Analyses of randomised trials are often based on regression models which adjust for baseline covariates, in addition to randomised group. Based on such models, one can obtain estimates of the marginal mean outcome for the population under assignment to each treatment, by averaging the model based predictions across the empirical distribution of the baseline covariates in the trial. We identify under what conditions such estimates are consistent, and in particular show that for canonical generalised linear models, the resulting estimates are always consistent. We show that a recently proposed variance estimator underestimates the true variance when the baseline covariates are not fixed in repeated sampling, and provide a simple adjustment to remedy this. We also describe an alternative semiparametric estimator which is consistent even when the outcome regression model used is misspecified. The different estimators are compared through simulations and application to a recently conducted trial in asthma.
Covariate adjustment has the potential to increase power in the analysis of randomised trials, but mis-specification of the adjustment model could cause error. We explore what error is possible when the adjustment model omits a covariate by randomised treatment interaction, in a setting where the covariate is perfectly balanced between randomised treatments. We use mathematical arguments and analyses of single hypothetical data sets. We show that analysis by a generalised linear model with the canonical link function leads to no error under the null -- that is, if treatment effect is truly zer…
Background: It has long been advised to account for baseline covariates in the analysis of confirmatory randomised trials, with the main statistical justifications being that this increases power and, when a randomisation scheme balanced covariates, permits a valid estimate of experimental error. There are various methods available to account for covariates but it is not clear how to choose among them. Methods: Taking the perspective of writing a statistical analysis plan, we consider how to choose between the three most promising broad approaches: direct adjustment, standardisation and invers…
Attrition is a common occurrence in cluster randomised trials (CRTs) which leads to missing outcome data. Two approaches for analysing such trials are cluster-level analysis and individual-level analysis. This paper compares the performance of unadjusted cluster-level analysis, baseline covariate adjusted cluster-level analysis and linear mixed model (LMM) analysis, under baseline covariate dependent missingness (CDM) in continuous outcomes, in terms of bias, average estimated standard error and coverage probability. The methods of complete case analysis (CCA) and multiple imputation (MI) are …
Missing outcomes are a commonly occurring problem for cluster randomised trials, which can lead to biased and inefficient inference if ignored or handled inappropriately. Two approaches for analysing such trials are cluster-level analysis and individual-level analysis. In this study, we assessed the performance of unadjusted cluster-level analysis, baseline covariate adjusted cluster-level analysis, random effects logistic regression (RELR) and generalised estimating equations (GEE) when binary outcomes are missing under a baseline covariate dependent missingness mechanism. Missing outcomes we…
We develop finite-population asymptotic theory for covariate adjustment in randomization-based causal inference for 2K factorial designs. In particular, we confirm that both the unadjusted and covariate-adjusted estimators of the factorial effects are asymptotically normal, and the latter is more precise than the former.
Covariate Adjustment for Wilcoxon Two Sample Statistic and Test
Zhejiang University of Finance and Economics（浙江财经大学）；University of Wisconsin, Madison（威斯康星大学麦迪逊分校）；University of Washington（华盛顿大学）；Eli Lilly and Company（礼来公司）
Randomised trials with continuous outcomes are often analysed using ANCOVA, with adjustment for prognostic baseline covariates. In an article published recently, Wang \etal proved that in this setting the model based standard error estimator for the treamtent effect is consistent under outcome model misspecification, provided the probability of randomisation to each treatment is 1/2. In this article, we extend their results allowing for unequal randomisation. These demonstrate that the model based standard error is in general inconsistent when the randomisation probability differs from 1/2. In…
In clinical trials, there is potential to improve precision and reduce the required sample size by appropriately adjusting for baseline variables in the statistical analysis. This is called covariate adjustment. Despite recommendations by regulatory agencies in favor of covariate adjustment, it remains underutilized leading to inefficient trials. We address two obstacles that make it challenging to use covariate adjustment. A first obstacle is the incompatibility of many covariate adjusted estimators with commonly used boundaries in group sequential designs (GSDs). A second obstacle is the unc…
