In particular, the reference set of colonisation states should exclude all serotypes included in either of the two vaccines. The target set of serotypes can be chosen in different ways, depending on the question and purpose of the study: (a) The vaccines are compared with regard to serotypes common to both vaccines: the target set includes the common serotypes only. In the non-inferiority settings, the statistical power is defined as the probability for the lower bound of the confidence interval for the relative efficacy

(investigational vs. active control) to be larger than a pre-chosen non-inferiority margin. Equivalently, the margin defines an upper bound selleck compound for the rate of overall target-type acquisition for the investigational vaccine (see Appendix B). In general, there are several aspects to be considered when specifying non-inferiority margins [14]. For vaccine licensure, a natural argument follows from the requirement to show vaccine efficacy against colonisation as high as to induce herd immunity if the vaccine

were used in large scale. If the active control vaccine DNA Synthesis inhibitor is hypothesised to have at least 50% efficacy (VEacq) against overall target-type acquisition, the investigational vaccine can be allowed to have ρ100% smaller efficacy. A margin of ρ = 0.2 may be reasonable still to induce herd immunity. For example, if VEacq of 50% is considered for the active control vaccine, the power is calculated with 40% efficacy

for the investigational vaccine. The margin for the efficacies does not uniquely determine Adenosine the margin for the relative efficacy. However, it can be shown that in the range in which VEacq ≥ 0.5 for the active control vaccine, the margin of the hazard ratio is approximated by −ρ. If the efficacy of the active control is clearly >50%, a wider margin can be allowed (see Appendix B for more details). Fig. 3 presents the power of a non-inferiority study for different values of the sample size (number of individuals per study group) and the vaccine efficacy of the investigational vaccine, assuming 50% efficacy for the active pneumococcal control vaccine and a margin ρ = 0.2. The analysis is based on alternative (a), i.e. on comparing the rates of acquisition for the target set of serotypes common to both vaccines. For instance, to obtain 80% power requires a group size of 500 or more if the efficacy of the investigational vaccine is as high as 60% under scenario of the moderate overall rate of acquisition. If the investigational vaccine has only about 50% efficacy, the sample size needs to be very large for a high power. Smaller sample sizes or less strict requirements on the efficacy of the investigational vaccine are needed if comparisons are made against the union set of target serotypes (alternative (c)).