Design and testing for clinical trials faced with misclassified causes of death

With clinical trials under pressure to produce more convincing results faster, we reexamine relative efficiencies for the semiparametric comparison of cause-specific rather than all-cause mortality events, observing that in many settings misclassification of cause of failure is not negligible. By incorporating known misclassification rates, we derive an adapted logrank test that optimizes power when the alternative treatment effect is confined to the cause-specific hazard. We derive sample size calculations for this test as well as for the corresponding all-cause mortality and naive cause-specific logrank test which ignores the misclassification. This may lead to new options at the design stage which we discuss. We reexamine a recently closed vaccine trial in this light and find the sample size needed for the new test to be 32% smaller than for the equivalent all-cause analysis, leading to a reduction of 41 224 participants.