Covariate adjustment is an important tool in the analysis of randomized clinical trials and observational studies. It can be used to increase efficiency and thus power, and to reduce possible bias. While most statistical tests in randomized clinical trials are nonparametric in nature, approaches for covariate adjustment typically rely on specific regression models, such as the linear model for a continuous outcome, the logistic regression model for a dichotomous outcome and the Cox model for survival time. Several recent efforts have focused on model-free covariate adjustment. This paper makes…
In randomized clinical trials, adjustments for baseline covariates at both design and analysis stages are highly encouraged by regulatory agencies. A recent trend is to use a model-assisted approach for covariate adjustment to gain credibility and efficiency while producing asymptotically valid inference even when the model is incorrect. In this article we present three considerations for better practice when model-assisted inference is applied to adjust for covariates under simple or covariate-adaptive randomized trials: (1) guaranteed efficiency gain: a model-assisted method should often gai…
The purpose of this work is to improve the efficiency in estimating the average causal effect (ACE) on the survival scale where right-censoring exists and high-dimensional covariate information is available. We propose new estimators using regularized survival regression and survival random forests (SRF) to make the adjustment for the high dimensional covariates to improve efficiency. We study the behavior of the adjusted estimator under mild assumptions and show theoretical guarantees that the proposed estimators are more efficient than the unadjusted ones asymptotically when using SRF for ad…
We consider inference for the mean and covariance functions of covariate adjusted functional data using Local Linear Kernel (LLK) estimators. By means of a double asymptotic, we differentiate between sparse and dense covariate adjusted functional data - depending on the relative order of m (the discretization points per function) and n (the number of functions). Our simulation results demonstrate that the existing asymptotic normality results can lead to severely misleading inferences in finite samples. We explain this phenomenon based on our theoretical results and propose finite-sample corre…
Data-Adaptive and Model-Robust Covariate Adjustment for Time-to-Event Outcomes in Stratified Randomized Trials
Cornell Tech, Cornell University（康奈尔科技校区，康奈尔大学）；Department of Biostatistics, Department of Population Health, New York University School of Medicine（纽约大学医学院生物统计学系、人口健康系）
Two commonly used methods for improving precision and power in clinical trials are stratified randomization and covariate adjustment. However, many trials do not fully capitalize on the combined precision gains from these two methods, which can lead to wasted resources in terms of sample size and trial duration. We derive consistency and asymptotic normality of model-robust estimators that combine these two methods, and show that these estimators can lead to substantial gains in precision and power. Our theorems cover a class of estimators that handle continuous, binary, and time-to-event outc…
Continuous biomarkers are common for disease screening and diagnosis. To reach a dichotomous clinical decision, a threshold would be imposed to distinguish subjects with disease from non-diseased individuals. Among various performance metrics for a continuous biomarker, specificity at a controlled sensitivity level (or vice versa) is often desirable for clinical utility since it directly targets where the clinical test is intended to operate. Covariates, such as age, race, and sample collection, could impact the controlled sensitivity level in subpopulations and may also confound the associati…
Randomized experiments are the gold standard for causal inference, and justify simple comparisons across treatment groups. Regression adjustment provides a convenient way to incorporate covariate information for additional efficiency. This article provides a unified account of its utility for improving estimation efficiency in multi-armed experiments. We start with the commonly used additive and fully interacted models for regression adjustment, and clarify the trade-offs between the resulting ordinary least-squares (OLS) estimators for estimating average treatment effects in terms of finite-s…
The Welch-Satterthwaite t-test is one of the most prominent and often used statistical inference method in applications. The method is, however, not flexible with respect to adjustments for baseline values or other covariates, which may impact the response variable. Existing analysis of covariance methods are typically based on the assumption of equal variances across the groups. This assumption is hard to justify in real data applications and the methods tend to not control the type-1 error rate satisfactorily under variance heteroscedasticity. In the present paper, we tackle this problem and…
Cluster-randomized trials (CRTs) involve randomizing entire groups of participants -- called clusters -- to treatment arms but are often comprised of a limited or fixed number of available clusters. While covariate adjustment can account for chance imbalances between treatment arms and increase statistical efficiency in individually-randomized trials, analytical methods for individual-level covariate adjustment in small CRTs have received little attention to date. In this paper, we systematically investigate, through extensive simulations, the operating characteristics of propensity score weig…
