Practical and analytical considerations when performing interim analyses in diagnostic test accuracy studies

Journal article

Abstract:: Interim analysis is a common methodology in randomised clinical trials but has received less attention in studies of diagnostic test accuracy. In such studies, early termination for futility may be beneficial if early evidence indicates that a diagnostic test is unlikely to achieve a clinically useful level of diagnostic performance, as measured by the sensitivity and specificity. In this paper, we describe relevant practical and analytical considerations when planning and performing interim analysis in diagnostic accuracy studies, focusing on stopping rules for futility. We present an adaptation of the exact group sequential method for diagnostic testing, with R code provided for implementing this method in practice. The method is illustrated using two simulated data sets and data from a published diagnostic accuracy study for point-of-care testing for SARS-CoV-2. The considerations described in this paper can be used to guide decisions as to when an interim analysis in a diagnostic accuracy study is suitable and highlight areas for further methodological development.

Files:: Fleming_et_al_2024_Practical_and_analytical.pdf

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Language:: English
Keywords:: group sequential methods

specificity

stopping rule

diagnostic accuracy

interim analysis

adaptive design

sensitivity
Pubs id:: 2010451
Local pid:: pubs:2010451
Deposit date:: 2024-06-27
ARK identifier:: ark:/29072/ora_be7cc30022d9418382fc45d39e20bf25

Copyright holder:: Fleming et al
Rights statement:: ©The Author(s), 2024. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

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