Estimating the Sampling Distribution of Posterior Decision Summaries in Bayesian Clinical Trials

Bayesian inference and the use of posterior or posterior predictive probabilities for decision making have become increasingly popular in clinical trials. The current practice in Bayesian clinical trials relies on a hybrid Bayesian-frequentist approach where the design and decision criteria are assessed with respect to frequentist operating characteristics such as power and type I error rate conditioning on a given set of parameters. These operating characteristics are commonly obtained via simulation studies. The utility of Bayesian measures, such as ``assurance", that incorporate uncertainty about model parameters in estimating the probabilities of various decisions in trials has been demonstrated recently. However, the computational burden remains an obstacle toward wider use of such criteria. In this article, we propose methodology which utilizes large sample theory of the posterior distribution to define parametric models for the sampling distribution of the posterior summaries used for decision making. The parameters of these models are estimated using a small number of simulation scenarios, thereby refining these models to capture the sampling distribution for small to moderate sample size. The proposed approach toward the assessment of conditional and marginal operating characteristics and sample size determination can be considered as simulation-assisted rather than simulation-based. It enables formal incorporation of uncertainty about the trial assumptions via a design prior and significantly reduces the computational burden for the design of Bayesian trials in general.