Background : The non-inferiority trials are becoming increasingly popular in public health and clinical research. The choice of the non-inferiority margin is the cornerstone of the non-inferiority trial. When the effect of active control intervention is unknown, it can be interesting to choose the non-inferiority margin as a function of the active control intervention effect. In this case, the uncertainty surrounding the non-inferiority margin should be accounted for in statistical tests. In this work, we explored how to perform the non-inferiority test with a flexible margin for continuous endpoint.
Methods: It was proposed in this study two procedures for the non-inferiority test with a flexible margin for the continuous endpoint. The proposed test procedures are based on test statistic and confidence interval approach. Simulations have been used to assess the performances and properties of the proposed test procedures. An application was done on clinical real data, which the purpose was to assess the efficacy of clinical monitoring alone versus laboratory and clinical monitoring in HIV-infected adult patients.
Results : Basically, the two proposed test procedures have good properties. In the test based on a statistic, the actual type 1 error rate estimate is approximatively equal to the nominal value. It has been found that the confidence interval level determines approximately the level of significance. The $80\%$ , $90\%$ , and $95\%$ one-sided confidence interval levels led approximately to a type I error of $10\%$ , $5\%$ and $2.5\%$ respectively. The power estimate was almost $100\%$ for two proposed tests, except for the small scale values of the reference treatment where the power was relatively low when the sample sizes were small.
Conclusions : Based on type I error rate and power estimates, the proposed non-inferiority hypothesis test procedures have good performance and are applicable in practice.
Trial registration : The trial data used in this study was from the "Stratall ANRS 12110 / ESTHER", registered with ClinicalTrials.gov, number NCT00301561. Date : March 13, 2006, url : https://clinicaltrials.gov/ct2/show/NCT00301561.