Utility of Adaptive Sample Size Designs and A Review Example

Sample size can be a key design feature that not only affects the probability of a trial＇s success but also determines the duration and feasibility of a trial. If an investigational drug is expected to be effective and address unmet medical needs of an orphan disease, where the accrual period may require many years with a large sample size to detect a minimal clinically relevant treatment effect, a minimum sample size may be set to maintain nominal power. In limited situations such as this, there may be a need for flexibility in the initial and final sample sizes; thus, it is useful to consider the utility of adaptive sample size designs that use sample size re-estimation or group sequential design. In this paper, we propose a new adaptive performance measure to consider the utility of an adaptive sample size design in a trial simulation. Considering that previously proposed sample size re-estimation methods do not take into account errors in estimation based on interim results, we propose Bayesian sample size re-estimation criteria that take into account prior information on treatment effect, and then, we assess its operating characteristics in a simulation study. We also present a review example of sample size re-estimation mainly based on published paper and review report in Pharmaceuticals and Medical Devices Agency （PMDA）.