Bayesian; Clinical Trials; Health Economics; Sequential Experimentation; Ranking and Selection; Simulation Optimization; Dynamic Programming;
The authors propose and analyze the first model for clinical trial design that integrates each of three important trends intending to improve the effectiveness of clinical trials that inform health-technology adoption decisions: adaptive design, which dynamically adjusts the sample size and allocation of interventions to different patients; multiarm trial design, which compares multiple interventions simultaneously; and value-based design, which focuses on cost-benefit improvements of health interventions over a current standard of care. Example applications are to seamless phase II/III dose-finding trials and to trials that test multiple combinations of therapies.The authors' objective is to maximize the expected population health-economic benefit of health-technology adoption decisions less clinical trial costs.The authors show that unifying the adaptive, multiarm, and value-based approaches to trial design can reduce the cost and duration of multiarm trials with efficient adaptive look ahead policies that focus on value to patients and account for correlated rewards across arms.Features that differentiate the authors' approach from much other work on stochastic optimization include stopping times that balance sampling costs and the expected value of information of those samples, performance guarantees offered by new asymptotic convergence proofs, and the modeling of arms’ potentially different sampling costs.The authors' proposed solution can be computed feasibly and can randomize patients. The class of trials for the base model assumes that health-economic data are collected and observed quickly. Related work from Bayesian optimization can enable the further inclusion of trials with intermediate duration delays between the time of treatment initiation and observation of outcomes.