title: Sample size considerations for split-mouth design.
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.
authors: Division of Biostatistics, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Hong
authors: H
authors: Zhu
authors: Division of Biostatistics, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Song
authors: S
authors: Zhang
authors: Division of Biostatistics, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Chul
authors: C
authors: Ahn
mesh_terms: D056808:Biostatistics / Q000379:methods*; D003198:Computer Simulation; D018865:Dental Research / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D015233:Models, Statistical; D009055:Mouth; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D018401:Sample Size
keywords: Continuous and binary outcomes; dental clinical trial; generalized estimating equation; sample size; split-mouth