Common Medical and Statistical Problems: The Dilemma of the Sample Size Calculation for Sensitivity and Specificity Estimation

Sample size calculation in biomedical practice is typically based on the problematic Wald method for a binomial proportion, with potentially dangerous consequences. This work highlights the need of incorporating the concept of conditional probability in sample size determination to avoid reduced sample sizes that lead to inadequate confidence intervals. Therefore, new definitions are proposed for coverage probability and expected length of confidence intervals for conditional probabilities, like sensitivity and specificity. The new definitions were used to assess seven confidence interval estimation methods. In order to determine the sample size, two procedures—an optimal one, based on the new definitions, and an approximation—were developed for each estimation method. Our findings confirm the similarity of the approximated sample sizes to the optimal ones. R code is provided to disseminate these methodological advances and translate them into biomedical practice.

Homogeneity testing for binomial proportions under stratified double-sampling scheme with two fallible classifiers

This article investigates the homogeneity testing problem of binomial proportions for stratified partially validated data obtained by double-sampling method with two fallible classifiers. Several test procedures, including the weighted-least-squares test with/without log-transformation, logit-transformation and double log-transformation, and likelihood ratio test and score test, are developed to test the homogeneity under two models, distinguished by conditional independence assumption of two classifiers. Simulation results show that score test performs better than other tests in the sense that the empirical size is generally controlled around the nominal level, and hence be recommended to practical applications. Other tests also perform well when both binomial proportions and sample sizes are not small. Approximate sample sizes based on score test, likelihood ratio test and the weighted-least-squares test with double log-transformation are generally accurate in terms of the empirical power and type I error rate with the estimated sample sizes, and hence be recommended. An example from the malaria study is illustrated by the proposed methodologies.

Test procedure and sample size determination for a proportion study using a double-sampling scheme with two fallible classifiers

Double sampling is usually applied to collect necessary information for situations in which an infallible classifier is available for validating a subset of the sample that has already been classified by a fallible classifier. Inference procedures have previously been developed based on the partially validated data obtained by the double-sampling process. However, it could happen in practice that such infallible classifier or gold standard does not exist. In this article, we consider the case in which both classifiers are fallible and propose asymptotic and approximate unconditional test procedures based on six test statistics for a population proportion and five approximate sample size formulas based on the recommended test procedures under two models. Our results suggest that both asymptotic and approximate unconditional procedures based on the score statistic perform satisfactorily for small to large sample sizes and are highly recommended. When sample size is moderate or large, asymptotic procedures based on the Wald statistic with the variance being estimated under the null hypothesis, likelihood rate statistic, log- and logit-transformation statistics based on both models generally perform well and are hence recommended. The approximate unconditional procedures based on the log-transformation statistic under Model I, Wald statistic with the variance being estimated under the null hypothesis, log- and logit-transformation statistics under Model II are recommended when sample size is small. In general, sample size formulae based on the Wald statistic with the variance being estimated under the null hypothesis, likelihood rate statistic and score statistic are recommended in practical applications. The applicability of the proposed methods is illustrated by a real-data example.