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Biostatistics Advance Access published online on December 6, 2006
Biostatistics, doi:10.1093/biostatistics/kxl040
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© The Author 2006. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

The influence of competing risks setting on the choice of hypothesis test for treatment effect

PR Williamson*, R Kolamunnage-Dona and C. Tudur Smith

Centre for Medical Statistics and Health Evaluation, Shelley's Cottage, Brownlow Street, University of Liverpool, L69 3GS

* Corresponding author, Email: prw{at}liv.ac.uk, Tel: 0151 794 4760, Fax: 0151 794 5130

There is considerable debate regarding the choice of test for treatment difference in a randomised clinical trial in the presence of competing risks. This question arose in the SANAD trial comparing new and standard anti-epileptic drugs. This paper provides simulation results for the logrank test comparing cause specific hazard rates and Gray's test comparing cause specific cumulative incidence curves. To inform the analysis of the SANAD trial, competing risks settings were considered where both events are of interest, events may be negatively correlated and the degree of correlation may differ in the two treatment groups. In settings where there are effects in opposite directions for the two event types, a likely situation for the SANAD trial, Gray's test has greater power to detect treatment differences than logrank analysis. For the epilepsy application, conclusions were qualitatively similar for both logrank and Gray's tests.


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J. J. Dignam and M. N. Kocherginsky
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