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Sample Size Calculation for Clinical Trials of Medical Decision Support Systems with Binary Outcome
1Professor, Department of Medical Cybernetics and Informatics; Pirogov Russian National Research Medical University, 1 Ostrovityanova St., Moscow, 117997, Russia; Professor, Department of Endocrinology, Institute for Higher Education and Additional Professional Training; Endocrinology Research Centre, 11 Dmitriya Ulyanova St., Moscow, 117292, Russia; Leading Researcher, Sector of Dynamic Neural Networks, Department of Neuroinformatics, Center for Optical-Neuron Technologies; Federal State Institution "Scientific Research Institute for System Analysis of the Russian Academy of Sciences", 36/1 Nakhimovsky Prospect, Moscow, 117218, Russia; Chief Researcher, Laboratory of Evidence-Based Medicine and Biostatistics; Mental Health Research Center, 34 Kashirskoye Shosse, Moscow, 115522, Russia.
This study details sample size calculations for clinical decision support systems (CDSS) with binary outcomes in diagnostic and predictive models. Proper study design and representativeness are crucial for reliable medical software validation.
Area of Science:
- Medical Informatics
- Biostatistics
- Clinical Trial Design
Background:
- Software medical devices, particularly clinical decision support systems (CDSS), require rigorous clinical trials for state registration.
- Accurate sample size calculation is a mandatory component of clinical trial protocols for CDSS.
Purpose of the Study:
- To discuss sample size calculation methodologies for binary outcomes in diagnostic/screening and predictive CDSS.
- To highlight the importance of study design and sample representativeness over mere sample size in clinical trials.
Main Methods:
- Consideration of sample size calculations for non-comparative and comparative studies (superiority, non-inferiority) for diagnostic/screening models.
- Examination of sample size calculations for randomized controlled trials of predictive models involving patient management strategies.
Main Results:
- Specific sample size calculation approaches are presented for various CDSS types and study designs.
- Emphasis is placed on the critical role of study design and representativeness, which are paramount for valid clinical trial outcomes.
Conclusions:
- Clinical trials for medical software must have designs adequate to their tasks to enable comprehensive assessment.
- Reducing clinical trials to external validation alone is insufficient; robust design is essential for reliable medical technology evaluation.
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