν 2 ) .

Similar arguments are required to show that the plug-in variance estimator is consistent (when cross-fitting is used). Some care is required to address the terms r w ( μ ̂ 0 , μ ̂ 1 ) , etc., but the elementary tools of asymptotic statistics suffice.

A.2 Proof of Theorem 1

Beginning with Eq. (4), we have that

(13) ν * 2 = V r 0 ϕ 0 + r 1 ϕ 1 = r 0 2 V ϕ 0 + r 1 2 V ϕ 1 + 2 r 0 r 1 C ϕ 0 , ϕ 1

from expansion of the variance. We will use several tricks to analyze these terms. The first is that W w Y = W w Y w , by the fact that Y = Y0W0 + Y1W1 (note W w 2 = W w and W0W1 = 0, which we will also use). Secondly, W w Y w , μ ̂ w ( X ) by unconfoundedness, allowing for factorization of expectations.

These tricks and a few lines of algebra show that the variances in the first and second terms above (Eq. (13)) are

(14) V ϕ w = 1 π w π w E σ w 2 ( X ) + V Y w = 1 π w π w κ w 2 + σ w 2

where σ w 2 ( X ) V Y w | X is the conditional variance function in treatment arm w. In the last line we define κ w 2 . E σ w 2 ( X ) (the average conditional variance) and σ w 2 V Y w (the marginal variance) to simplify notation.

Similar manipulation reduces the covariance term in Eq. (13) to

(15) C ϕ 0 , ϕ 1 = C μ 0 ( X ) , μ 1 ( X ) = Corr [ μ 0 ( X ) , μ 1 ( X ) ] V μ 0 ( X ) V μ 1 ( X ) = γ ( σ 0 2 κ 0 2 ) ( σ 1 2 κ 1 2 )

by exploitation of the law of total variance V Y w σ w 2 = E σ w 2 ( X ) κ w 2 + V μ w ( X ) and definition of γ ≡ Corr[μ0(X), μ1(X)]. Assembling the above and making explicit the known signs of r w gives

(16) ν * 2 = r 0 2 π 1 π 0 κ 0 2 + σ 0 2 + r 1 2 π 0 π 1 κ 1 2 + σ 1 2 2 | r 0 r 1 | γ ( σ 0 2 κ 0 2 ) ( σ 1 2 κ 1 2 )

Appendix B. Additional simulation results

Figure 4: 
Empirical power and prospectively-calculated enrollment targets for AIPW estimators with different learners used to estimate the conditional means. Visual elements are as in Figures 1 and 3.
Figure 4:

Empirical power and prospectively-calculated enrollment targets for AIPW estimators with different learners used to estimate the conditional means. Visual elements are as in Figures 1 and 3.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/ijb-2021-0039).


Received: 2021-05-10
Revised: 2021-07-12
Accepted: 2021-07-12
Published Online: 2021-08-06

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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