Distribution Theory Following Blinded and Unblinded Sample Size Re-estimation under Parametric Models.

Asymptotic distribution theory for maximum likelihood estimators under fixed alternative hypotheses is reported in the literature even though the power of any realistic test converges to one under fixed alternatives. Under fixed alternatives, authors have established that nuisance parameter estimates are inconsistent when sample size re-estimation (SSR) follows blinded randomization. These results have helped to inhibit the use of SSR. In this paper, we argue for local alternatives to be used instead of fixed alternatives. Motivated by Gould and Shih (1998), we treat unavailable treatment assignments in blinded experiments as missing data and rely on single imputation from marginal distributions to fill in for missing data. With local alternatives, it is sufficient to proceed only with the first step of the EM algorithm mimicking imputation under the null hypothesis. Then, we show that blinded and unblinded estimates of the nuisance parameter are consistent, and re-estimated sample sizes converge to their locally asymptotically optimal values. This theoretical finding is confirmed through Monte-Carlo simulation studies. Practical utility is illustrated through a multiple logistic regression example. We conclude that, for hypothesis testing with a predetermined minimally clinically relevant local effect size, both blinded and unblinded SSR procedures lead to similar sample sizes and power.