The impact of block size on treatment imbalance and blinding integrity
in randomized clinical trials
Abstract
Randomization is very important in clinical trials which can prevent
selection bias and valid statistical inference. Block randomization is
often considered to prevent treatment imbalance in comparative clinical
trials, especially when the sample size is small, or subjects’
characteristics change overtime. In practice, however, treatment
imbalance may still occur, especially in multi-center clinical trials.
Breaching blindness in clinical trials is another serious problem
leading to subjective judgement and observational bias. In this article,
we consider two fixed block randomization design with block size of 4
and 2 when comparing a placebo or an active control and a test treatment
under investigation. The probabilities of observing various degrees of
imbalance and the probabilities of correctly guessing the treatment
under three types of prior knowledge are investigated. The results show
that smaller block size design is more likely to maintain treatment
balance than larger block size; however, the difference of imbalance
between the two designs decreases when the sample size gets larger. The
number of subjects per site in multi-center trials also has impact on
the degree of imbalance. Additionally, both block size and prior
knowledge have impact on the probability of guessing the treatment
right. Large sample size in conjunction with varying block size are
suggested for keeping treatment balance and avoiding the chance of
guessers to guess the treatment right.