A comparison of methods for analyzing a binary composite endpoint with partially observed components in randomized controlled trials

Tra My Pham*, Ian R. White, Brennan C. Kahan, Tim P. Morris, Simon J. Stanworth, Gordon Forbes

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

Composite endpoints are commonly used to define primary outcomes in randomized controlled trials. A participant may be classified as meeting the endpoint if they experience an event in one or several components (eg, a favorable outcome based on a composite of being alive and attaining negative culture results in trials assessing tuberculosis treatments). Partially observed components that are not missing simultaneously complicate the analysis of the composite endpoint. An intuitive strategy frequently used in practice for handling missing values in the components is to derive the values of the composite endpoint from observed components when possible, and exclude from analysis participants whose composite endpoint cannot be derived. Alternatively, complete record analysis (CRA) (excluding participants with any missing components) or multiple imputation (MI) can be used. We compare a set of methods for analyzing a composite endpoint with partially observed components mathematically and by simulation, and apply these methods in a reanalysis of a published trial (TOPPS). We show that the derived composite endpoint can be missing not at random even when the components are missing completely at random. Consequently, the treatment effect estimated from the derived endpoint is biased while CRA results without the derived endpoint are valid. Missing at random mechanisms require MI of the components. We conclude that, although superficially attractive, deriving the composite endpoint from observed components should generally be avoided. Despite the potential risk of imputation model mis-specification, MI of missing components is the preferred approach in this study setting.

Original languageEnglish
Pages (from-to)6634-6650
Number of pages17
JournalStatistics in Medicine
Volume40
Issue number29
DOIs
Publication statusPublished - 20 Dec 2021

Keywords

  • compatibility
  • composite endpoints
  • missing data
  • multiple imputation
  • RCTs

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