Bayesian adaptive designs for clinical trials

A Bayesian adaptive design is proposed for a comparative two-armed clinical trial using decision-theoretic approaches. A loss function is specified, based on the cost for each patient and the costs of making incorrect decisions at the end of a trial. At each interim analysis, the decision to terminate or to continue the trial is based on the expected loss function while concurrently incorporating efficacy, futility and cost. The maximum number of interim analyses is determined adaptively by the observed data. We derive explicit connections between the loss function and the frequentist error rates, so that the desired frequentist properties can be maintained for regulatory settings. The operating characteristics of the design can be evaluated on frequentist grounds. Extensive simulations are carried out to compare the proposed design with existing ones. The design is general enough to accommodate both continuous and discrete types of data. We illustrate the methods with an animal study evaluating a medical treatment for cardiac arrest. Copyright 2005, Oxford University Press.