---
title: "Power Analysis and Sample Size Determination for Agreement Studies"
author: "Aaron R. Caldwell"
date: "Last Updated: `r Sys.Date()`"
bibliography: refs.bib
link-citations: true
output: 
  rmarkdown::html_vignette:
    toc: true
    toc_depth: 1
vignette: >
  %\VignetteIndexEntry{Power Analysis and Sample Size Determination for Agreement Studies}
  %\VignetteEncoding{UTF-8}
  %\VignetteEngine{knitr::rmarkdown}
---

```{r setup, include = FALSE}
knitr::opts_chunk$set(
  collapse = TRUE,
  comment = "#>",
  fig.width = 7,
  fig.height = 5
)
```

# Introduction

This vignette provides comprehensive guidance on power analysis and sample size determination for method comparison and agreement studies using the `SimplyAgree` package.

## Available Methods

`SimplyAgree` implements four approaches to power/sample size calculations:

1. **`power_agreement_exact()`** - Exact agreement test [@shieh2019]
2. **`blandPowerCurve()`** - Bland-Altman power curves [@lu2016]
3. **`agree_expected_half()`** - Expected half-width criterion [@JanShieh2018]
4. **`agree_assurance()`** - Assurance probability criterion [@JanShieh2018]

```{r load}
library(SimplyAgree)
```

# Understanding the Approaches

## Hypothesis Testing vs. Estimation

The methods divide into two categories:

**Hypothesis Testing** (binary decision):

- `power_agreement_exact()` - Tests if central proportion, essentially tolerance intevals, are within the maximal allowable difference
- `blandPowerCurve()` - Tests if confidence intervals of limits of agreement fall within the maximal allowable difference

**Estimation** (quantifying precision):

- `agree_expected_half()` - Controls average CI half-width of limits of agreement
- `agree_assurance()` - Controls probability of achieving target CI half-width of limits of agreement

# Method 1: Exact Agreement Test

## Overview

Tests whether the central P* proportion of paired differences falls within the maximal allowable difference [-delta, delta].

**Hypotheses:**

- H0: Methods disagree (central portion extends beyond bounds)
- H1: Methods agree (central portion within bounds)

## Usage

```{r exact_usage, eval=FALSE}
power_agreement_exact(
  n = NULL,           # Sample size
  delta = NULL,       # Tolerance bound
  mu = 0,            # Mean of differences
  sigma = NULL,       # SD of differences
  p0_star = 0.95,    # Central proportion (tolerance coverage)
  power = NULL,       # Target power
  alpha = 0.05       # Significance level
)
```

Specify **exactly three** of: n, delta, power, sigma.

## Example: Sample Size Calculation

```{r exact_ex1, eval=TRUE}
# Blood pressure device comparison
result <- power_agreement_exact(
  delta = 7,          # +/-7 mmHg tolerance
  mu = 0.5,          # Expected bias
  sigma = 2.5,       # Expected SD
  p0_star = 0.95,    # 95% must be within bounds
  power = 0.80,      # 80% power
  alpha = 0.05
)
print(result)
```


# Method 2: Bland-Altman Power Curves

## Overview

Calculates power curves using approximate Bland-Altman confidence intervals using the method of @lu2016 (which is approximate). Useful for exploring power across sample sizes.

## Usage

```{r bland_usage, eval=FALSE}
blandPowerCurve(
  samplesizes = seq(10, 100, 1),  # Range of sample sizes
  mu = 0,                          # Mean difference
  SD,                              # SD of differences
  delta,                           # Tolerance bound(s)
  conf.level = 0.95,              # CI confidence level
  agree.level = 0.95               # LOA agreement level
)
```

## Example: Power Curve

```{r bland_ex1, eval=TRUE}
# Generate power curve
pc <- blandPowerCurve(
  samplesizes = seq(10, 200, 1),
  mu = 0,
  SD = 3.3,
  delta = 8,
  conf.level = 0.95,
  agree.level = 0.95
)

# Plot
plot(pc, type = 1)

# Find n for 80% power
find_n(pc, power = 0.8)
```


# Method 3: Expected Half-Width

## Overview

Determines sample size to ensure **average** CI half-width <= delta across hypothetical repeated studies.

## Usage

```{r expected_usage, eval=FALSE}
agree_expected_half(
  conf.level = 0.95,    # CI confidence level
  delta = NULL,         # Target expected half-width
  pstar = 0.95,        # Central proportion
  sigma = 1,           # SD of differences
  n = NULL             # Sample size
)
```

Specify **either** n OR delta.

## Example: Sample Size for Precision

```{r expected_ex1, eval=TRUE}
# Want E[H] <= 2.5*sigma
result <- agree_expected_half(
  conf.level = 0.95,
  delta = 2.5,         # As multiple of sigma
  pstar = 0.95,
  sigma = 1            # Standardized
)
print(result)
```


# Method 4: Assurance Probability

## Overview

Determines sample size to ensure **probability** that CI half-width <= omega is at least (1-gamma).

Stronger guarantee than expected half-width --- ensures specific probability of achieving target precision.

## Usage

```{r assurance_usage, eval=FALSE}
agree_assurance(
  conf.level = 0.95,     # CI confidence level
  assurance = 0.90,      # Target assurance probability
  omega = NULL,          # Target half-width bound
  pstar = 0.95,         # Central proportion
  sigma = 1,            # SD of differences
  n = NULL              # Sample size
)
```

Specify **either** n OR omega.

