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Methods For Exploring Treatment Effect Heterogeneity In Subgroup Analysis: An Application To Global Clinical Trials, I. Manjula Schou, Ian C. Marschner

COBRA Preprint Series

Multi-country randomised clinical trials (MRCTs) are common in the medical literature and their interpretation has been the subject of extensive recent discussion. In many MRCTs, an evaluation of treatment effect homogeneity across countries or regions is conducted. Subgroup analysis principles require a significant test of interaction in order to claim heterogeneity of treatment effect across subgroups, such as countries in a MRCT. As clinical trials are typically underpowered for tests of interaction, overly optimistic expectations of treatment effect homogeneity can lead researchers, regulators and other stakeholders to over-interpret apparent differences between subgroups even when heterogeneity tests are insignificant. In this …