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Sample size considerations for split-mouth design.

Authors
  • Zhu, Hong1
  • Zhang, Song1
  • Ahn, Chul1
  • 1 Division of Biostatistics, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Type
Published Article
Journal
Statistical Methods in Medical Research
Publisher
SAGE Publications
Publication Date
Dec 01, 2017
Volume
26
Issue
6
Pages
2543–2551
Identifiers
DOI: 10.1177/0962280215601137
PMID: 26303156
Source
Medline
Keywords
License
Unknown

Abstract

Split-mouth designs are frequently used in dental clinical research, where a mouth is divided into two or more experimental segments that are randomly assigned to different treatments. It has the distinct advantage of removing a lot of inter-subject variability from the estimated treatment effect. Methods of statistical analyses for split-mouth design have been well developed. However, little work is available on sample size consideration at the design phase of a split-mouth trial, although many researchers pointed out that the split-mouth design can only be more efficient than a parallel-group design when within-subject correlation coefficient is substantial. In this paper, we propose to use the generalized estimating equation (GEE) approach to assess treatment effect in split-mouth trials, accounting for correlations among observations. Closed-form sample size formulas are introduced for the split-mouth design with continuous and binary outcomes, assuming exchangeable and "nested exchangeable" correlation structures for outcomes from the same subject. The statistical inference is based on the large sample approximation under the GEE approach. Simulation studies are conducted to investigate the finite-sample performance of the GEE sample size formulas. A dental clinical trial example is presented for illustration.

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