## Example: Sample Size with Guarantee

```{r assurance_ex1}
# Want 90% probability that H <= 2.5*sigma
result <- agree_assurance(
  conf.level = 0.95,
  assurance = 0.90,    # 90% probability
  omega = 2.5,         # Target bound
  pstar = 0.95,
  sigma = 1
)
print(result)
```


# Decision Guide for the Method

```
Research Goal?
|
|- Hypothesis Testing -> 
|   \- Need exact Type I error control -> Power for Agreement
|
\- Precision Estimation ->
    |- Average precision sufficient -> Expected Half-Width
    \- Need probabilistic guarantee -> Assurance Probability
```

# Handling Clustered/Nested Data

## The Problem

Many studies have **clustered** data where there are multiple measurements per subject or natural groupings (e.g., repeated measures, multi-center studies). Note, the advice here only applies to clustering but not to situations where replicate measures are taken within a measurement occasion (e.g., multiple measures at the same time point wherein any variation would only represent measurement error). 

Standard formulas assume independence^[Implications of which are discussed by @bland2003cluster among many others]. Ignoring clustering can leads to studies that lack precision. To my knowledge, there is no well developed methods for accounting for clustering in sample size calculations for agreement studies, so we use a common approximation from survey sampling and multilevel modeling: the **design effect**. 

## My Best Approximation: Design Effect

The design effect (DEFF) quantifies loss of efficiency due to clustering:

$$\text{DEFF} = 1 + (m - 1) \times \text{ICC}$$

where:

- m = observations per cluster
- ICC = intraclass correlation coefficient
- $n_{ESS}$ = effective sample size

**Effect on sample size:**
$$n_{\text{ESS}} = n_{\text{independent}} \times \text{DEFF}$$

## Understanding ICC

ICC = proportion of variance between clusters:

$$\text{ICC} = \frac{\sigma^2_{\text{between}}}{\sigma^2_{\text{between}} + \sigma^2_{\text{within}}}$$


## Application Workflow

1. Calculate independent sample size (using power function)
2. Determine m (observations per cluster)
3. Estimate ICC (from pilot data, literature, or theory)
4. Calculate DEFF = 1 + (m-1)*ICC
5. Inflate: n_total = n_indep * DEFF
6. Calculate clusters: K = the smallest integer greater than or equal to (n_total / m) (i.e., round up n_total / m)

## Example: Repeated Measures Design

```{r cluster_ex1, eval=TRUE}
# Step 1: Independent sample size
result <- power_agreement_exact(
  delta = 7, mu = 0.5, sigma = 2.5,
  p0_star = 0.95, power = 0.80, alpha = 0.05
)
n_indep <- result$n
cat("Independent pairs needed:", n_indep, "\n")

# Step 2: Apply design effect
m <- 3  # 3 measurements per participant
ICC <- 0.15  # from pilot or literature
DEFF <- 1 + (m - 1) * ICC
cat("Design effect:", round(DEFF, 3), "\n")

# Step 3: Calculate participants needed
n_ess <- ceiling(n_indep * DEFF)
K <- ceiling(n_ess / m)
cat("Total observations:", n_ess, "\n")
cat("Participants needed:", K, "\n")
```

**Result**: Instead of 34 independent pairs, need ~15 participants (45 total observations).

## Impact of ICC

```{r cluster_ex2, eval=TRUE}
# Compare different ICC values
n_indep <- 50
m <- 4

ICC_values <- c(0, 0.05, 0.10, 0.15, 0.20)
for (ICC in ICC_values) {
  DEFF <- 1 + (m - 1) * ICC
  K <- ceiling(ceiling(n_indep * DEFF) / m)
  cat(sprintf("ICC = %.2f: Need %d participants\n", ICC, K))
}
```

## When Design Effect Works Well

**Good situations:**

- Balanced designs (equal cluster sizes)
- Moderate ICC (0.01 - 0.30)
- Sufficient clusters (K >= 10)
- Simple two-level hierarchy

**Problematic:**

- Highly unbalanced clusters
- Very high ICC (> 0.4)
- Small number of clusters (K < 10)
- Complex correlation structures
- Multiple levels of nesting

For complex designs, consider simulation-based power analysis and consult a statistician.

## Complete Example with Clustering

```{r cluster_complete, eval=TRUE}
# Study parameters
sigma <- 3.3
delta <- 7
m <- 4  # measurements per participant
ICC <- 0.15
dropout <- 0.20

# Step 1: Independent sample size
result <- power_agreement_exact(
  delta = delta, mu = 0, sigma = sigma,
  p0_star = 0.95, power = 0.80, alpha = 0.05
)

# Step 2: Account for clustering
DEFF <- 1 + (m - 1) * ICC
n_total <- ceiling(result$n * DEFF)
K_pre <- ceiling(n_total / m)

# Step 3: Account for dropout
K_final <- ceiling(K_pre / (1 - dropout))

# Summary
cat("Independent pairs:", result$n, "\n")
cat("Design effect:", round(DEFF, 3), "\n")
cat("Participants (no dropout):", K_pre, "\n")
cat("Participants to recruit:", K_final, "\n")
cat("Total measurements:", K_final * m, "\n")
```

# Practical Recommendations

## Planning Checklist

- [ ] Define research question (hypothesis test vs. estimation)
- [ ] Choose appropriate power method
- If possible, obtain pilot estimates (SD, ICC if clustered)
- [ ] Calculate independent sample size
- [ ] Adjust for clustering (if applicable)
- [ ] Adjust for dropout
- [ ] Conduct sensitivity analyses
- [ ] Document all assumptions and sources
- [ ] Pre-register before data collection

## Conservative Planning

When uncertain:

- Use **upper range** of plausible SD estimates
- Use **upper range** of plausible ICC estimates
- Build in **10-20% buffer** beyond calculated required sample size
- Conduct **sensitivity analyses** for key parameters (SD, ICC, etc)


# References


