Two-Arm Crossover Randomized Controlled Trial Versus Meta-Analysis of N-of-1 Studies: Comparison of Statistical Efficiency in Determining an Intervention Effect.

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Tác giả: Arne C Bathke, Anna Eleonora Carrozzo, Stefan T Kulnik, Daniel Neunhaeuserer, Josef Niebauer, Georg Zimmermann

Ngôn ngữ: eng

Ký hiệu phân loại:

Thông tin xuất bản: Germany : Biometrical journal. Biometrische Zeitschrift , 2025

Mô tả vật lý:

Bộ sưu tập: NCBI

ID: 698905

N-of-1 trials are currently receiving broader attention in healthcare research when assessing the effectiveness of interventions. In contrast to the most commonly applied two-arm randomized controlled trial (RCT), in an N-of-1 design, the individual acts as their own control condition in the sense of a multiple crossover trial. N-of-1 trials can lead to a higher quality of patient by examining the effectiveness of an intervention at an individual level. Moreover, when a series of N-of-1 trials are properly aggregated, it becomes possible to detect an intervention effect at a population level. This work investigates whether a meta-analysis of summary data of a series of N-of-1 trials allows us to detect a statistically significant intervention effect with fewer participants than in a traditional, prospectively powered two-arm RCT and crossover design when evaluating a digital health intervention in cardiovascular care. After introducing these different analysis approaches, we compared the empirical properties in a simulation study both under the null hypothesis and with respect to power with different between-subject heterogeneity settings and in the presence of a carry-over effect. We further investigate the performance of a sequential aggregation procedure. In terms of simulated power, the threshold of 80% was achieved earlier for the aggregating procedure, requiring fewer participants.
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