282 8 Bayesian Approach to Inference
The FDA guidelines document (FDA, 2010) recommends the use of a
Bayesian methodology in the design and analysis of clinical trials for medi-
cal devices. This document eloquently outlines the reasons why a Bayesian
methodology is recommended.
• Valuable prior information is often available for medical devices because of their
mechanism of action and evolutionary development.
• The Bayesian approach, when correctly employed, may be less burdensome than a
frequentist approach.
• In some instances, the use of prior information may alleviate the need for a larger
sized trial. In some scenarios, when an adaptive Bayesian model is applicable, the
size of a trial can be reduced by stopping the trial early when conditions warrant.
• The Bayesian approach can sometimes be used to obtain an exact analysis when
the corresponding frequentist analysis is only approximate or is too difficult to imple-
ment.
• Bayesian approaches to multiplicity problems are different from frequentist ones
and may be advantageous. Inferences on multiple endpoints and testing of multiple
subgroups (e.g., race or sex) are examples of multiplicity.
• Bayesian methods allow for great flexibility in dealing with missing data.
In the context of clinical trials, an unlimited look at the accumulated data
when sampling is of a sequential nature will not affect the inference. In the
frequentist approach, interim data analyses affect type I errors. The ability to
stop a clinical trial early is important from the moral and economic viewpoints.
Trials should be stopped early due to both futility, to save resources or stop
an ineffective treatment, and superiority, to provide patients with the best
possible treatments as fast as possible.
Bayesian models facilitate meta-analysis. Meta-analysis is a methodology
for the fusion of results of related experiments performed by different re-
searchers, labs, etc. An example of a rudimentary meta-analysis is discussed
in Sect. 8.10.
8.2 Ingredients for Bayesian Inference
A density function for a typical observation X that depends on an unknown
(possibly multivariate) parameter
θ is called a model and denoted by f (x|θ).
As a function of
θ, f (x|θ) = L(θ) is called the likelihood. If a sample x =
(x
1
, x
2
,... , x
n
) is observed, the likelihood takes a familiar form, L(θ|x
1
,... , x
n
) =
Q
n
i
=1
f (x
i
|θ). This form was used in Chap. 7 to produce MLEs for θ.
Thus both terms model and likelihood are used to describe the distribution
of observations. In the standard Bayesian inference the functional form of f is
given in the same manner as in the classical parametric approach; the func-
tional form is fully specified up to a parameter
θ. According to the generally
accepted likelihood principle, all information from the experimental data is
summarized in the likelihood function, f (x
|θ) =L(θ|x
1
,... , x
n
).