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Remote, bivariate prior elicitation for a Bayesian non-inferiority randomized controlled trial.

Arlene Jiang¹, Alex Aregbesola^2,3, Apoorva Gangwani²

¹Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada. arlene.jiang@sickkids.ca.

|June 5, 2026

Summary

Remote expert elicitation successfully established a prior distribution for a Bayesian clinical trial on croup treatment. This method efficiently incorporated expert opinion for designing trials when evidence is limited.

Keywords:

Bayesian statistics Expert elicitation Non-inferiority trial Prior probability distribution Randomized controlled trials Sample size determination Trial design

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Area of Science:

Bayesian statistics
Clinical trial design
Pediatric emergency medicine

Background:

Bayesian clinical trials require prior distributions, often derived from expert elicitation.
Remote elicitation offers a feasible alternative to traditional in-person methods, especially when evidence is limited.
This study focused on eliciting priors for a trial comparing two dexamethasone doses for pediatric croup.

Purpose of the Study:

To remotely elicit a bivariate prior distribution for the Croup Dosing Trial.
To assess the efficacy of two dexamethasone doses (0.15 mg/kg vs. 0.60 mg/kg) in reducing emergency department return visits for croup.
To determine the sample size for a Bayesian non-inferiority trial design.

Main Methods:

Conducted three remote workshops with emergency medicine physicians.
Utilized a two-round survey with group discussion, preceded by literature review.
Aggregated expert beliefs using bivariate distributions with latent effects to inform trial design.

Main Results:

Twelve physicians participated in the remote elicitation.
Generated a prior distribution with estimated efficacy rates of 6% for the 0.60 mg/kg dose and 8% for the 0.15 mg/kg dose.
The aggregated prior distribution determined a required sample size of 1850 participants for a 4% non-inferiority margin.

Conclusions:

Successfully elicited a prior distribution integrating existing evidence and expert judgment.
The elicited prior aligns with existing literature on dexamethasone efficacy in croup treatment.
Demonstrated the feasibility and utility of remote bivariate distribution elicitation for clinical trial design.