Randomized block factorial experiments are widely used in industrial engineering, clinical trials, and social science. Researchers often use a linear model and analysis of covariance to analyze experimental results; however, limited studies have addressed the validity and robustness of the resulting inferences because assumptions for a linear model might not be justified by randomization in randomized block factorial experiments. In this paper, we establish a new finite population joint central limit theorem for usual (unadjusted) factorial effect estimators in randomized block $2^K$ factorial…
Background: Subgroup analyses are frequently conducted in randomized clinical trials to assess evidence of heterogeneous treatment effect across patient subpopulations. Although randomization balances covariates within subgroups in expectation, chance imbalance may be amplified in small subgroups and harm the precision. Covariate adjustment in overall analysis of RCT is often conducted, via either ANCOVA or propensity score weighting, but for subgroup analysis has been rarely discussed. In this article, we develop propensity score weighting methodology for covariate adjustment to improve the p…
The Regression Discontinuity (RD) design is a widely used non-experimental method for causal inference and program evaluation. While its canonical formulation only requires a score and an outcome variable, it is common in empirical work to encounter RD analyses where additional variables are used for adjustment. This practice has led to misconceptions about the role of covariate adjustment in RD analysis, from both methodological and empirical perspectives. In this chapter, we review the different roles of covariate adjustment in RD designs, and offer methodological guidance for its correct us…
Identifying effects of actions (treatments) on outcome variables from observational data and causal assumptions is a fundamental problem in causal inference. This identification is made difficult by the presence of confounders which can be related to both treatment and outcome variables. Confounders are often handled, both in theory and in practice, by adjusting for covariates, in other words considering outcomes conditioned on treatment and covariate values, weighed by probability of observing those covariate values. In this paper, we give a complete graphical criterion for covariate adjustme…
Towards Best Practices for Covariate Adjustment in Regulatory Trials: From Fixed to Data-Adaptive Approaches
University of California Berkeley（加州大学伯克利分校）；Division of Biometrics IV, OB/OTS/CDER/FDA（美国食品药品监督管理局药物评价与研究中心生物统计学第四处）；Harvard T.H. Chan School of Public Health（哈佛大学陈曾熙公共卫生学院）；Beth Israel Deaconess Hospital（贝斯以色列女执事医疗中心）；Novo Nordisk A/S（诺和诺德公司）；Pfizer Inc.（辉瑞公司）；Northeastern University（东北大学）；Gilead Sciences（吉利德科学公司）；National Center for the Advancement of Translational Science, National Institutes of Health（美国国立卫生研究院转化科学促进国家中心）；Section of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark（南丹麦大学流行病学、生物统计学和生物人口学系）；Forum for Collaborative Research, School of Public Health, University of California Berkeley（加州大学伯克利分校公共卫生学院合作研究论坛）；OncoBrain Inc（OncoBrain 公司）；Moffitt Cancer Center（莫菲特癌症中心）；Department of Biostatistics, University of Michigan（密歇根大学生物统计学系）；Department of Mathematics, Computer Science and Statistics, Ghent University（根特大学数学、计算机科学和统计系）；Department of Mathematics and Data Science, Vrije Universiteit Brussel（布鲁塞尔自由大学数学与数据科学系）
The restricted mean survival time is a clinically easy-to-interpret measure that does not require any assumption of proportional hazards. We focus on two ways to directly model the survival time and adjust the covariates. One is to calculate the pseudo-survival time for each subject using leave-one-out, and then perform a model analysis using all pseudo-values to adjust for covariates. The pseudo-survival time is used to reflect information of censored subjects in the model analysis. The other method adjusts for covariates using subjects for whom the time-to-event was observed while adjusting …
Chance imbalance in baseline characteristics is common in randomized clinical trials. Regression adjustment such as the analysis of covariance (ANCOVA) is often used to account for imbalance and increase precision of the treatment effect estimate. An objective alternative is through inverse probability weighting (IPW) of the propensity scores. Although IPW and ANCOVA are asymptotically equivalent, the former may demonstrate inferior performance in finite samples. In this article, we point out that IPW is a special case of the general class of balancing weights, and advocate to use overlap weig…
The idea of "stratified medicine" is an important driver of methodological research on the identification of predictive biomarkers. Most methods proposed so far for this purpose have been developed for the use on randomized data only. However, especially for rare cancers, data from clinical registries or observational studies might be the only available data source. For such data, methods for an unbiased estimation of the average treatment effect are well established. Research on confounder adjustment when investigating the heterogeneity of treatment effects and the variables responsible for t…
